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in category obstetrics and gynecology

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1: Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV-2 in women with COVID-19: A systematic review
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Posted 15 Apr 2020

Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV-2 in women with COVID-19: A systematic review
4,599 downloads medRxiv obstetrics and gynecology

Rahul Gajbhiye, Deepak Modi, Smita Mahale

Abstract Objective: The aim of this systematic review was to examine published and preprint reports for maternal and fetal outcomes in pregnant women with COVID-19 and also assess the incidence of maternal-fetal transmission of SARS CO-V-2 infection. Design : Systematic review Data sources:We searched PUMBED. Medline, Embase, MedRxiv and bioRxiv databases upto 31st March 2020 utilizing combinations of word variants for " coronavirus " or " COVID-19 " or " severe acute respiratory syndrome " or " SARS-COV-2 " and " pregnancy " . We also included data from preprint articles. Study selection : Original case reports and case series on pregnant women with a confirmed diagnosis of SARS-CoV-2 infection. Data extraction : We included 23 studies [China (20), USA (01), Republic of Korea (01) and Honduras, Central America (01) reporting the information on 172 pregnant women and 162 neonates. The primary outcome measures were maternal health characteristics and adverse pregnancy outcomes, neonatal outcomes and SARS-CoV-2 infection in neonates was extracted. Treatments given to pregnant women with COVID-19 were also recorded. Results: Out of 172 women affected by COVID-19 in pregnancy, 160 women had delivered 162 newborns (2 set of twins, 12 ongoing pregnancies). In pregnant women with COVID-19, the most common symptoms were fever (54%), cough (35%), myalgia (17%), dyspnea (12%) and diarrhea (4%). Pneumonia was diagnosed by CT scan imaging in 100 % of COVID-19 pregnant women. Pregnancy complications included delivery by cesarean section (89%), preterm labor (21%), fetal distress (9%) and premature rupture of membranes (8%). The most common co-morbidities associated with pregnant women with COVID-19 were diabetes (11%), hypertensive disorders (9%), placental disorders (5%), co-infections (6%), scarred uterus (5%), hypothyroidism (5%) and anemia (4%). Amongst the neonates of COVID-19 mothers, preterm birth (23%), respiratory distress syndrome (14%), pneumonia (14%) low birth weight (11%), small for gestational age (3%) were reported. There was one still birth and one neonatal death reported. Vertical transmission rate of SARS-CoV-2 is estimated to be 11%. Conclusion In pregnant women with COVID-19, diabetes and hypertensive disorders are common co-morbidities and there is a risk of preterm delivery. Amongst the neonates born to mothers with COVID-19, respiratory distress syndrome and pneumonia are common occurrence. There is an evidence of vertical transmission of SARS-CoV-2 infection in women with COVID-19.

2: Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS)
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Posted 12 May 2020

Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS)
3,576 downloads medRxiv obstetrics and gynecology

Marian Knight, Kathryn Bunch, Nicola Vousden, Edward Morris, Nigel Simpson, Christopher Gale, Patrick O'Brien, Maria Quigley, Peter Brocklehurst, Jennifer J Kurinczuk

Objective: To describe a national cohort of pregnant women hospitalised with SARS-CoV-2 infection in the UK, identify factors associated with infection and describe outcomes, including transmission of infection, for mother and infant. Design: Prospective national population-based cohort study using the UK Obstetric Surveillance System (UKOSS). Setting: All 194 obstetric units in the UK Participants: 427 pregnant women admitted to hospital with confirmed Sars-CoV-2 infection between 01/03/2020 and 14/04/2020. 694 comparison women who gave birth between 01/11/2017 and 31/10/2018. Main outcome measures: Incidence of maternal hospitalisation, infant infection. Rates of maternal death, level 3 critical care unit admission, preterm birth, stillbirth, early neonatal death, perinatal death; odds ratios for infected versus comparison women. Results: Estimated incidence of hospitalisation with confirmed SARS-CoV-2 in pregnancy 4.9 per 1000 maternities (95%CI 4.5-5.4). The median gestation at symptom onset was 34 weeks (IQR 29-38). Black or other minority ethnicity (aOR 4.49, 95%CI 3.37-6.00), older maternal age (aOR 1.35, 95%CI 1.01-1.81 comparing women aged 35+ with those aged 30-34), overweight and obesity (aORs 1.91, 95%CI 1.37-2.68 and 2.20, 95%CI 1.56-3.10 respectively compared to women with a BMI<25kg/m2) and pre-existing comorbidities (aOR 1.52, 95%CI 1.12-2.06) were associated with admission with SARS-CoV-2 during pregnancy. 247 women (58%) gave birth or had a pregnancy loss; 180 (73%) gave birth at term. 40 (9%) hospitalised women required respiratory support. Twelve infants (5%) tested positive for SARS-CoV-2 RNA, six of these infants within the first 12 hours after birth. Conclusions: The majority of pregnant women hospitalised with SARS-CoV-2 were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes and transmission of SARS-CoV-2 to infants was uncommon. The strong association between admission with infection and black or minority ethnicity requires urgent investigation and explanation. Study Registration: ISRCTN 40092247

3: Estrogen and COVID-19 symptoms: associations in women from the COVID Symptom Study
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Posted 01 Aug 2020

Estrogen and COVID-19 symptoms: associations in women from the COVID Symptom Study
2,157 downloads medRxiv obstetrics and gynecology

Ricardo Costeira, Karla A Lee, Benjamin Murray, Colette Christiansen, Juan Castillo-Fernandez, Mary Ni Lochlainn, Joan Capdevila Pujol, Iain Buchan, Louise C. Kenny, Jonathan Wolf, Janice Rymer, Sebastien Ourselin, Claire Steves, Timothy Spector, Louise Newson, Jordana Bell

