PDF herunterladen
CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(12): 949-960
DOI: 10.1055/s-0041-1733913
Review Article

Clinical and Obstetric Aspects of Pregnant Women with COVID-19: A Systematic Review

Aspectos clínicos e obstétricos de gestantes com COVID-19: Uma revisão sistemática
Sarah Nilkece Mesquita Araújo Nogueira Bastos 
1   Departamento de Medicina, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
,
Bárbara Louise Freire Barbosa 
1   Departamento de Medicina, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
,
Larisse Giselle Barbosa Cruz 
1   Departamento de Medicina, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
,
Rayza Pereira de Souza 
2   Departamento de Medicina, Faculdade Uninassau, Parnaíba, PI, Brazil
,
Simone Santos e Silva Melo 
1   Departamento de Medicina, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
,
Caroline Camargo Bandeira da Silveira Luz 
1   Departamento de Medicina, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Objective To analyze the clinical and obstetric aspects of pregnant women with COVID-19.

Methods A systematic literature review in the MEDLINE/PubMed, LILACS, SCIELO, and CNKI databases was performed from March to May 2020, with the descriptors: Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Of those chosen were original titles, without language and period restriction and that addressed pregnant women with a clinical and/or laboratory diagnosis of COVID-19. Revisions, editorials, and duplicate titles were excluded. The Newcastle-Ottawa (NOS) and Murad et al. scales were used to assess the quality of the studies.

Results We included 34 articles with 412 pregnant women infected with severe acute respiratory syndrome (SARS-Cov-2), with an average age of 27.5 years of age and 36.0 gestational weeks. The most common symptom was fever (205 [49.7%]), and 89 (21.6%) pregnant women progressed to severe viral pneumonia. Laboratory tests showed an increase in C-reactive protein (154 [37.8%]), and radiological tests showed pneumonia with peripheral ground-glass pattern (172 [51.4%]). Emergency cesarean delivery was indicated for most pregnant women, and the most common gestational complication was premature rupture of ovarian membranes (14 [3.4%;]). We detected 2 (0.5%) neonatal deaths, 2 (0.5%) stillbirths, and 1 (0.2%) maternal death.

Conclusion Pregnant women with COVID-19 presented a clinical picture similar to that of non-infected pregnant women, with few obstetric or neonatal repercussions. There was a greater indication of cesarean deliveries before the disease aggravated, and there was no evidence of vertical transmission of the infection.

Resumo

Objetivo Analisar os aspectos clínicos e obstétricos de gestantes com COVID-19.

Métodos Revisão sistemática da literatura nas bases: MEDLINE/PubMed, LILACS, SCIELO e CNKI, realizada de março a maio de 2020, com os descritores Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Elegeram-se títulos originais, sem restrição de idioma e período e que abordassem gestantes com diagnóstico clínico e/ou laboratorial de COVID-19. Excluíram-se revisões, editoriais, títulos duplicados. As escalas de Newcastle-Ottawa (NOS, na sigla em inglês) e a de Murad et al. foram utilizadas para avaliar a qualidade dos estudos.

Resultados Foram incluídos 34 artigos com 412 gestantes infectadas pela síndrome respiratória aguda grave (SARS-Cov, na sigla em inglês) com idade média de 27,5 anos e média de 36,0 semanas gestacionais. O sintoma mais incidente foi a febre (49,7%;205). e 89 (21,6%) gestantes evoluíram para pneumonia viral grave. Os exames laboratoriais demonstraram aumento da proteína C reativa (37,8%; 154) e os radiológicos mostraram pneumonia com padrão em vidro fosco periférico (51,4%; 172). O parto cesáreo de emergência foi indicado para a maior parte das gestantes, e a complicação gestacional mais comum foi a ruptura prematura de membranas ovulares (3,4%; 14). Foram detectados 2 (0,5%) mortes neonatais, 2 (0,5%) natimortos, e 1 (0,2%) morte materna.

Conclusão Gestantes com doença coronavírus (COVID-19, na sigla em inglês apresentaram quadro clínico semelhante a gestantes não infectadas, com poucas repercussões obstétricas ou neonatais. Houve uma maior indicação de partos cesáreos antes do agravamento da doença e não se observaram evidências de transmissão vertical da infecção.

