key: cord-0797429-etx23fuy authors: Liao, Jing; He, Xiaoyan; Gong, Qing; Yang, Lingyun; Zhou, Chunhua; Li, Jiafu title: Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID‐19 pandemic date: 2020-05-19 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13188 sha: 9226e5c5e4a803f708fc8c64d4caf622a174dc3e doc_id: 797429 cord_uid: etx23fuy OBJECTIVE: To study vaginal delivery outcomes and neonatal prognosis and summarize the management of vaginal delivery during the COVID‐19 pandemic. METHODS: A retrospective analysis of medical records and comparison of vaginal delivery outcomes between 10 pregnant women with clinical diagnosis of COVID‐19 and 53 pregnant women without COVID‐19 admitted to Zhongnan Hospital of Wuhan University between January 20 and March 2, 2020. Results of laboratory tests, imaging tests, and SARS‐CoV‐2 nucleic acid tests were also analyzed in neonates delivered by pregnant women with clinical diagnosis of COVID‐19. RESULTS: There were no significant differences in gestational age, postpartum hemorrhage, and perineal resection rates between the two groups. There were no significant differences in birth weight of neonates and neonatal asphyxia rates between the two groups. Neonates delivered by pregnant women with clinical diagnosis of COVID‐19 tested negative for SARS‐CoV‐2 infection. CONCLUSIONS: Under the premise of full evaluation of vaginal delivery conditions and strict protection measures, pregnant women with ordinary type COVID‐19 can try vaginal delivery without exacerbation of COVID‐19 and without increasing the risk of SARS‐CoV‐2 infection in neonates. The first case of coronavirus virus disease 2019 (COVID-19) was discovered in Wuhan in December 2019 1 ; the virus spread rapidly in China and then globally. 2 Some scholars in China have summarized the clinical manifestations of COVID-19 in terms of patient epidemiology, symptoms and laboratory examinations, and pulmonary imaging characteristics, which indicate that it can lead to severe lung disease in some patients. 3 Others report interpersonal transmission during the latent period of the disease. 4 At present, prevention and control of COVID-19 remain in a critical period globally. As the designated hospital for patients with COVID-19, Zhongnan Hospital of Wuhan University in Hubei province, China, accepted and treated pregnant women with confirmed or suspected COVID-19. The aim of the present study was to analyze vaginal delivery outcomes of pregnant women with clinical diagnosis of COVID-19 in the obstetric isolation ward and compare with pregnant women without COVID-19 in the general ward of our hospital. We also analyzed the prognosis of neonates delivered by pregnant woman with clinical diagnosis of COVID-19 to assess the effects of vaginal delivery on pregnant women and newborns. Furthermore, to protect the perinatal safety of this group of pregnant women and avoid intrahospital spread of COVID-19 (according to national guidelines for the diagnosis and treatment of COVID-19 and the treatment process of clinical cases in our hospital), we also summarized the vaginal delivery experience of pregnant women with COVID-19 for future reference. Liao ET aL. We retrospectively reviewed the medical records of 10 pregnant women with clinical diagnosis of COVID-19 on the obstetric isolation ward and 53 pregnant women without COVID-19 on general wards admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, between January 20 and March 2, 2020. All women delivered vaginally during this period. Ethical approval was obtained from the Medical Ethics Committee of Zhongnan Hospital of Wuhan University (No. 2020078). The study was a retrospective analysis of medical records and patient identities were anonymized; thus, informed consent was not required. The diagnostic criteria of COVID-19 were according to the National Health Commission of China, 5 as follows: Suspected cases with imaging features of pneumonia. Clinically confirmed cases or suspected cases, with one of the following: (1) positive detection of SARS-CoV-2 using real-time reverse transcription polymerase chain reaction (RT-PCR); (2) viral gene sequence highly homologous to SARS-CoV-2. We compared and analyzed the ages of pregnant women, number of pregnancies, gestational weeks, postpartum hemorrhage, perineal resection rates, blood counts, birth weight of neonates, and neonatal asphyxia rate. Neonates delivered by pregnant woman with clinical diagnosis of COVID-19 were transferred to the neonatal isolation ward; at the same time, blood count, throat swab test for SARS-CoV-2, and chest radiograph were performed. A structured form in Excel (Microsoft; Redmond, WA, USA) was used to collate data. Statistical analysis was performed using SPSS version 19.0 (IBM, Armonk, NY, USA). Categorical data were expressed as rate and compared using the Fisher exact test. Continuous data were expressed as mean and standard deviation (SD) and compared using the t test. P<0.05 was considered statistically significant. A total of 88 pregnant women with confirmed or suspected COVID-19 were admitted to the obstetric isolation ward of Zhongnan Hospital of Wuhan University. Among them, 10 pregnant women with clinical diagnosis of COVID-19 delivered vaginally. Age ranged from 27-36 years. Number of pregnancies ranged from 1-4, number of deliveries ranged from 0-2, and gestational age ranged from 36 + 2 weeks/d to 40 + 2 weeks/d. Five of the 10 patients had low fever a few days before the onset of labor, four patients had mild respiratory symptoms, and one patient did not complain of particular discomfort. Data from laboratory tests showed that 9 of the 10 pregnant women had a low lymphocyte ratio. All 10 patients had a chest CT scan that showed typical