Background: Men and older women have been shown to be at higher risk of adverse COVID-19 outcomes. Animal model studies of SARS-CoV and MERS suggest that the age and sex difference in COVID-19 symptom severity may be due to a protective effect of the female sex hormone estrogen. Females have shown an ability to mount a stronger immune response to a variety of viral infections because of more robust humoral and cellular immune responses. Objectives: We sought to determine whether COVID-19 positivity increases in women entering menopause. We also aimed to identify whether premenopausal women taking exogenous hormones in the form of the combined oral contraceptive pill (COCP) and post-menopausal women taking hormone replacement therapy (HRT) have lower predicted rates of COVID-19, using our published symptom-based model. Design: The COVID Symptom Study developed by Kings College London and Zoe Global Limited was launched in the UK on 24th March 2020. It captured self-reported information related to COVID-19 symptoms. Data used for this study included records collected between 7th May - 15th June 2020. Main outcome measures: We investigated links between COVID-19 rates and 1) menopausal status, 2) COCP use and 3) HRT use, using symptom-based predicted COVID-19, tested COVID-19, and disease severity based on requirement for hospital attendance or respiratory support. Participants: Female users of the COVID Symptom Tracker Application in the UK, including 152,637 women for menopause status, 295,689 for COCP use, and 151,193 for HRT use. Analyses were adjusted for age, smoking and BMI. Results: Post-menopausal women aged 40-60 years had a higher rate of predicted COVID (P=0.003) and a corresponding range of symptoms, with consistent, but not significant trends observed for tested COVID-19 and disease severity. Women aged 18-45 years taking COCP had a significantly lower predicted COVID-19 (P=8.03E-05), with a reduction in hospital attendance (P=0.023). Post-menopausal women using HRT or hormonal therapies did not exhibit consistent associations, including increased rates of predicted COVID-19 (P=2.22E-05) for HRT users alone. Conclusions: Our findings support a protective effect of estrogen on COVID-19, based on positive association between predicted COVID-19 and menopausal status, and a negative association with COCP use. HRT use was positively associated with COVID-19 symptoms; however, the results should be considered with caution due to lack of data on HRT type, route of administration, duration of treatment, and potential comorbidities. Trial registration: The App Ethics has been approved by KCL ethics Committee REMAS ID 18210, review reference LRS-19/20-18210

4: Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies
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Posted 06 May 2020

Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies
2,071 downloads medRxiv obstetrics and gynecology

Juan Juan, Maria M Gil, Zhihui Rong, Yuanzhen Zhang, Huixia Yang, Liona Chiu Yee Poon

Objective: To perform a systematic review of available published literature on pregnancies affected by COVID-19 to evaluate the effects of COVID-19 on maternal, perinatal and neonatal outcomes. Methods: We performed a systematic review to evaluate the effects of COVID-19 on pregnancy, perinatal and neonatal outcomes. We conducted a comprehensive literature search using PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure Database and Wan Fang Data until April 20, 2020 (studies were identified through PubMed alert after April 20, 2020). For the research strategy, combinations of the following keywords and MeSH terms were used: SARS-CoV-2, COVID-19, coronavirus disease 2019, pregnancy, gestation, maternal, mothers, vertical transmission, maternal-fetal transmission, intrauterine transmission, neonates, infant, delivery. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient was pregnant on admission, availability of clinical characteristics, including maternal, perinatal or neonatal outcomes. Exclusion criteria were unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, and unreported maternal or perinatal outcomes. No language restrictions were applied. Results: We identified several case-reports and case-series but only 19 studies, including a total of 266 pregnant women with COVID-19, met eligibility criteria and were finally included in the review. In the combined data from seven case-series, the maternal age ranged from 20 to 41 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath and fatigue. The rate of severe pneumonia was relatively low, with the majority of the cases requiring intensive care unit admission. Almost all cases from the case-series had positive computer tomography chest findings. There were six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, which were negative for SARS-CoV-2. Only a few cases had spontaneous miscarriage or abortion. 177 cases had delivered, of which the majority by Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at 1 and 5 minutes ranged from 7 to 10 and 8 to 10, respectively. A few neonates had birthweight less than 2500 grams and over one-third of cases were transferred to neonatal intensive care unit. There was one case each of neonatal asphyxia and neonatal death. There were 113 neonates that had nucleic-acid testing in throat swab, which was negative for SARS-CoV-2. From the case-reports, two maternal deaths among pregnant women with COVID-19 were reported. Conclusions: The clinical characteristics of pregnant women with COVID-19 are similar to those of nonpregnant adults with COVID-19. Currently, there is no evidence that pregnant women with COVID-19 are more prone to develop severe pneumonia, in comparison to nonpregnant patients. The subject of vertical transmission of SARS-CoV-2 remains controversial and more data is needed to investigate this possibility. Most importantly, in order to collect meaningful pregnancy and perinatal outcome data, we urge researchers and investigators to reference previously published cases in their publications and to record such reporting when the data of a case is being entered into a registry or several registries.

5: Coronavirus and birth in Italy: results of a national population-based cohort study
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Posted 12 Jun 2020

Coronavirus and birth in Italy: results of a national population-based cohort study
1,851 downloads medRxiv obstetrics and gynecology

Alice Maraschini, Edoardo Corsi, Michele Antonio Salvatore, Serena Donati

Introduction The study was implemented to provide guidance to decision makers and clinicians by describing hospital care offered to women who gave birth with confirmed COVID 19 infection. Materials and methods National population based prospective cohort study involving all women with confirmed COVID 19 who gave birth between February 25 and April 22, 2020 in any Italian hospital. Results The incidence rate of confirmed SARS-CoV-2 infection in women who gave birth was 2.1 per 1000 maternities at a national level and 6.9/1000 in the Lombardy Region. Overall one third of the women developed a pneumonia and 49.7% assumed at least one drug. Caesarean section rate was 32.9%, no mothers nor newborns died. Six percent of the infants tested positive for SARS CoV 2 at birth. Conclusions Clinical features and outcomes of COVID 19 in women who gave birth are similar to those described for the general population, most women developing mild to moderate illness.

