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      Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID‐19) infection

      research-article
      Author(s): 1 , , 12 , , 23 , 31 , 32 , 33 , 34 , 35 , 36 , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 12 , 12 , 18 , 19 , 36 , 20 , 21 , 12 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 1 , 6 , 30
      Publication date (Electronic):
      Journal: International Journal of Gynaecology and Obstetrics
      Publisher: John Wiley and Sons Inc.
      Keywords: COVID‐19 , Expert consensus, Management guidelines, Neonates, Pregnant women

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          To provide clinical management guidelines for novel coronavirus ( COVID‐19) in pregnancy.

          Methods

          On February 5, 2020, a multidisciplinary teleconference comprising Chinese physicians and researchers was held and medical management strategies of COVID‐19 infection in pregnancy were discussed.

          Results

          Ten key recommendations were provided for the management of COVID‐19 infections in pregnancy.

          Conclusion

          Currently, there is no clear evidence regarding optimal delivery timing, the safety of vaginal delivery, or whether cesarean delivery prevents vertical transmission at the time of delivery; therefore, route of delivery and delivery timing should be individualized based on obstetrical indications and maternal–fetal status.

          Abstract

          Currently, there is no clear evidence regarding optimal delivery timing or route of delivery for pregnant women with COVID‐19 infection; these should be individualized based on obstetrical indications and maternal–fetal status.

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          Most cited references33

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          Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia.

          Theo M. Bestebroer, Albert Osterhaus, Sander van Boheemen … (2012)
          A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
          Article 0 comments Cited 3033 times – based on 0 reviews     Review now
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            A novel coronavirus associated with severe acute respiratory syndrome.

            Thomas G Ksiazek, Dean Erdman, Cynthia Goldsmith … (2003)
            A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated with exposures originating from a single ill health care worker from Guangdong Province, China. We conducted studies to identify the etiologic agent of this outbreak. We received clinical specimens from patients in seven countries and tested them, using virus-isolation techniques, electron-microscopical and histologic studies, and molecular and serologic assays, in an attempt to identify a wide range of potential pathogens. None of the previously described respiratory pathogens were consistently identified. However, a novel coronavirus was isolated from patients who met the case definition of SARS. Cytopathological features were noted in Vero E6 cells inoculated with a throat-swab specimen. Electron-microscopical examination revealed ultrastructural features characteristic of coronaviruses. Immunohistochemical and immunofluorescence staining revealed reactivity with group I coronavirus polyclonal antibodies. Consensus coronavirus primers designed to amplify a fragment of the polymerase gene by reverse transcription-polymerase chain reaction (RT-PCR) were used to obtain a sequence that clearly identified the isolate as a unique coronavirus only distantly related to previously sequenced coronaviruses. With specific diagnostic RT-PCR primers we identified several identical nucleotide sequences in 12 patients from several locations, a finding consistent with a point-source outbreak. Indirect fluorescence antibody tests and enzyme-linked immunosorbent assays made with the new isolate have been used to demonstrate a virus-specific serologic response. This virus may never before have circulated in the U.S. population. A novel coronavirus is associated with this outbreak, and the evidence indicates that this virus has an etiologic role in SARS. Because of the death of Dr. Carlo Urbani, we propose that our first isolate be named the Urbani strain of SARS-associated coronavirus. Copyright 2003 Massachusetts Medical Society
            Article 0 comments Cited 2120 times – based on 0 reviews     Review now
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              Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

              Huijun Chen, Juanjuan Guo, Chen Wang … (2020)
              Summary Background Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. Methods Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. Findings All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. Interpretation The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. Funding Hubei Science and Technology Plan, Wuhan University Medical Development Plan.
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                Author and article information