Keywords

pregnancy - coronavirus infections - severe acute respiratory syndrome - SARS virus - betacoronavirus

Palavras-chave

gravidez - infecções por coronavírus - síndrome respiratória aguda grave - vírus da SARS - betacoronavírus

Supplementary Material



Publikationsverlauf

Eingereicht: 25. Mai 2020

Angenommen: 05. März 2021

Artikel online veröffentlicht:
21. Dezember 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr 2020; 87 (04) 281-286
    CrossrefPubMedSuche in Google Scholar
  • 2 Wang D, Hu B, Hu C. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
    CrossrefPubMedSuche in Google Scholar
  • 3 Ramalho C. [COVID-19 in pregnancy, what do we know?]. Acta Obstet Ginecol Port [Internet]. 2020 [cited 2020 May 6];14(1):6–7. Available from: lng = pt. Portuguese. http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1646-58302020000100001&
    PubMedSuche in Google Scholar
  • 4 Johns Hopkins University & Medicine, Coronavirus Resource Center. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) [Internet]. 2020 [cited 2020 May 6]. Available from: https://coronavirus.jhu.edu/map.html
    PubMedSuche in Google Scholar
  • 5 Elshafeey F, Magdi R, Hindi N. et al. A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet 2020; 150 (01) 47-52
    CrossrefPubMedSuche in Google Scholar
  • 6 Smith V, Seo D, Warty R. et al. Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review. PLoS One 2020; 15 (06) e0234187
    CrossrefPubMedSuche in Google Scholar
  • 7 Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound Obstet Gynecol 2020; 56 (01) 15-27
    CrossrefPubMedSuche in Google Scholar
  • 8 Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol 2020; 223 (01) 36-41
    CrossrefPubMedSuche in Google Scholar
  • 9 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    CrossrefPubMedSuche in Google Scholar
  • 10 Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018; 23 (02) 60-63
    CrossrefPubMedSuche in Google Scholar
  • 11 Wells GA, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. 2000 [cited 2020 May 6]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    PubMedSuche in Google Scholar
  • 12 Xiong X, Wei H, Zhang Z. et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID–19. J Med Virol 2020; 92 (09) 1657-1659
    CrossrefPubMedSuche in Google Scholar
  • 13 Yu N, Li W, Kang Q. et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis 2020; 20 (05) 559-564
    CrossrefPubMedSuche in Google Scholar
  • 14 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
    CrossrefPubMedSuche in Google Scholar
  • 15 Li N, Han L, Peng M. et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020; 71 (16) 2035-2041
    CrossrefPubMedSuche in Google Scholar
  • 16 Kang X, Zhang R, He H. et al. [Anesthesia management in cesarean section for a patient with coronavirus disease 2019]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49 (01) 249-252
    PubMedSuche in Google Scholar
  • 17 Liu Y, Chen H, Tang K, Guo Y. Withdrawn: Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020;•••S0163-4453(20)30109-2. Doi: 10.1016/j.jinf.2020.02.028 [ahead of print]
    PubMed
  • 18 Li Y, Zhao R, Zheng S. et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis 2020; 26 (06) 1335-1336
    CrossrefPubMedSuche in Google Scholar
  • 19 Chen S, Huang B, Luo DJ. et al. [Pregnancy with new coronavirus infection: clinical characteristics and placental pathological analysis of three cases]. Zhonghua Bing Li Xue Za Zhi 2020; 49 (05) 418-423
    CrossrefPubMedSuche in Google Scholar
  • 20 Zhang L, Jiang Y, Wei M. et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi 2020; 55 (03) 166-171
    CrossrefPubMedSuche in Google Scholar
  • 21 Yan J, Guo J, Fan C. et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020; 223 (01) 111.e1-111.e14
    CrossrefPubMedSuche in Google Scholar
  • 22 Ferrazzi EM, Frigerio L, Cetin I. et al. COVID-19 Obstetrics Task Force, Lombardy, Italy: Executive management summary and short report of outcome. Int J Gynaecol Obstet 2020; 149 (03) 377-378
    CrossrefPubMedSuche in Google Scholar
  • 23 Kalafat E, Yaprak E, Cinar G. et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol 2020; 55 (06) 835-837
    CrossrefPubMedSuche in Google Scholar
  • 24 Wen R, Sun Y, Xing QS. A patient with SARS-CoV-2 infection during pregnancy in Qingdao, China. J Microbiol Immunol Infect 2020; 53 (03) 499-500
