Obstetric issues raised by SARS-CoV-2 infection

Abstract

Background and Purpose: Available information on the occurrence of adverse events in pregnancy in women affected by coronavirus (CoV) disease 2019 (COVID-19) is currently scarce and based on data from other CoV-related infections (severe acute respiratory syndrome [SARS] and Middle East Respiratory Syndrome [MERS]) during pregnancy.
Methods: In this context, cases of miscarriage, premature birth and low birth weight have been reported. Furthermore, the development of fever during the first trimester of pregnancy can increase the risk of fetal damage. To date, it is unclear whether the new coronavirus can cross the transplacental barrier, and thus result in vertical transmission. Some unproven cases of newborns who tested positive for the virus shortly after birth have been reported, but validated data are needed to understand how these babies were infected and whether or not the virus can be transmitted during pregnancy.
Results: In the limited series of cases reported in the literature, there are no reports of presence of the virus in amniotic fluid or in neonatal blood taken from the umbilical cord in women with clinical symptoms of COVID-19 in pregnancy. There are no data regarding differences in transmission of the infection based on the method of delivery. Current data show that SARS-CoV-2 has not been detected in breastmilk.
Conclusions: At present, in the presence of stable maternal conditions, there are no contraindications to vaginal delivery, and therefore there is no elective indication for cesarean section in women suffering from COVID-19. In view of the undoubted benefits of breastfeeding, and in accordance with current recommendations, breastfeeding must be started and/or maintained, directly on the breast or with manually or mechanically expressed milk.

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