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Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis.
BJOG. 2020 08; 127(9):1116-1121.BJOG

Abstract

OBJECTIVE

To report mode of delivery and immediate neonatal outcome in women infected with COVID-19.

DESIGN

Retrospective study.

SETTING

Twelve hospitals in northern Italy.

PARTICIPANTS

Pregnant women with COVID-19-confirmed infection who delivered.

EXPOSURE

COVID 19 infection in pregnancy.

METHODS

SARS-CoV-2-infected women who were admitted and delivered from 1 to 20 March 2020 were eligible. Data were collected from the clinical records using a standardised questionnaire on maternal general characteristics, any medical or obstetric co-morbidity, course of pregnancy, clinical signs and symptoms, treatment of COVID 19 infection, mode of delivery, neonatal data and breastfeeding.

MAIN OUTCOME AND MEASURES

Data on mode of delivery and neonatal outcome.

RESULTS

In all, 42 women with COVID-19 delivered at the participating centres; 24 (57.1%, 95% CI 41.0-72.3) delivered vaginally. An elective caesarean section was performed in 18/42 (42.9%, 95% CI 27.7-59.0) cases: in eight cases the indication was unrelated to COVID-19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI 29.8-61.3) cases: of these, 7/19 (36.8%, 95% CI 16.3-61.6) required oxygen support and 4/19 (21.1%, 95% CI 6.1-45.6) were admitted to a critical care unit. Two women with COVID-19 breastfed without a mask because infection was diagnosed in the postpartum period: their newborns tested positive for SARS-Cov-2 infection. In one case, a newborn had a positive test after a vaginal operative delivery.

CONCLUSIONS

Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn.

TWEETABLE ABSTRACT

This study suggests that vaginal delivery may be associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn.

Authors+Show Affiliations

Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy.Department of Woman, Mother and Neonate, Sacco Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy. Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, Monza, Italy. University of Milano Bicocca, Monza, Italy.Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy. University of Brescia, Brescia, Italy.Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy.Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy.Obstetrics Unit, Mother Infant Department, AOU of Modena, Modena, Italy.Obstetrics and Gynecology Unit, Department of Woman's and Child's, Health University Hospital of Padua, Padua, Italy.Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Neonatology, Papa Giovanni XXIII Hospital, Bergamo, Italy.Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Milano, Italy.Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy.Obstetrics and Gynecology Unit, Azienda Ospedaliera Bolognini, Seriate, Italy.Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy. IRCCS Foundation Policlinico San Matteo, Pavia, Italy.Obstetrics and Gynecology Department "Madonna delle Grazie" Hospital, Matera, Italy.Obstetrics and Gynecology Unit, P.O. Macedonio Melloni-ASST Fatebenefratelli-Sacco, Milan, Italy. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.Obstetrics and Gynecology Unit, Hospital of Treviglio-Caravaggio, Bergamo, Italy.Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy. Department of Pediatrics, Ospedale dei Bambini V. Buzzi, Milan, Italy.Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy. Department of Woman, Mother and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco Milan, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32339382

Citation

Ferrazzi, E, et al. "Vaginal Delivery in SARS-CoV-2-infected Pregnant Women in Northern Italy: a Retrospective Analysis." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 127, no. 9, 2020, pp. 1116-1121.
Ferrazzi E, Frigerio L, Savasi V, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-1121.
Ferrazzi, E., Frigerio, L., Savasi, V., Vergani, P., Prefumo, F., Barresi, S., Bianchi, S., Ciriello, E., Facchinetti, F., Gervasi, M. T., Iurlaro, E., Kustermann, A., Mangili, G., Mosca, F., Patanè, L., Spazzini, D., Spinillo, A., Trojano, G., Vignali, M., ... Cetin, I. (2020). Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG : an International Journal of Obstetrics and Gynaecology, 127(9), 1116-1121. https://doi.org/10.1111/1471-0528.16278
Ferrazzi E, et al. Vaginal Delivery in SARS-CoV-2-infected Pregnant Women in Northern Italy: a Retrospective Analysis. BJOG. 2020;127(9):1116-1121. PubMed PMID: 32339382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. AU - Ferrazzi,E, AU - Frigerio,L, AU - Savasi,V, AU - Vergani,P, AU - Prefumo,F, AU - Barresi,S, AU - Bianchi,S, AU - Ciriello,E, AU - Facchinetti,F, AU - Gervasi,M T, AU - Iurlaro,E, AU - Kustermann,A, AU - Mangili,G, AU - Mosca,F, AU - Patanè,L, AU - Spazzini,D, AU - Spinillo,A, AU - Trojano,G, AU - Vignali,M, AU - Villa,A, AU - Zuccotti,G V, AU - Parazzini,F, AU - Cetin,I, Y1 - 2020/05/28/ PY - 2020/04/23/accepted PY - 2020/4/28/pubmed PY - 2020/10/22/medline PY - 2020/4/28/entrez KW - COVID-19 KW - delivery KW - transmission SP - 1116 EP - 1121 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 127 IS - 9 N2 - OBJECTIVE: To report mode of delivery and immediate neonatal outcome in women infected with COVID-19. DESIGN: Retrospective study. SETTING: Twelve hospitals in northern Italy. PARTICIPANTS: Pregnant women with COVID-19-confirmed infection who delivered. EXPOSURE: COVID 19 infection in pregnancy. METHODS: SARS-CoV-2-infected women who were admitted and delivered from 1 to 20 March 2020 were eligible. Data were collected from the clinical records using a standardised questionnaire on maternal general characteristics, any medical or obstetric co-morbidity, course of pregnancy, clinical signs and symptoms, treatment of COVID 19 infection, mode of delivery, neonatal data and breastfeeding. MAIN OUTCOME AND MEASURES: Data on mode of delivery and neonatal outcome. RESULTS: In all, 42 women with COVID-19 delivered at the participating centres; 24 (57.1%, 95% CI 41.0-72.3) delivered vaginally. An elective caesarean section was performed in 18/42 (42.9%, 95% CI 27.7-59.0) cases: in eight cases the indication was unrelated to COVID-19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI 29.8-61.3) cases: of these, 7/19 (36.8%, 95% CI 16.3-61.6) required oxygen support and 4/19 (21.1%, 95% CI 6.1-45.6) were admitted to a critical care unit. Two women with COVID-19 breastfed without a mask because infection was diagnosed in the postpartum period: their newborns tested positive for SARS-Cov-2 infection. In one case, a newborn had a positive test after a vaginal operative delivery. CONCLUSIONS: Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn. TWEETABLE ABSTRACT: This study suggests that vaginal delivery may be associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/32339382/Vaginal_delivery_in_SARS_CoV_2_infected_pregnant_women_in_Northern_Italy:_a_retrospective_analysis_ L2 - https://doi.org/10.1111/1471-0528.16278 DB - PRIME DP - Unbound Medicine ER -