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Review
. 2021 Aug:263:106-116.
doi: 10.1016/j.ejogrb.2021.06.001. Epub 2021 Jun 15.

Severe acute respiratory syndrome (SARS) coronavirus-2 infection (COVID-19) in pregnancy - An overview

Wafaa Ali Belail Hammad  1 , Mariam Al Beloushi  2 , Badreleden Ahmed  3 , Justin C Konje  4
Affiliations
Review

Severe acute respiratory syndrome (SARS) coronavirus-2 infection (COVID-19) in pregnancy - An overview

Wafaa Ali Belail Hammad et al. Eur J Obstet Gynecol Reprod Biol. 2021 Aug.

Abstract

The novel severe acute respiratory syndrome (SARS) coronavirus-2 which causes COVID-19 disease results in severe morbidity and mortality especially in vulnerable groups. Pregnancy by virtue of its physiological and anatomical adaptations increases the risk of severe infections especially those of the respiratory tract. This single stranded RNA virus is transmitted by droplets as well as soiled fomites. There are various degrees of disease severity- asymptomatic, mild, moderate severe and critical. Most infections in pregnancy are asymptomatic or mildly symptomatic. For these women, the consequences on the mother or pregnancy are minimal unless they have additional risk factors such as diabetes, hypertension, cardiorespiratory disease, obesity or are of ethnic minority background. Most women with symptoms will present with fever, unproductive cough, sore throat, myalgia, nasal congestion, loss of smell and taste with associated leukocytosis and lymphopenia. Diagnosis is by RT-PCR on nasopharyngeal flocked swabs or saliva and pathognomonic features of ground-glass appearance and pulmonary infiltrates on chest X-ray or CT scans. Management in pregnancy is same as that for non-pregnant women with COVID-19. It is not an indication for elective delivery but assisted delivery in the second stage for those with moderate, severe or critical disease may be required to shorten this stage. COVID-19 is not an indication for interrupting pregnancy or caesarean section but the latter may be performed to facilitate ventilation support or resuscitation in those with severe disease. Pain relief in labour should not be different but regional analgesia is preferred for operative deliveries. Postpartum thromboprophylaxis should be considered and breast feeding encouraged with appropriate precautions to minimize vertical transmission. Pregnant and lactating women should be encouraged to receive the mRNA based vaccines as there is no evidence of adverse outcomes with these.

Keywords: COVID-190; Coronavirus; Pregnancy; SARS-2; Vaccination; Vertical transmission.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Illustration of the structure of SARS2-CoV-2 (proteins and RNA) (Downloaded on-line from Shutterstock)
Fig. 2
Fig. 2
Suggested algorithm for antenatal care of women with COVID-19. *Consider serial growth scans from about 2 weeks after acute illness.
Fig. 3
Fig. 3
Suggested Algorithm for intrapartum care of women with COVID-19.
See this image and copyright information in PMC

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