6: Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019
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Posted 27 Mar 2020

Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019
1,842 downloads medRxiv obstetrics and gynecology

Rui Nie, Shao-shuai Wang, Qiong Yang, Cui-fang Fan, Yu-ling Liu, Wen-cong He, Mei Jiang, Cheng-cheng Liu, Wan-jiang Zeng, Jian-li Wu, Kutluk Oktay, Ling Feng, Lei Jin

BACKGROUNDThere is little information about the coronavirus disease 2019 (Covid-19) during pregnancy. This study aimed to determine the clinical features and the maternal and neonatal outcomes of pregnant women with Covid-19. METHODSIn this retrospective analysis from five hospitals, we included pregnant women with Covid-19 from January 1 to February 20, 2020. The primary composite endpoints were admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Secondary endpoints included the clinical severity of Covid-19, neonatal mortality, admission to neonatal intensive care unit (NICU), and the incidence of acute respiratory distress syndrome (ARDS) of pregnant women and newborns. RESULTSThirty-three pregnant women with Covid-19 and 28 newborns were identified. One (3%) pregnant woman needed the use of mechanical ventilation. No pregnant women admitted to the ICU. There were no moralities among pregnant women or newborns. The percentages of pregnant women with mild, moderate, and severe symptoms were 13 (39.4%),19(57.6%), and 1(3%). One (3.6%) newborn developed ARDS and was admitted to the NICU. The rate of perinatal transmission of SARS-CoV-2 was 3.6%. CONCLUSIONSThis report suggests that pregnant women are not at increased risk for severe illness or mortality with Covid-19 compared with the general population. The SARS-CoV-2 infection during pregnancy might not be associated with as adverse obstetrical and neonatal outcomes that are seen with the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy. (Funded by the National Key Research and Development Program.)

7: Pregnancy and breastfeeding during COVID-19 pandemic: A systematic review of published pregnancy cases
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Posted 29 Apr 2020

Pregnancy and breastfeeding during COVID-19 pandemic: A systematic review of published pregnancy cases
1,699 downloads medRxiv obstetrics and gynecology

Carina Rodrigues, Ines Baia, Rosa Domingues, Henrique Barros

Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19. Methods: Searches were conducted in PubMed up to 8 April 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality. Results: We identified 30 original studies reporting 212 cases of pregnant women with COVID-19 (30 discharged while pregnant), 200 from China and 12 from other countries. The 182 published deliveries resulted in one stillbirth and 185 live births. Four women with severe COVID-19 required admission to an intensive care unit but no cases of maternal death were reported. There was one neonatal death. Preterm births occurred in 28.7% of cases, but it is unclear whether this was iatrogenic. All cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus were negative. Four newborns were positive for SARS-CoV-2 and three newborns had high levels of IgM antibodies. Breast milk samples from 13 mothers and described in seven studies showed no evidence of SARS-CoV-2. Conclusion: The evidence related to the effect of COVID-19 on pregnant women is still limited. Pregnant women and newborns should be considered particularly vulnerable populations regarding COVID-19 prevention and management strategies.

8: COVID-19 and first trimester spontaneous abortion: a case-control study of 225 pregnant patients
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Posted 20 Jun 2020

COVID-19 and first trimester spontaneous abortion: a case-control study of 225 pregnant patients
1,553 downloads medRxiv obstetrics and gynecology

Stefano Cosma, Andrea Carosso, Jessica Cusato, Fulvio Borella, Marco Carosso, Marialuisa Bovetti, Claudia Filippini, Antonio D'Avolio, Valeria Ghisetti, Giovanni Di Perri, Chiara Benedetto

Background Evidence for the impact of COVID-19 during the second and the third trimester of pregnancy is limited to a relatively small series, while data on the first trimester are scant. With this study we evaluated COVID-19 infection as a risk factor for spontaneous abortion in first trimester of pregnancy. Methods Between February 22 and May 21, 2020, we conducted a case-control study at S. Anna hospital, Torino, among first trimester pregnant women, paired for last menstruation. The cumulative incidence of COVID-19 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by detection of SARS-CoV-2 from nasopharingeal swab and SARS-CoV-2 IgG/IgM antibodies in blood sample. Patient demographics, COVID-19-related symptoms, and the main risk factors for abortion were collected. Findings Twenty-three (10.2%) of the 225 women tested positive for COVID-19 infection. There was no difference in the cumulative incidence of COVID-19 between the cases (11/100, 11%) and the controls (12/125, 9.6%) (p=0.73). Logistic regression analysis confirmed that COVID-19 was not an independent predictor of abortion (1.28 confidence interval 0.53-3.08). Interpretation COVID-19 infection during the first trimester of pregnancy does not appear to predispose to abortion; its cumulative incidence did not differ from that of women with ongoing pregnancy.

