RESUMEN
Introduction In Saudi Arabia and countries around the world, clinical health practice has been transformed by the coronavirus 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During the early days of the pandemic, it was a major challenge to care for pregnant women with laboratory-confirmed COVID-19 and their newborn infants. In this article, we share our experience in the management of newborn infants delivered to mothers with laboratory-confirmed COVID-19. Methods A prospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, National Guard Health Affairs, Saudi Arabia. Data collection started in March 2020 and was completed in October 2020. The inclusion criteria included mothers with laboratory-confirmed COVID-19 and their newborn infants. Results A total of 45 pregnant women with polymerase chain reaction (PCR)-confirmed COVID-19 were included in the study. Their mean age was 30.23±5.92 years. The mode of delivery was spontaneous vaginal delivery in 27 women (60%), cesarean section in 15 women (33.3%), and assisted vaginal delivery in three women (6.7%). Three mothers (6.7%) required intensive care unit admission. A total of 45 babies were born and 25 were females (55.6%), 20 males (44.4%). None of the babies had specific symptoms related to COVID-19. All babies were tested negative on the two COVID-19 nasopharyngeal swabs. Babies were initially admitted to the NICU and one baby required prolonged NICU stay due to extreme prematurity (23 weeks), one baby died due to hypoxic-ischemic encephalopathy and respiratory distress syndrome, and the remaining babies were discharged home in a stable condition. Conclusion Our experience suggests that maternal outcomes are generally favorable and no difference between vaginal and cesarean delivery in the risk of virus transmission. With strict implementation of infection prevention measures, mother-to-infant transmission is very unlikely. Early bathing of the newborn infant is preferred to reduce the risk of transmission of infection to newborn infants and the hospital staff. Breastfeeding is safe if performed under strict infection prevention measures.
RESUMEN
Introduction/Objectives Women with high-risk pregnancies require careful follow-up, management, and efficient allocation of resources to achieve optimal pregnancy outcomes. This study investigated the association between an updated, validated antenatal risk index score and neonatal mortality and morbidity in a tertiary care center in Saudi Arabia. Methods This retrospective cohort study included pregnant women delivered at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between June 2016 and December 2018. Pregnant women who delivered before arrival, delivered in another hospital, or without an antenatal risk score because of missing data were excluded. The study cohort was recruited by simple random selection. Data of mothers and neonates were extracted from electronic health records. The pregnancy risk was assigned using a validated antenatal risk score index, creating low, moderate, and high-risk pregnancy categories. The association between antenatal risk scores, maternal and neonatal outcomes was investigated. Results A total of 533 pregnant women were included in the analysis, of whom 298 (55.9%) had low antenatal risk scores, 185 (34.7%) had moderate-risk scores, and 50 (9.4%) had high-risk scores. Maternal characteristics showed that high-risk mothers had higher age, gravidity, parity, and abortions than those with low or moderate-risk pregnancies. Newborns of high-risk mothers belonged more often to the male gender and had lower gestational ages, birth weights, and Apgar scores. For maternal outcomes, there was no maternal mortality. High-risk mothers had more cesarean sections and longer lengths of stay as compared to the low and moderate risk group. There was a trend toward increased stillbirths. Neonatal mortality, neonatal intensive care unit (NICU) admission, congenital anomalies, and length of stay were significantly increased in neonates of high-risk mothers. Conclusions An antenatal risk score is a feasible tool in identifying low, moderate, and high-risk pregnancies in a tertiary center outside a North American system. The higher scores were associated with maternal complications as well as neonatal mortality and morbidity. This is the first study to report maternal demographics, mortality, stillbirths, male gender, and congenital anomalies and their associations with categories of pregnancy level of risk. The clinical and economic benefits of antenatal risk screening in Saudi Arabia warrant further large population-based study that includes multi-domain socioeconomic determinants of health specific to our region.