key: cord-1004465-1hmvkrcg
authors: Yin, Kyla Ng; Lee, Keng Siang; Zhang, John J.Y.
title: Potential challenges in managing obstetric patients with COVID-19
date: 2020-06-09
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.06.014
sha: 23e7bd615c896a3e06723111abfa1200a668b9fb
doc_id: 1004465
cord_uid: 1hmvkrcg

nan

While reassuring, we must not take for granted the largely optimal outcomes reported. Being the 20 largest series of pregnant COVID-19 patients to date, the authors present the most comprehensive 21 analysis we have witnessed so far on this distinct group of patients. However, their findings must be 22 interpreted with the caveats they have highlighted. Only slightly over half of the included patients had 23 laboratory-diagnosed COVID-19, among which there was a substantially higher rate of preterm 24 delivery before 37 weeks (32.0% versus 10.2% in clinically-diagnosed patients). Furthermore, while 25 no association was identified between COVID-19 and risk of spontaneous preterm birth, the authors 26 found an increased risk of any preterm birth before 37 weeks. This was despite the fact that among the 27 18 cases that had presented before 34 weeks, 14 were still ongoing at the point of study completion.

It is recognized that physiological maternal adaptations to pregnancy, especially with its inadvertent 30 immunosuppressed state, predispose pregnant patients to a more severe course of pneumonia, and 31 hence higher materno-fetal morbidity and mortality. Increased complication rates have been reported 32 for pregnant patients in H1N1 and severe acute respiratory syndrome (SARS)-coronavirus (SARS-33 CoV). 2 At present, little is known regarding the interplay between COVID-19 and pregnancy, but 34 there is a possibility of COVID-19 following a similar clinical course as SARS-CoV and even H1N1. 

Coronavirus disease 2019 (COVID-19) in pregnant 51 women: A report based on 116 cases

Outcome of Coronavirus spectrum 53 infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and 54 meta-analysis

Extracorporeal Membrane Oxygenation in 56 Pregnant and Postpartum Women: A Systematic Review and Meta-Regression 57

Extracorporeal Membrane Oxygenation in 59 Pregnancy: An Analysis of the Extracorporeal Life Support Organization Registry