9: THE EMOTIONAL IMPACT OF THE ASRM GUIDELINES ON FERTILITY PATIENTS DURING THE COVID-19 PANDEMIC
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Posted 01 Apr 2020

THE EMOTIONAL IMPACT OF THE ASRM GUIDELINES ON FERTILITY PATIENTS DURING THE COVID-19 PANDEMIC
1,510 downloads medRxiv obstetrics and gynecology

Jenna Turocy, Alex Robles, Daniel Hercz, Mary D’Alton, Eric J. Forman, Zev Williams

ObjectiveTo survey fertility patients agreement with ASRM recommendations during the COVID-19 pandemic and the emotional impact on them. DesignAn online survey was sent to current fertility patients SettingNew York City academic fertility practice at the epicenter of the COVID-19 pandemic Patient(s)Fertility patients seen within the last year Intervention(s)None Main Outcome Measures(s)Patient agreement with the ASRM recommendations during the COVID-19 pandemic and the emotional impact rated on a Likert scale. Result(s)A total of 518 patients completed the survey for a response rate of 17%. Fifty percent of respondents had a cycle canceled due to the COVID-19 pandemic. Of those who had a cycle cancelled, 85% of respondents found it to be moderately to extremely upsetting with 22% rating it to be equivalent to the loss of a child. There was no difference on the emotional impact based on the type of cycle cancelled. Fifty-five percent of patients agreed that diagnostic procedures such as hysterosalpingograms should be cancelled while 36% of patients agreed all fertility cycles should be cancelled. Patients were slightly more likely to agree with the ASRM guidelines if they have an upcoming cycle cancelled (p = 0.041). Of all respondents 82% would have preferred to have the option to start a treatment cycle in consultation with their doctor. Conclusion(s)Given the severity of the COVID-19 pandemic, the physical, financial and emotional impact of this unprecedented threat cannot be underestimated in our fertility patients.

10: SARS-CoV-2 in first trimester pregnancy - does it affect the fetus?
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Posted 09 Jun 2020

SARS-CoV-2 in first trimester pregnancy - does it affect the fetus?
1,319 downloads medRxiv obstetrics and gynecology

Nina la Cour Freiesleben, Pia Egerup, Kathrine Vauvert Rommelmayer Hviid, Elin Rosenbek Severinsen, Astrid Marie Kolte, David Westergaard, Line Fich Olsen, Lisbeth Praetorius, Anne Zedeler, Ann-Marie Hellerung Christiansen, Josefine Reinhardt Nielsen, Didi Bang, Sine Berntsen, Joaquim Olle-Lopez, Andreas Ingham, Judith Bello-Rodriuez, Ditte Marie Storm, Jeppe Ethelberg-Findsen, Eva R. Hoffmann, Charlotte Wilken-Jensen, Finn Stener Jorgensen, Henrik Westh, Henrik Lovendahl Jorgensen, Henriette Svarre Nielsen

Background Several viral infections are known to be harmful to the fetus in the first trimester of pregnancy and can cause increased nuchal translucency thickness and pregnancy loss. Currently, no evidence exists regarding possible effects of SARS-CoV-2 in first trimester pregnancies. Methods Cohort 1 included pregnant women with a double test taken between Feb. 17 and Apr. 23, 2020, during the SARS-CoV-2 epidemic peak in Denmark. The double test was taken as part of the first trimester risk assessment. Cohort 2 included women with a first trimester pregnancy loss before double test. Serum from the double test or from a blood sample, in case of pregnancy loss, was analyzed for SARS-CoV-2 antibodies. The results were correlated to the nuchal translucency thickness and the number of pregnancy losses. Results In total, 1,019 pregnant women with double test and 36 women with pregnancy loss participated in the study. Thirty (2.9%) women had SARS-CoV-2 antibodies in the serum from the double test. All women with pregnancy loss prior to the double test were negative for SARS-CoV-2 antibodies. There were no significant differences in nuchal translucency thickness for women testing positive (n=14) versus negative (p=0.20) or grey zone (n=16) versus negative (p=0.28). In total, 54 women experienced a pregnancy loss of whom two had grey zone or positive SARS-CoV-2 antibodies. Conclusion Maternal SARS-CoV-2 infection did not seem harmful in first trimester pregnancies. Infection had no effect on the nuchal translucency thickness and women with SARS-CoV-2 antibodies were not overrepresented among women with pregnancy loss.

11: Knowledge and practice of preventive measures against COVID-19 infection among pregnant women in a low-resource African setting
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Posted 20 Apr 2020

Knowledge and practice of preventive measures against COVID-19 infection among pregnant women in a low-resource African setting
1,145 downloads medRxiv obstetrics and gynecology

Johnbosco Ifunanya Nwafor, Joseph Kenechi Aniukwu, Bonaventure Okechukwu Anozie, Arinze Chidiebere Ikeotuonye

Background: Coronavirus disease pandemic has resulted in death of thousands of people across several countries. Several preventive measures have been recommended to halt the spread of the disease and its associated mortality. However, the level knowledge and practice of these preventive measures against COVID-19 infection among pregnant women, which constitute vulnerable groups, are yet to be evaluated. Aim: To determine the knowledge and practice of preventive measures against COVID-19 infection among pregnant women in Abakaliki. Materials and Methods: This was a self-administered questionnaire-based cross-sectional study conducted from February 1, 2020 to March 31, 2020 among 284 antenatal clinic attendees at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State. A pretested and validated questionnaire was used to collect the data. Data analysis was done using SPSS version 22. Results: Of 284 participants, 60.9% (n=173) had adequate knowledge of the preventive measures against COVID-19 infection. However, the overall practice of these preventive measures among the participants were poor as 69.7% of the participants were not practicing the preventive measures against the coronavirus. The determinants of poor practice of the preventive measures among the participants were being in age group 31-40 years (AOR=2.04, 95%CI: 1.26 - 5.37, p=0.022), married (AOR=2.99, 95%CI: 1.40 - 6.33, p=0.035) grandmultiparous (AOR=3.11, 95%CI: 1.32 - 6.56, p=0.021), residing in rural area (AOR=2.08, 95%CI: 1.32 - 4.05, p=0.031), and having no formal education (AOR=6.73, 95%CI: 2.66 - 18.34, p=0.002). Conclusion: The study showed that most of the participants had adequate knowledge of preventive measures against COVID-19 infection but the practice of these preventive measures were poor among the participants.

