SARS-CoV-2 Infection and C-Section: A Prospective Observational Study.

Pregnant women are particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In addition to unfavorable perinatal outcomes, there has been an increase in obstetric interventions. With this study, we aimed to clarify the reasons, using Robson's classification model, and risk factors for cesarean section (C-section) in SARS-CoV-2-infected mothers and their perinatal results. This was a prospective observational study that was carried out in 79 hospitals (Spanish Obstetric Emergency Group) with a cohort of 1704 SARS-CoV-2 PCR-positive pregnant women that were registered consecutively between 26 February and 5 November 2020. The data from 1248 pregnant women who delivered vaginally (vaginal + operative vaginal) was compared with those from 456 (26.8%) who underwent a C-section. C-section patients were older with higher rates of comorbidities, in vitro fertilization and multiple pregnancies (p < 0.05) compared with women who delivered vaginally. Moreover, C-section risk was associated with the presence of pneumonia (p < 0.001) and 41.1% of C-sections in patients with pneumonia were preterm (Robson's 10th category). However, delivery care was similar between asymptomatic and mild-moderate symptomatic patients (p = 0.228) and their predisposing factors to C-section were the presence of uterine scarring (due to a previous C-section) and the induction of labor or programmed C-section for unspecified obstetric reasons. On the other hand, higher rates of hemorrhagic events, hypertensive disorders and thrombotic events were observed in the C-section group (p < 0.001 for all three outcomes), as well as for ICU admission. These findings suggest that this type of delivery was associated with the mother's clinical conditions that required a rapid and early termination of pregnancy.

The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.

BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Obstetric Outcomes of SARS-CoV-2 Infection in Asymptomatic Pregnant Women.

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.

Hemorragia fetal intracraneal recurrente, no asociada a prematuridad:a propósito de un caso / Recurrent intracranial fetal hemorrhage not associated with prematurity: a case report

Objetivo: presentación de un caso recurrente de una patología fetal poco frecuente y revisión de posibles etiologías de la misma. Material y métodos: estudio descriptivo de caso único de hemorragia fetal intracraneal no asociada a prematuridad con recurrencia en siguiente gestación. Resultados: presentamos el caso de una gestante cuya sospecha se estableció en la semana 27 de gestación mediante control ecográfico seriado y con antecedente de feto con hemorragia fetal intracraneal de IV grado. Presentamos igualmente la evolución de ambos hijos ya que decidió continuar con la gestación. Conclusiones: La hemorragia fetal intracraneal es una entidad cuya incidencia es desconocida y cuya etiología generalmente no se conoce. Además la recurrencia es muy improbable. Con un mayor conocimiento de las etiologías probables sería posible una mejor prevención y asesoramiento a los progenitores

Objective: Report on a recurrent case relating to a rare fetal pathology and review of its etiologies. Material and methods: a descriptive study of a case of intracranial fetal hemorrhage not associated with prematurity and with recurrence in the following gestation. Results: we report the case of a pregnant woman, in which we suspected a recurrence of fetal intracranial hemorrhage at week 27 of gestation by means of serial ultrasound monitoring, and with a history of fetus with intracranial IV grade fetal hemorrhage. We also present the evolution of both children, since the parents decided to continue with the pregnancy. Conclusions: Intracranial fetal hemorrhage is an unknown entity and of which etiology is not generally known. In addition, recurrence is very unlikely. With a greater knowledge of probable etiologies, prevention and advice to parents would be better

Clasificación de cesáreas por Grupos de Robson en dos periodos comparativos en el Hospital de Manacor / Cesarean section classification according to Robson's Groups in two comparative periods at the Manacor Hospital

Objetivo. Identificar los grupos de mujeres en los que cambian las tasas de cesáreas durante dos periodos comparativos. Sujetos y métodos. Revisamos los partos del Hospital de Manacor en 2000-1 y 2005-6, mediante el análisis retrospectivo de las historias clínicas, agrupándolos según la Clasificación de Robson. Resultados. El porcentaje de cesáreas aumentó del 14 al 18,6%, con un incremento significativo entre las mujeres con feto único en cefálica a término inducidas, o sometidas a cesárea electiva, que son quienes más contribuyen al porcentaje de cesáreas del hospital. Conclusión. Ha aumentado el porcentaje de cesáreas. Con la Clasificación de Robson sabemos qué pacientes contribuyen a ese incremento (AU)

Objective. To identify groups of women with changes in cesarean rates in two different periods. Subjects and methods. Deliveries in the Manacor Hospital in 2000-2001 and 2005-2006, were analyzed through a retrospective review of clinical records and were grouped using Robsonìs classification. Results. The cesarean rate increased from 14 to 18.6% with a statistically significant increase among women with a single cephalic pregnancy at term who underwent labor induction or elective cesarean section. These two groups were the major contributors to the cesarean rate at our hospital. Conclusion. A trend towards an increase in the rates of cesarean section was found during the study period. Robson's Classification allowed us to identify the groups of women contributing to this increase (AU)