A Comprehensive Review of the Management of Pregnant Women with COVID-19: Useful Information for Obstetricians

Figures & data

Table 1 Included Studies About Perinatal Complications

Studies	Research Type	Number of Mothers/Neonates	Maternal Outcomes	Neonatal Outcomes
Chen et al^Citation31	Retrospective study	9/9	No pregnant women developed pneumonia. No patients died.	Nine newborns survived without asphyxia.
Elshafeey et al^Citation34	Systematic review	385/256	17 pregnant females had ICU admission. One female died.	There were two cases of intrauterine fetal death, and one neonate died.
Kayem et al^Citation36	Retrospective study	617/NA	The incidence of preterm birth was between 10.6–79.3%. One pregnant woman died.	One neonate died.
Vousden et al^Citation37	Prospective study	1148/NA	Symptomatic patients were more likely to have ICU admission, but the overall incidence of adverse outcomes was low.	The admission of NICU increased regardless of symptom condition.
Allotey et al^Citation39	Systematic review and meta-analysis	67,271/9466	Compared with non-pregnant females, pregnant women with COVID-19 were more likely to have preterm delivery, ICU admission and maternal death.	The neonates were more likely to enter NICU compared with those born from non-pregnant females.
Dubey et al^Citation77	Systematic review and meta-analysis	790/548	The proportions of cesarean section, premature delivery, low birth weight, and adverse pregnancy complications were considered as 72%, 23%, 7%, and 27%.	One newborn died.
Yan et al^Citation80	Retrospective study	116/100	6.9% of the patients had severe pneumonia. There was no maternal death, and the incidence of preterm birth was 21.2%.	One newborn died.
Yoon et al^Citation81	Systematic review	223/201	The incidence of preterm birth was 25.9%.	The incidences of small for gestational age and low birth weight were 8.3% and 15.6%.
Di et al^Citation40	Systematic review and meta-analysis	1100/444	89% of the patients developed pneumonia, 8% received ICU treatment, and 5 pregnant women died.	The NICU occupancy rate associated with infection was 2%, and 3 newborns died.
Huntley et al^Citation41	Systematic review	538/313	Maternal ICU admission occurred in 3.0% of cases. No maternal deaths were reported. The preterm birth rate was 20.1%.	One neonate died.
Juan et al^Citation42	Systematic review	324/221	Four pregnant women experienced spontaneous abortion.	Eight newborns showed low birth weight. About one third of newborns were admitted to NICU. One newborn had asphyxia and one newborn died.

Abbreviations: ICU, intensive care unit; NICU, neonatal intensive care unit; NA, non-analyzed.

Table 2 Included Studies About Vertical Transmission

Studies	Number of Tested Neonates	Neonatal Throat Swab Viral RNA	Cord Blood Viral RNA	Amniotic Fluid Viral RNA	Placenta Viral RNA	Breast Milk Viral RNA	Increased IgM (≥10 AU/mL)	Increased IgG (≥10 AU/mL)	Neonatal Blood Viral RNA
Chen et al^Citation31	6	–	–	–	NA	–	NA	NA	NA
Yu et al^Citation121	3	+	–	NA	–	NA	NA	NA	NA
Kirtsman et al^Citation122	1	+	NA	NA	NA	NA	NA	NA	+
Alzamora et al^Citation123	1	+	NA	NA	NA	NA	–	–	–
Zamaniyan et al^Citation124	1	+	–	+	NA	NA	NA	NA	NA
Fenizia et al^Citation125	31	+	+	NA	+	+	NA	NA	NA
Dong et al^Citation126	1	–	NA	NA	NA	NA	+	+	NA
Zeng et al^Citation127	6	–	NA	NA	NA	NA	+	+	–
Hosier et al^Citation129	1	NA	+	NA	+	NA	NA	NA	NA
Baud et al^Citation130	1	–	–	–	+	NA	NA	NA	–
Penfield et al^Citation131	11	–	NA	NA	+	NA	NA	NA	NA
Hecht et al^Citation132	19	NA	NA	NA	+	NA	NA	NA	NA
Menter et al^Citation133	5	–	–	–	+	–	NA	NA	NA
Vivanti et al^Citation138	1	+	NA	+	+	NA	NA	NA	+

Abbreviation: NA, non-analysed.

Figure 1 Admission workflow of emergency pregnant patients during the epidemic of COVID-19 pneumonia in our hospital.

Abbreviations: COVID-19, novel coronavirus disease; RT-PCR, Reverse Transcription-Polymerase Chain Reaction; CT, Computed Tomography; ICU, intensive care unit; PPE, personal protective equipment; NICU, neonatal intensive care unit.

Figure 2 The possible mechanism of vertical transmission of SARS-CoV-2 in pregnant women.

Notes: In infection process, SARS-CoV-2 combines with angiotensin-converting enzyme 2 (ACE2) through sharp S protein on the surface of the virus. Afterwards, transmembrane protease serine 2 (TMPRSS2) helps the S protein of SARS-CoV-2 to enter the cell and cause infection.

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