12: Impact of COVID-19 infection on maternal and neonatal outcomes: a review of 287 pregnancies
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Posted 15 May 2020

Impact of COVID-19 infection on maternal and neonatal outcomes: a review of 287 pregnancies
1,130 downloads medRxiv obstetrics and gynecology

Fatemeh Azarkish, Roksana Janghorban

Pregnant women are vulnerable group in viral outbreaks especially in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The aim of this review was to identify maternal and neonatal outcomes in available articles on pregnancies affected by COVID-19. The articles that had assessed outcomes of pregnancy and perinatal of women with COVID-19 between Oct 2019 and Apr 30, 2020 without language limitation were considered. All kinds of studies such as case report, case series, retrospective cohort, case control were included. We searched databases, selected relevant studies and extracted data regarding maternal and neonatal outcomes from each article. Data of 287 pregnant women with COVID-19 of 6 countries were assessed from 28 articles between December 8, 2019 and April 6, 2020. Most pregnant women reported in their third trimester, 102 (35.5%) cases were symptomatic at the time of admission. Common onset symptoms, abnormal laboratory findings, and chest computed tomography pattern were fever (51.5%), lymphocytopenia (67.9%), and multiple ground-glass opacities (78.5%) respectively. 93% of all deliveries were done through cesarean section. No maternal mortality and 3 % ICU admission were reported. Vertical transmission was not reported but its possibility was suggested in three neonates. One neonatal death, one stillbirth, and one abortion were reported. All newborns were not breastfed. This review showed fewer adverse maternal and neonatal outcomes in pregnant women with COVID-19 in comparison with previous coronavirus outbreak infection in pregnancy. Limited data are available regarding possibility of virus transmission in utero, during vaginal childbirth and breastfeeding. Effect of COVID-19 on first and second trimester and ongoing pregnancy outcomes in infected mothers is still questionable.

13: Persistence of SARS-CoV-2 in the first trimester placenta leading to vertical transmission and fetal demise from an asymptomatic mother
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Posted 21 Aug 2020

Persistence of SARS-CoV-2 in the first trimester placenta leading to vertical transmission and fetal demise from an asymptomatic mother
1,128 downloads medRxiv obstetrics and gynecology

Prajakta Shende, Pradip Gaikwad, Manisha Gandhewar, Pawankumar Ukey, Anshul Bhide, Vainav Patel, Sharad Bhagat, Vikrant Bhor, Smita Mahale, Rahul Gajbhiye, Deepak Modi

Coronaviruses infect the respiratory tract and are known to survive in these tissues during the clinical course of infection. However, how long can SARS-CoV-2 survive in the tissues is hitherto unknown. Herein, we report a case where the virus is detected in the first trimester placental cytotrophoblast and syncytiotrophoblasts five weeks after the asymptomatic mother cleared the virus from the respiratory tract. This first trimester placental infection was vertically transmitted as the virus was detected in the amniotic fluid and fetal membranes. This congenitally acquired SARS-CoV-2 infection was associated with hydrops and fetal demise. This is the first study providing concrete evidences towards persistent tissue infection of SARS-CoV-2, its congenital transmission in early pregnancy leading to intrauterine fetal death.

14: IN-UTERO MOTHER-TO-CHILD SARS-CoV-2 TRANSMISSION: viral detection and fetal immune response
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Posted 10 Jul 2020

IN-UTERO MOTHER-TO-CHILD SARS-CoV-2 TRANSMISSION: viral detection and fetal immune response
1,048 downloads medRxiv obstetrics and gynecology

Claudio Fenizia, Mara Biasin, Irene Cetin, Patrizia Vergani, Davide Mileto, Arsenio Spinillo, Maria Rita Gismondo, Francesca Perotti, Clelia Callegari, Alessandro Mancon, Selene Cammarata, Ilaria Beretta, Manuela Nebuloni, Daria Trabattoni, Mario Clerici, Valeria Savasi

Pregnancy is known to increase the risk of severe illnesses in response to viral infections. Therefore, the impact of SARS-CoV-2 infection during gestational ages might be detrimental and the potential vertical transmission should be thoroughly studied. Herein, we investigated whether SARS-CoV-2 vertical transmission is possible and, in case, whether this results in a fetal involvement. Additionally, we analyzed the role of the antibody and the inflammatory responses in placenta and plasma from SARS-CoV-2-positive pregnant women and fetuses. 31 SARS-CoV-2 pregnant women were enrolled. Real-time PCR was performed to detect the virus on maternal and newborns nasopharyngeal swabs, vaginal swabs, maternal and umbilical cord plasma, placenta and umbilical cord biopsies, amniotic fluids and milk. Maternal and umbilical cord plasma, and milk were tested for specific anti-SARS-CoV-2 antibodies. RNA expression quantification of genes involved in the inflammatory response was performed on four selected placentas. On maternal and umbilical cord plasma of the same subjects, secreted cytokines/chemokines were quantified. SARS-CoV-2 is found in at-term placentae and in the umbilical cord blood, in the vaginal mucosa of pregnant women and in milk. Furthermore, we report the presence of specific anti-SARS-CoV-2 IgM and IgG antibodies in the umbilical cord blood of pregnant women, as well as in milk specimens. Finally, a specific inflammatory response is triggered by SARS-CoV-2 infection in pregnant women at both systemic and placental level, and in umbilical cord blood plasma. Our data strongly support the hypothesis that in-utero vertical transmission is possible in SARS-CoV-2 positive pregnant women. This is essential for defining proper obstetric management of COVID-19 pregnant women, or putative indications for mode and timing of delivery.