findings of multiple patchy ground-glass shadows ( Table 1) . Over the same period, 53 pregnant women without COVID-19 delivered vaginally on the general ward. Age ranged from 21-37 years. Number of pregnancies ranged from 1-4, number of deliveries ranged from 0-1, and gestational age ranged from 31 + 1 weeks/d to 42 weeks. Pregnant women with clinical diagnosis of COVID-19 were older than those without COVID-19 (P=0.042). Pregnant women with clinical diagnosis of COVID-19 had more pregnancies than those without COVID-19 (P=0.009). There was no statistically significant difference in gestational age (P=0.921) or number of deliveries (P=0.118) between the two groups ( Table 2 ). There was no statistically significant difference in premature rupture of membranes, premature delivery, neonatal asphyxia, amniotic fluid pollution, postpartum hemorrhage, or perineal lateral resection rate between the two groups (Table 3) . Among the 10 neonates delivered by pregnant women with clinical diagnosis of COVID-19, three neonates were self-discharged from the hospital owing to family refusal of neonatal pediatric treatment. Seven neonates were transferred to neonatal isolation according to management principles for neonates delivered by infected pregnant women. Among these seven, six were term infants and one was premature. Blood count test results of the seven neonates were normal. Throat swab tests for nucleic acid of SARS-CoV-2 performed twice (24 hours apart) in each of the seven neonates were all negative. One neonate's chest X-ray was considered to be hyaline membrane disease, which improved after treatment with pulmonary surfactant substitutes and symptomatic support therapy (Table 4 ). The present study reports clinical data from 10 pregnant women with clinical diagnosis of COVID-19. Based on our findings, the outcomes Liao ET aL. of vaginal delivery such as volume of postpartum hemorrhage blood loss, perineal resection rate, blood counts, birth weight of neonates, and neonatal asphyxia rate were similar to pregnant women without COVID-19. There is no evidence to suggest that vaginal delivery could lead to severe adverse outcomes in pregnant women with clinical diagnosis of COVID-19 and infection in neonates. COVID-19 is highly infectious. Due to the pathophysiological changes during pregnancy, pregnant women with pneumonia can easily progress to severe disease and the risk of adverse pregnancy outcomes is increased. 6 During the COVID-19 outbreak, cesarean delivery under general anesthesia has been the preferred mode of delivery to ensure a controllable delivery process, avoid emergency respiratory problems, and reduce the risk of infection exposure. However, the effects of these measures have not been fully proven. [7] [8] [9] During the COVID-19 pandemic, choosing cesarean delivery unnecessarily may cause long-term adverse effects. The present study showed that the 10 patients were classified by clinical diagnosis with ordinary type COVID-19 in combination with the results of laboratory and imaging examination. At admission, these women had already begun labor and the fetal head was engaged. Therefore, we believed that there was no indication for cesarean delivery. Before deciding on mode of delivery, in addition to routine laboratory tests, SARS-CoV-2 nucleic acid throat swab test and other respiratory pathogen detection, which is helpful for differential diagnosis, should also be completed. When necessary, chest CT could be performed-using radiation protection of the pregnant woman with abdominal lead covering-to evaluate lung lesions. 10 In our opinion, T A B L E 1 Clinical, laboratory, and imaging characteristics of 10 pregnant women with clinical diagnosis of COVID-19. signs of pneumonia were detected on chest radiograph, they could be discharged from the NICU. Breastfeeding was not permitted at the beginning because the infants and their mothers were isolated separately. Artificial feeding was provided for the infants isolated in the NICU for the first few days. The mothers were asked to maintain milk secretion by using breast pumps. After a 14-day isolation period, mothers were able to start breastfeeding when their chest CT scans showed no progression and throat swab tests for nucleic acid of SARS-CoV-2 were negative. A recent retrospective clinical study reported that hospitalrelated transmission of COVID-19 is common. 14 Therefore, environ- JL and XH made substantial contributions to the study concept, design, and manuscript writing. QG contributed to conception and planning. CZ and LY made contributions to data acquisition, analysis, and interpretation. JL made substantial revisions to the manuscript. Department emergency project (No. 2020FCA011). A novel coronavirus from patients with pneumonia in China The outbreak of COVID-19: An overview Clinical features of patients infected with 2019 novel coronavirus in Wuhan A familial cluster of infection associated with the 2019 novel coronavirus indicating potential person-to-person transmission during the incubation period New coronavirus pneumonia prevention and control program Pneumonia in pregnancy Management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syndrome (SARS) Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records A College of Obstetricians and Gynecologists' Committee on Obstetric Practice. Committee opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation N95 respirators vs medical masks for preventing influenza among health care personnel: A randomized clinical trial Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome Infants born to mothers with severe acute respiratory syndrome Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China The authors have no conflicts of interest.