                Contributors
                Dunjin Chen: gzdrchen@gzhmu.edu.cn
                Huixia Yang: yanghuixia@bjmu.edu.cn
                Journal
                Journal ID (nlm-ta): Int J Gynaecol Obstet
                Journal ID (iso-abbrev): Int J Gynaecol Obstet
                Journal ID (doi): 10.1002/(ISSN)1879-3479
                Journal ID (publisher-id): IJGO
                Title: International Journal of Gynaecology and Obstetrics
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0020-7292
                ISSN (Electronic): 1879-3479
                Publication date (Electronic): 01 April 2020
                Publication date (Print): May 2020
                Publication date PMC-release: 01 April 2020
                Volume: 149
                Issue: 2 ( doiID: 10.1002/ijgo.v149.2 )
                Pages: 130-136
                Affiliations
                [ 1 ] Department of Obstetrics and Gynecology The Third Affiliated Hospital of Guangzhou Medical University Guangzhou City, Guangdong Province China
                [ 2 ] Department of Obstetrics and Gynecology Women's Hospital Zhejiang University School of Medicine Hangzhou Hangzhou Zhejiang Province China
                [ 3 ] Department of Obstetrics and Gynecology Nanjing Drum Tower Hospital the Affiliated Hospital of Nanjing University Medical School Nanjing JiangSu Province China
                [ 4 ] Department of Pediatrics Peking University First Hospital Beijing China
                [ 5 ] Department of Critical Care Unit The First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong Province China
                [ 6 ] Department of Obstetrics and Gynecology Zhongnan Hospital of Wuhan University Wuhan Hubei Province China
                [ 7 ] Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University Shanghai China
                [ 8 ] Department of Obstetrics and Gynecology the First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shanxi Province China
                [ 9 ] Department of Affective Disorder Brain Hospital Affiliated of Guangzhou Medical University Guangzhou Guangdong Province China
                [ 10 ] Department of Obstetrics and Gynecology Shengjing Hospital of China Medical University Shenyang , Liaoning Province China
                [ 11 ] Department of Obstetrics and Gynecology Chinese Academy of Medical Sciences & Peking Union Medical college Hospital Beijing China
                [ 12 ] Department of Obstetrics and Gynecology Peking University First Hospital Beijing China
                [ 13 ] Department of Obstetrics and Gynecology West China Second University Hospital Sichuan University Chengdu Sichuan Province China
                [ 14 ] Department of Infectious Diseases The Third Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong Province China
                [ 15 ] Department of Obstetrics and Gynecology You'an Hospital Capital Medical University Beijing China
                [ 16 ] Department of Pediatrics Peking University Third Hospital Beijing China
                [ 17 ] Department of Obstetrics and Gynecology The First Affiliated Hospital of Chongqing Medical University Chongqing China
                [ 18 ] Department of Obstetrics and Gynecology The First Affiliated Hospital of Harbin Medical University Harbin Helongjiang Province China
                [ 19 ] Department of Obstetrics and Gynecology Provincial Hospital Affiliated to Shandong University Shandong Province China
                [ 20 ] Department of Obstetrics and Gynecology The First Affiliated Hospital Sun Yat‐sen University Guangzhou Guangdong Province China
                [ 21 ] Department of Gynecology and Obstetrics Nanfang Hospital Southern Medical University Guangzhou Guangdong Province China
                [ 22 ] School of Health Education of Wuhan University Wuhan Hubei Province China
                [ 23 ] Department of Neonatology Children's Hospital Affiliated of Fudan University Shanghai China
                [ 24 ] Department of Obstetrics and Gynecology The Second Affiliated Hospital of Hebei Medical University Hebei Province China
                [ 25 ] Department of Obstetrics Fujian Provincial Maternity and Children Hospital Fuzhou Fujian Province China
                [ 26 ] Department of Obstetrics and Gynecology Peking University Third Hospital Beijing China
                [ 27 ] Department of Neonatology Tianjin Central Hospital of Gynecology Obstetrics Tianjin China
                [ 28 ] Department of Infectious Diseases Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu Province China
                [ 29 ] Department of Obstetrics and Gynecology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
                [ 30 ] Department of Obstetrics and Gynecology Baylor College of Medicine Houston TX USA
                [ 31 ] Department of Obstetrics International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
                [ 32 ] Department of Obstetrics and Gynecology Shanghai First Maternity and Infant Hospital Shanghai China
                [ 33 ] Department of Obstetrics and Gynecology Renmin Hospital of Wuhan University Wuhan Hubei Province China
                [ 34 ] Department of Obstetrics and Gynecology Peking University Shenzhen Hospital Shenzhen Guangdong Province China
                [ 35 ] Department of Perinatal Medicine Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei Province China
                [ 36 ] Department of Critical Care Unit the Third Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong Province China
                Author notes
                [*] [* ] Correspondence

                Dunjin Chen, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou City, Guangdong Province, China.

                Email: gzdrchen@ 123456gzhmu.edu.cn

                Huixia Yang, Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.

                Email: yanghuixia@ 123456bjmu.edu.cn

                [†]

                These authors contributed equally.

                Article
                Publisher ID: IJGO13146
                DOI: 10.1002/ijgo.13146
                PMC ID: 9087756
                PubMed ID: 32196655
                SO-VID: 0051a289-0922-4510-8fb2-bbe517eae41b
                Copyright © © 2020 International Federation of Gynecology and Obstetrics
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date revision received : 15 March 2020
                Date received : 25 February 2020
                Date accepted : 18 March 2020
                Page count
                Figures: 1, Tables: 2, Pages: 7, Words: 4738
                Categories
                Subject: Special Article
                Subject: Special Article
                Subject: Obstetrics
                Custom metadata
                source-schema-version-number 2.0
                cover-date May 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.5 mode:remove_FC converted:10.05.2022

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: covid‐19,expert consensus,management guidelines,neonates,pregnant women
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: covid‐19, expert consensus, management guidelines, neonates, pregnant women

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