15: The association between COVID-19 and preterm delivery: A cohort study with a multivariate analysis
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Posted 07 Sep 2020

The association between COVID-19 and preterm delivery: A cohort study with a multivariate analysis
1,008 downloads medRxiv obstetrics and gynecology

SPANISH OBSTETRIC EMERGENCY GROUP, Oscar Martinez Perez, Pilar Prats Rodriguez, Marta Muner Hernandez, Maria Begona Encinas Pardilla, Noelia Perez Perez, Maria Rosa Vila Hernandez, Ana Villalba Yarza, Olga Nieto Velasco, Pablo G Del Barrio Fernandez, Laura Forcen Acebal, Carmen M Orizales Lago, Alicia Martinez Varea, Begona Munoz Abellana, Maria Suarez Arana, Raquel Gonzalez Seoane, Clara Martinez Diago, Esther Canedo Carballeira, Macarena Alferez Alvarez Mallo, Cristina Casanova Pedraz, Onofre Alomar Mateu, Cristina Lesmes Heredia, Juan Carlos Wizner de Alva, Ruth Bernardo Vega, Montserrat Macia Badia, Cristina Alvarez Colomo, Antonio Sanchez Munoz, Laia Pratcorona Alicart, Ruben Alonso Saiz, Monica Lopez Rodriguez, Maria Carmen Barbancho Lopez, Marta Meca Casbas, Oscar Vaquerizo Ruiz, Eva Moran Antolin, Maria Jose Nunez Valera, Camino Fernandez Fernandez, Albert Tubau Navarra, Alejandra M Cano Garcia, Carmen Baena Luque, Susana Soldevilla Perez, Irene Gastaca Abasolo, Jose Adanez Garcia, Maria Teulon Gonzalez, Alberto Puertas Prieto, Rosa Ostos, Maria del Pilar Guadix Martin, Monica Catalina Coello, Maria Luisa De la Cruz Conti, Africa Cano Aguilar, Jose A Sainz Bueno

Structured abstract Objective: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS CoV 2, the cause of COVID 19 disease) exposure in pregnancy, compared to non exposure, is associated with infection related obstetric morbidity. Design and setting: Throughout Spain, 45 hospitals took part in the universal screening of pregnant women going into labour using polymerase chain reaction (PCR) for COVID 19 since late March 2020. Methods: The cohort of exposed and unexposed pregnancies was followed up until 6 weeks postpartum. Multivariate logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of COVID 19 exposure, compared to non exposure, with infection related obstetric outcomes. Main outcome measures: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. Results: In the cohort of 1,009 screened pregnancies, 246 were COVID 19 positive. Compared to non exposure, COVID 19 exposure increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32 3.36, p=0.002), premature rupture of membranes at term (39 vs 75, % vs 9.8%, aOR 1.70, 95% CI 1.11 2.57, p=0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43 8.94, p<0.001). Conclusion: This first prospective cohort study demonstrated that pregnant women infected with SARS CoV 2 have more infection related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

16: High prevalence of Human Papillomavirus (HPV) type 66 in low-grade cervical lesions of Mexican women
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Posted 10 Jan 2020

High prevalence of Human Papillomavirus (HPV) type 66 in low-grade cervical lesions of Mexican women
994 downloads medRxiv obstetrics and gynecology

Karina Juárez-González, Vladimir Paredes-Cervantes, Silvia Gordillo-Rodríguez, Saúl González-Guzmán, Xochilt Moncayo-Valencia, Rocío Méndez-Martínez, Alejandro García-Carrancá, José Darío Martínez-Ezquerro, Rodolfo Rivas-Ruiz, Patricia Sánchez-Suárez, Paola Álvarez-Sandoval, Patricia Padilla-Arrieta, Martha Martínez-Salazar, Salvador Vázquez-Vega

BackgroundHPV-16 infections constitute the highest risk for developing uterine cervix cancer. However, the role of other high-risk types is still controversial. ObjectiveTo analyze HR-HPV prevalence and its possible associations between HPV and risk factors related to cervical lesions among Mexican women. MethodsCross sectional study using 362 cervical samples collected between 2016 and 2017. Fourteen HR-HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) were detected by highly sensitive PCR amplification followed by reverse hybridization. Bivariate and multivariate analyses were performed to investigate the association between HPV types and risk factors among lesions. ResultsMost samples were HR-HPV positive (83.43%). HPV-16 was the most prevalent infection among negative for intraepithelial lesions or malignancy (78.6%), high-grade squamous intraepithelial lesions (50%), and cervical cancer (58.2%). HPV-66 showed an unexpected high prevalence in atypical squamous cells of undetermined significance (50%), low-grade squamous intraepithelial (45.7%), and only found in 3.6% of cervical cancers. HPV-16 was significantly prevalent among women between 30-39 years, whereas types 66 and 52 were significantly associated when previously sexually transmitted disease had occurred (p< 0.05). ConclusionsHPV-66 either in single or co-infection with other HR-HPV types (excluding 16 and 18) might be indicative of non-progressive cancer lesions. HPV-66 prevalence was unusually high in low-grade cervical lesions, predominantly in co-infection with HPV-51, and very low among cervical cancer. This should be addressed to interpret results obtained by methods that group type 66 with other HR-types.

