Abstract
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.
Highlights
In March 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared by the World Health Organization (WHO) to have caused a pandemic [1,2]
The type of delivery varied according to COVID-19 symptomatology: the proportions of C-sections among the asymptomatic patients, the ones who had COVID-19 mild
Regarding Robson’s classification of C-sections, there was a higher proportion of patients belonging to the 4th and the 10th categories among those who developed pneumonia (Table 3)
Summary
In March 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared by the World Health Organization (WHO) to have caused a pandemic [1,2]. Most people with a fully functional immune system who are exposed to SARS-CoV-2 undergo asymptomatic infection, while 5–10% are symptomatic and 1–2% are critically affected. These severely affected patients display a cytokine storm due to a dysfunctional immune response, which brutally destroys the affected organs and can lead to death [3]. It is known that SARS-CoV-2 infection presents a similar clinical picture in pregnant women to non-pregnant women, and only a small percentage of the former develop pneumonia due to coronavirus disease 2019 (COVID-19) (0–14%) and severe maternal and neonatal complications [5]. Hypertension, obesity, diabetes mellitus, previous cardiopulmonary diseases and older maternal age are among the risk factors that have been described to be associated with complicated COVID-19 disease in this population [2]
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