    CrossrefPubMedSuche in Google Scholar
  • 25 Fan C, Lei D, Fang C. et al. Perinatal Transmission of 2019 Coronavirus Disease-Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry?. Clin Infect Dis 2021; 72 (05) 862-864
    CrossrefPubMedSuche in Google Scholar
  • 26 Pierce-Williams RAM, Burd J, Felder L. et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM 2020; 2 (03) 100134
    CrossrefPubMedSuche in Google Scholar
  • 27 Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol 2020; 92 (09) 1556-1561
    CrossrefPubMedSuche in Google Scholar
  • 28 Blauvelt CA, Chiu C, Donovan AL. et al. Acute respiratory distress syndrome in a preterm pregnant patient with Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2020; 136 (01) 46-51
    CrossrefPubMedSuche in Google Scholar
  • 29 Hong L, Smith N, Keerthy M. et al. Severe COVID-19 infection in pregnancy requiring intubation without preterm delivery: A case report. Case Rep Womens Health 2020; 27: e00217
    CrossrefPubMedSuche in Google Scholar
  • 30 Li J, Wang Y, Zeng Y. et al. Critically ill pregnant patient with COVID-19 and neonatal death within two hours of birth. Int J Gynaecol Obstet 2020; 150 (01) 126-128
    CrossrefPubMedSuche in Google Scholar
  • 31 Schnettler WT, Al Ahwel Y, Suhag A. Severe acute respiratory distress syndrome in coronavirus disease 2019-infected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM 2020; 2 (03) 100120
    CrossrefPubMedSuche in Google Scholar
  • 32 Wu C, Yang W, Wu X. et al. Clinical manifestation and laboratory characteristics of SARS-CoV-2 infection in pregnant women. Virol Sin 2020; 35 (03) 305-310
    CrossrefPubMedSuche in Google Scholar
  • 33 Peng Z, Wang J, Mo Y. et al. Unlikely SARS-CoV-2 vertical transmission from mother to child: A case report. J Infect Public Health 2020; 13 (05) 818-820
    CrossrefPubMedSuche in Google Scholar
  • 34 Breslin N, Baptiste C, Gyamfi-Bannerman C. et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2 (02) 100118
    CrossrefPubMedSuche in Google Scholar
  • 35 Karami P, Naghavi M, Feyzi A. et al. WITHDRAWN: Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Med Infect Dis 2020; 101665: 101665 [ahead of print]
    CrossrefPubMedSuche in Google Scholar
  • 36 Iqbal SN, Overcash R, Mokhtari N. et al. An Uncomplicated Delivery in a Patient with Covid-19 in the United States. N Engl J Med 2020; 382 (16) e34
    CrossrefPubMedSuche in Google Scholar
  • 37 Xia H, Zhao S, Wu Z, Luo H, Zhou C, Chen X. Emergency Caesarean delivery in a patient with confirmed COVID-19 under spinal anaesthesia. Br J Anaesth 2020; 124 (05) e216-e218
    CrossrefPubMedSuche in Google Scholar
  • 38 Buonsenso D, Costa S, Sanguinetti M. et al. Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Am J Perinatol 2020; 37 (08) 869-872
    Thieme ConnectPubMedSuche in Google Scholar
  • 39 Qiancheng X, Jian S, Lingling P. et al; sixth batch of Anhui medical team aiding Wuhan for COVID-19. Coronavirus disease 2019 in pregnancy. Int J Infect Dis 2020; 95: 376-383
    CrossrefPubMedSuche in Google Scholar
  • 40 Lyra J, Valente R, Rosário M, Guimarães M. Cesarean section in a pregnant woman with COVID-19: first case in Portugal. Acta Med Port 2020; 33 (06) 429-431
    CrossrefPubMedSuche in Google Scholar
  • 41 Kelly JC, Dombrowksi M, O'Neil-Callahan M, Kernberg AS, Frolova AI, Stout MJ. False-negative testing for severe acute respiratory syndrome coronavirus 2: consideration in obstetrical care. Am J Obstet Gynecol MFM 2020; 2 (03) 100130
    CrossrefPubMedSuche in Google Scholar
  • 42 Browne PC, Linfert JB, Perez-Jorge E. Successful treatment of preterm labor in association with acute COVID-19 infection. Am J Perinatol 2020; 37 (08) 866-868
    Thieme ConnectPubMedSuche in Google Scholar
  • 43 Indraccolo U. A pregnant woman and the SARS-CoV-2 infection: how are barriers easily crossed?. Recenti Prog Med 2020; 111 (04) 259-260
    CrossrefPubMedSuche in Google Scholar
  • 44 Lu D, Sang L, Du S, Li T, Chang Y, Yang XA. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol 2020; 92 (09) 1660-1664
    CrossrefPubMedSuche in Google Scholar
  • 45 Liu D, Li L, Wu X. et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol 2020; 215 (01) 127-132
    CrossrefPubMedSuche in Google Scholar