COVID-19 and caesareans

In their recent systematic review of SARS-CoV-2 in pregnancy, Akhtar et al (2020) considered 22 studies, which identified 156 pregnant women with SARS-CoV-2 and 108 neonatal outcomes. The most common maternal/fetal complications included intrauterine/fetal distress (14%) and premature rupture of membranes (8%). Neonatal clinical manifestations of SARS-CoV-2 included shortness of breath (6%), gastrointestinal symptoms (4%), and fever (3%). There was no evidence to support vertical transmission of SARS-CoV-2 infection to the unborn child (Akhtar et al, 2020). Similarly, when Chen et al (2020) investigated nine women who developed SARS-CoV-2 pneumonia in late pregnancy, they failed to find evidence for intrauterine infection caused by vertical transmission.

Significantly, all nine women investigated by Chen et al (2020) had undergone caesareans, so the possibility of vaginal transmission could not be evaluated. Further, Chua et al (2020) cite previous studies of long-established human coronaviruses – first visualised in the 1960s (Almeida and Tyrrell, 1967) while studying common cold agents – demonstrating the possibility of materno-fetal transmission, with human coronavirus detected in both maternal respiratory and vaginal swabs: ‘As such, we should aim to reduce the exposure of newborns to all maternal bodily fluids’ (Chua et al, 2020). And in their retrospective analysis of 42 pregnant women from Northern Italy with confirmed SARS-CoV-2 infection, Ferrazzi et al (2020) suggest that vaginal delivery may be associated with a low risk of intrapartum SARS-CoV-2 transmission to the newborn.