key: cord-0959501-yxzrymc6
authors: Polónia-Valente, R; Moucho, M; Tavares, M; Vilan, A; Montenegro, N; Rodrigues, T
title: Vaginal delivery in a woman infected with SARS-CoV-2 – the first case reported in Portugal
date: 2020-05-11
journal: Eur J Obstet Gynecol Reprod Biol
DOI: 10.1016/j.ejogrb.2020.05.007
sha: 4d5f8155f1b0334aaf897e47d48e36e2eb65139d
doc_id: 959501
cord_uid: yxzrymc6

nan

diagnosed with COVID-19 and hospitalized on March 12 nd , 2020. At admission, she presented dry cough, with no fever, chills or shortness of breath. Because she was a close contact of a confirmed COVID-19 case, she was attended as a suspected case and settled in an isolation room. SARS-CoV-2 was detected by reverse-transcription polymerase chain reaction (RT-PCR) analysis on nasal and oropharyngeal swabs. After obstetric evaluation, latent phase of labor was diagnosed, the cervix was 3 cm dilated and 30% effaced. Care in labor continued in the same isolation room. All health care workers in contact with the pregnant woman wore appropriate personal protective equipment for contact and airborne precautions with eye protection. Epidural analgesia was performed as earlier as possible and labor augmentation with oxytocin was started. The fetus was monitored with external continuous cardiotocography and cervical dilation was assessed every two hours. Ten hours after admission, cervix was full dilated and cardiotocography became suspicious (figure 1) requiring acute tocolysis with salbutamol. Subsequently, cardiotocography exhibited a normal fetal pattern and an operative vaginal delivery was performed with fetal vacuum extraction, in order to shorten the second stage of labor. Umbilical cord was immediately clamped without neonate-maternal contact. The female newborn weighed 3240 grams and Apgar score was 9 at 1 st and 10 at 5 th minutes. The child was separated from the mother immediately after birth and placed in a single-patient negative pressure room. Newborn nasal and oropharyngeal swabs RT-PCR test for SARS-Cov-2 were performed. Two hours after birth newborn tested negative and the repeated test (at 48h of life) was also negative. Mother was discharged at 3 rd day postpartum, symptomless, waiting for recovery criteria at home. The newborn remained at nursery unit until family provide conditions for receiving her at home.

The mother wished to breastfeed and started mechanical breast stimulation, in order to breastfeed soon after COVID-19 recovery.

COVID-19 is a highly contagious infection, requiring strictly planned intrapartum care for the safety of mother, newborn and healthcare workers. This obstetrical case report supports experts' opinion that women with COVID-19 without severe disease, should be offered vaginal delivery if labor has normal progress, guarantying that continuous electronic fetal monitoring is provided and appropriate infection prevention and control measures are in place.

The authors have nothing to disclose. The authors report no conflict of interest. This study had no financial support for the research.

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

Coronavirus in pregnancy and delivery: rapid review

We thank all health care professionals across departments for being committed and trained in advance, allowing this case to be managed in our hospital.