17: Creating a Survey Instrument for Self-Assessed Menstrual Cycle Characteristics and Androgen Excess
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Posted 06 Mar 2020

Creating a Survey Instrument for Self-Assessed Menstrual Cycle Characteristics and Androgen Excess
876 downloads medRxiv obstetrics and gynecology

Shruthi Mahalingaiah, Carol Cosenza, J. Jojo Cheng, Erika Rodriguez, Ann Aschengrau

ContextIn large population-based studies, there are a lack of existing questionnaires designed to ascertain menstrual cycle characteristics and tools to assess androgen excess including hirsutism, alopecia, and acne. ObjectiveOur objective was to create and evaluate an online survey instrument for identification of polycystic ovary syndrome (PCOS) using self-reported menstrual cycle characteristics and novel pictorial tools for self-evaluation of androgen excess characteristics. MethodsQuestions to assess menstrual characteristics and health were designed using existing surveys and clinical experience. Pictorial self-assessment tools for androgen excess were also developed with an experienced medical illustrator to include the modified Ferrimen-Galway, acne and androgenic alopecia. These were combined into an online survey instrument using REDCap and cognitively tested to assess question comprehension. The survey was revised based on feedback and subsequently used in the Ovulation and Menstruation (OM) Health Pilot study. ResultsA survey instrument was created which includes assessment of menstrual cycle characteristics and pictorial tools for levels of androgen excess. Cognitive testing identified questions and concepts not easily comprehended, recalled, or had problematic response choices. Comprehension examples include simplifying the definition for PCOS and revising questions on historic menstrual regularity and bleeding duration. Recall and answer formation examples include issues with recalling waist size, beverage consumption, and interpretation of questions using symbols (> or <). ConclusionWe present a cognitively tested, novel survey instrument to assess menstrual cycle characteristics and androgen excess. This survey instrument is a novel tool to ascertain the prevalence of PCOS in general population settings. What is already known on this subjectPolycystic ovary syndrome (PCOS), is the most common reproductive disorder in women of reproductive age. In large population-based studies, there are a lack of question sets designed for the ascertainment of menstrual cycle characteristics and tools to assess androgen excess necessary for diagnosis of PCOS. What this study addsOur team created an online survey instrument that underwent rigorous cognitive testing to ensure cognitively complex reproductive questions could be understood at an 8th grade reading level. Our goal was to identify obvious questionnaire problems which could impact participant comprehension and readability. The development and cognitive testing of this survey instrument may provide a better way to capture PCOS prevalence in future studies. We propose the use of this study as an example that validating survey questions can provide important insight into capturing accurate data from diverse groups of participants.

18: The impact of the COVID-19 lockdown on maternal mental health and coping in the UK: Data from the COVID-19 New Mum Study
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Posted 04 Aug 2020

The impact of the COVID-19 lockdown on maternal mental health and coping in the UK: Data from the COVID-19 New Mum Study
777 downloads medRxiv obstetrics and gynecology

Sarah Dib, Emeline Rougeaux, Adriana Vázquez-Vázquez, Jonathan CK Wells, Mary Fewtrell

Background: Depression and anxiety affect up to 20% of new and expectant mothers during the perinatal period; this rate may have increased due to COVID-19 and lockdown measures. This analysis aimed to assess how mothers are feeling and coping during lockdown, and to identify the potential pathways that can assist them. Methods: 1329 women living in the UK aged [&ge;]18 years with an infant [&le;]12 months of age completed an anonymous online survey. Descriptive analysis of maternal mental health, coping, support received, activities undertaken and consequences of lockdown was conducted. Linear regression was used to predict maternal mental health and coping, using activities, support, and consequences of the lockdown as predictors, while adjusting for age, gestational age, ethnicity, income, marital status and number of children. Results: More than half of the participants reported feeling down (56%), lonely (59%), irritable (62%) and worried (71%), to some or high extent since lockdown began. Despite this, 70% felt able to cope with the situation. Support with her own health (95% CI .004, .235), contacting infant support groups (95% CI -.003, .252), and higher infant gestational age (95% CI .000, .063) predicted better mental health. Travelling for work (95% CI -.680, -.121), lockdown having a major impact on the ability to afford food (95% CI -1.202, -.177), and having an income lower than 30k (95% CI -.475, -.042) predicted poorer mental health. Support with her own health and more equal division of household chores were associated with better coping. Conclusion: During lockdown, a large proportion of new mothers experienced symptoms of poor mental health; mothers of infants with lower gestational age, with low income, and who are travelling to work were particularly at risk. However, greater support for maternal health and with household chores showed positive associations with maternal mental health and coping. These findings highlight the urgent need to assess maternal mental health, and to identify prevention strategies for mothers during different stages of lockdown.

19: Analysis of the outcome of patients with stage IV uterine serous carcinoma mimicking ovarian cancer
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Posted 16 Jul 2019

Analysis of the outcome of patients with stage IV uterine serous carcinoma mimicking ovarian cancer
737 downloads medRxiv obstetrics and gynecology

