VP45.02: Screening for COVID‐19 and maternal‐fetal outcomes in a cohort of asymptomatic pregnant patients at term in Lombardy, Italy

Abstract

The RCOG recommends continuous fetal heart rate (cFHR) monitoring during labour in COVID-19 patients, whereas other sources do not consider this necessary if patients are asymptomatic. Vascular complications in COVID-19 are emerging; potential risks of both fetal hypoxia due to placental dysfunction and maternal disease deterioration secondary to cardiopulmonary overload may occur in labour. Our aim was to observe maternal-fetal outcomes in an unpublished series of asymptomatic pregnant patients screened for COVID-19 before admission to labour ward. COVID-19 screening with qRT-PCR on nasopharyngeal swabs was performed in patients admitted for delivery in a tertiary centre in Milan between 16 March and 2 May 2020. cFHR monitoring was performed and maternal-fetal outcomes were compared in COVID-19 positive and negative patients. 195 patients were admitted for delivery at a mean gestational age of 39.4 ± 1.8 weeks. Nine (4.6%) tested positive for COVID-19 (all NIH class “asymptomatic”); two were delivered via an emergency CS for fetal distress and one to elective CS for genital Herpes. Six out of 8 patients (75%) eligible for vaginal birth had vaginal delivery with no maternal symptoms developing thereafter. No significant differences in Apgar scores at 1 and 5 minutes (9.2 ± 1.2 vs 9.6 ± 0.5; p = 0.36; 9.9 ± 0.5 vs 10 ± 0.0; p = 0.42), umbilical artery pH at birth (7.27 ± 0.08 vs 7.26 ± 0.07; p = 0.69), and rate of urgent deliveries for fetal distress (20.3% vs 22.2%, p = 0.89) between patients testing negative and positive for COVID-19 were seen. No false-negative/positive swabs were recorded on the basis of a two week clinical follow-up. Screening results were comparable to the general population. Vaginal delivery appeared safe for the mother and the risk of fetal distress was not increased in our series of asymptomatic pregnant patients with COVID-19 at term. Further research is required to confirm this conclusion.