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      Maternal COVID-19 Infection and Perinatal Outcome in Three Waves of COVID Pandemic: A Cross-sectional Study

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          ABSTRACT

          Introduction

          Recent pandemic of COVID-19 has shaped economic, social, and political aspects of human civilization. Pregnant women were also affected during the pandemic. Effect of COVID-19 infection on pregnancy outcome as the pandemic progressed through various phases (first, second, and third waves) is of importance.

          Methodology

          A cross-sectional study carried out in a dedicated COVID tertiary care maternity unit during three waves of pandemic. Around 405 pregnant women with active COVID-19 infection at the time of delivery giving birth to 411 newborns (6 cases of twins) were enrolled to study the perinatal outcome. Primary outcome of study was to analyze the perinatal outcome in COVID-19-affected pregnant women and secondary outcome of study was to understand the sociodemographic profile of women affected by COVID-19 and to compare the maternal and fetal affection in all three phases of the COVID-19 pandemic.

          Results

          Among three phases, most commonly affected age-group was 21–25 years (44.2%). Among the affected women, body mass index (BMI) was normal in 49.9% of women. Phase-wise affection did not show any statistical difference for maternal age, BMI, socioeconomic class, parity, and gestational age. Overall 48.6% of women were symptomatic. Symptomatology and high dependency unit (HDU)/intensive care unit (ICU) requirement showed statistical significant difference in three waves of pandemic ( p < 0.001). The second wave had severe affection than the first and third waves. All four (1%) maternal mortalities during study period were noted in the second wave. Commonest obstetric high risks noted were anemia, 34.6% cases, followed by previous lower segment cesarean section (LSCS), 27.2% cases, and preeclampsia, 18.8% cases. Preterm delivery rate was found to be 27.4%. Obstetric high risks and preterm delivery rate did not show any statistical difference in all three phases of COVID. Cesarean section rate was 48.1% in COVID-19 pregnant population. Cesarean section rate among three phases showed statistical significance with highest (54.7%) in the first wave of COVID-19 pandemic. Neonatal transmission rate was 1.02% in our study. Stillbirth rate and neonatal intensive care unit (NICU) admission did not show any statistical difference in three waves of COVID-19 infection.

          Conclusion

          The second wave of COVID-19 was more severe compared with first and third waves with more symptomatic cases requiring HDU/ICU admission and high maternal mortality. Neonatal outcome did not show statistical difference in three stages of COVID-19 pandemic.

          How to cite this article

          Thakkarwad S, Asalkar M, Sharma N. Maternal COVID-19 Infection and Perinatal Outcome in Three Waves of COVID Pandemic: A Cross-sectional Study. J South Asian Feder Obst Gynae 2023;15(3):297–303.

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          Most cited references29

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          Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

          Abstract Objectives To describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants. 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 1 March 2020 and 14 April 2020. Main outcome measures Incidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission. Results The estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth. Conclusions Most pregnant women admitted to hospital with SARS-CoV-2 infection 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 high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation. Study registration ISRCTN 40092247.
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            Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis

            Objective The aim of this systematic review was to report pregnancy and perinatal outcomes of Coronavirus (CoV) spectrum infections, and particularly COVID-19 disease due to SARS-COV-2 infection during pregnancy. Data sources Medline, Embase, Cinahl and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for “coronavirus” or “severe acute respiratory syndrome” or “SARS” or “Middle East respiratory syndrome” or “MERS” or “COVID-19” and “pregnancy”. The search and selection criteria were restricted to English language. Study eligibility criteria Inclusion criteria were pregnant women with a confirmed Coronavirus related illness, defined as either SARS, MERS or COVID-19. Study appraisal and synthesis methods We used meta-analyses of proportions to combine data and reported pooled proportions. The pregnancy outcomes observed included miscarriage, preterm birth, pre-eclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score 90% of whom also had pneumonia, PTB is the most common adverse pregnancy outcome. Miscarriage, preeclampsia, cesarean, and perinatal death (7-11%) were also more common than in the general population. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy.
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              Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China

              This cohort study examines medical records of 33 neonates born to women with COVID-19 to provide information on maternal-child transmission and infant outcomes.
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                Author and article information

                Journal
                JSAFOG
                Journal of South Asian Federation of Obstetrics and Gynaecology
                JSAFOG
                Jaypee Brothers Medical Publishers
                0974-8938
                0975-1920
                May-June 2023
                : 15
                : 3
                : 297-303
                Affiliations
                [1–3 ]Department of Obstetrics and Gynaecology, PCMC'S PGI-YCMH, Pimpri, Pune, Maharashtra, India
                Author notes
                Mahesh Asalkar, Department of Obstetrics and Gynaecology, PCMC'S PGI-YCMH, Pimpri, Pune, Maharashtra, India, Phone: +91 9326972948, e-mail: mahesh@ 123456asalkarclinic.com
                Article
                10.5005/jp-journals-10006-2225
                f77919f3-a6d9-4f9a-8abf-055b87287cbb
                Copyright © 2023; The Author(s).

                © The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 February 2023
                : 27 March 2023
                : 31 July 2023
                Categories
                ORIGINAL ARTICLE
                Custom metadata
                jsafog-15-297.pdf

                Obstetrics & Gynecology
                COVID-19 pregnancies,COVID-19,Perinatal outcome,Pandemic waves
                Obstetrics & Gynecology
                COVID-19 pregnancies, COVID-19, Perinatal outcome, Pandemic waves

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