Murad Al-Aker, Karen Sanday, James Nicklin

ObjectivesTo identify clinicopathological factors that might influence survival in patients with stage IV uterine serous carcinoma, and to compare survival outcomes in patients with stage IV uterine serous carcinoma managed with neoadjuvant chemotherapy followed by interval cytoreduction (with or without adjuvant chemotherapy), primary cytoreductive surgery followed by adjuvant chemotherapy. MethodsA retrospective cohort study of all patients with stage IV Uterine serous carcinoma treated between 2005 and 2015 within a regional cancer centre. Progression-free and overall survival rates were calculated using the Kaplan-Meier method. ResultsOf 50 women with stage IV uterine serous carcinoma who met inclusion criteria, 37 underwent primary cytoreductive surgery, nine received neoadjuvant chemotherapy with planned interval cytoreductive surgery and four received palliative care only. A pre-treatment diagnosis of stage IV uterine serous carcinoma was made for only 45.9% of the primary cytoreductive surgery group and 56.6% of the neoadjuvant chemotherapy group, with advanced ovarian cancer the most common preoperative misdiagnosis. Median follow up was 19 months. Median overall survival was 27 months for the primary cytoreductive surgery group, 20 months for the neoadjuvant chemotherapy group and two months for the palliative care group. Optimal cytoreduction was achieved in 67.6% of the primary cytoreductive surgery group and 87.5% of the neoadjuvant chemotherapy group who underwent interval cytoreduction. Optimal cytoreduction was associated with improvement in overall survival, compared with suboptimal cytoreduction (36 versus 15 months; P=0.16). Adjuvant chemotherapy was associated with significantly higher overall survival compared with no adjuvant chemotherapy (36 versus four months; P<0.05). Median overall survival was 16 months for those with pure uterine serous carcinoma (n=40), compared with 32 months for those with mixed histopathology (n=10). ConclusionStage IV uterine serous carcinoma can mimic advanced ovarian cancer. It carries a poor prognosis, which is worse for pure uterine serous carcinoma than for mixed-type endometrial adenocarcinoma. Neoadjuvant chemotherapy followed by interval cytoreduction and adjuvant chemotherapy seems to be a safe option, with an increased rate of optimal cytoreduction and comparable overall survival, compared with primary cytoreductive surgery. Adjuvant chemotherapy significantly improves survival in all groups. Primary objectiveTo analyse the clinicopathological factors that might influence the progression-free survival and overall survival in patients with stage IV uterine serous carcinoma treated at Queensland Centre for Gynecological cancer. Secondary objectiveTo compare the survival outcomes of patients with stage IV uterine serous carcinoma treated with neoadjuvant chemotherapy and interval cytoreduction, with those treated with primary cytoreductive surgery followed by adjuvant chemotherapy and patients who received palliative care only. PRECISOptimal cytoreduction and adjuvant chemotherapy improved survival in stage IV uterine serous carcinoma. Neoadjuvant chemotherapy was feasible and safe. Patients with microscopic disease have similar poor prognosis. HIGHLIGHTSO_LIPure uterine serous carcinoma carries a worse prognosis compared to mixed uterine serous carcinoma C_LIO_LIOptimal cytoreduction and adjuvant chemotherapy improve survival in Stage IV uterine serous carcinoma C_LIO_LINeoadjuvant chemotherapy is feasible and a safe option in the management of stage IV uterine serous carcinoma C_LI

20: Placental SARS-CoV-2 in a patient with mild COVID-19 disease
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Posted 14 Jul 2020

Placental SARS-CoV-2 in a patient with mild COVID-19 disease
734 downloads medRxiv obstetrics and gynecology

Albert L. Hsu, Minhui Guan, Eric Johannesen, Amanda J. Stephens, Nabila Khaleel, Nikki Kagan, Breanna C. Tuhlei, Xiu-Feng Wan

Background: The full impact of COVID-19 on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality,1 and COVID-19 manifestations appear similar between pregnant and non-pregnant women.2 We present a case of placental SARS-CoV-2 virus in a woman with an uncomplicated pregnancy and mild COVID-19 disease. Methods: A pregnant woman was evaluated at University of Missouri Women and Childrens Hospital. Institutional review board approval was obtained; information was obtained from medical records. Reverse transcriptase-polymerase chain reaction (RT-PCR) was performed to detect SARS-CoV-2. A gynecological pathologist examined the placenta and performed histolopathology. Sections were formalin-fixed and paraffin-embedded; slides were cut and subjected to hematoxylin-and-eosin or immunohistochemistry (IHC) staining. IHC was performed with specific monoclonal antibodies to detect SARS-CoV-2 antigen or to identify trophoblasts. Findings: A 29 year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias two days prior, she tested positive for SARS-CoV-2. Her parents were in self-isolation for COVID-19 positivity; husband was asymptomatic and tested negative for COVID-19, but exposed to a workplace (meatpacking facility) outbreak. Prenatal course was uncomplicated, with no gestational hypertension. She was afebrile and asymptomatic with normal vital signs throughout hospitalization. Her myalgias improved prior to admission. A liveborn male infant was delivered vaginally. Newborn course was uneventful; he was appropriate for gestational age, physical was unremarkable, and he was discharged home at 36 hours. COVID-19 RT-PCR test was negative at 24 hours. At one-week follow-up, newborn was breastfeeding well, with no fevers or respiratory distress. Overall placental histology is consistent with acute uterine hypoxia (subchorionic laminar necrosis) superimposed on chronic uterine hypoxia (extra-villous trophoblasts and focal chronic villitis). IHC using SARS-CoV-2 nucleocapsid-specific monoclonal antibody demonstrated SARS-CoV-2 antigens throughout the placenta in chorionic villi endothelial cells, and rarely in CK7-expressing trophoblasts. Negative control placenta (November 2019 delivery) and ferret nasal turbinate tissues (not shown) were negative for SARS-CoV-2. Interpretation: In this report, SARS-CoV-2 was found in the placenta, but newborn was COVID-19 negative. Our case shows maternal vascular malperfusion, with no features of fetal vascular malperfusion. To our knowledge, this is the first report of placental COVID-19 despite mild COVID-19 disease in pregnancy (with no symptoms of COVID-19 aside from myalgias); specifically, this patient had no fever, cough, or shortness of breath, but only myalgias and sick contacts. Despite her having mild COVID-19 disease in pregnancy, we demonstrate placental vasculopathy and presence of SARS-CoV-2 virus across the placenta. Evidence of placental COVID-19 raises concern for possible placental vasculopathy (potentially leading to fetal growth restriction, pre-eclampsia, and other pregnancy complications) as well as for potential vertical transmission -- especially for pregnant women who may be exposed to COVID-19 in early pregnancy. Further studies are urgently needed, to determine whether women with mild, pre-symptomatic, or asymptomatic COVID-19 may have SARS-CoV-2 virus that can cross the placenta, cause fetal vascular malperfusion, and possibly affect the fetus. This raises important public health and public policy questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID-19 symptoms, increased antenatal surveillance, and possibly routine COVID-19 testing on a regular basis throughout pregnancy.

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