Updates on obstetric complications:
Title: Placental Pathology in COVID-19
Publisher: American Journal of Clinical Pathology
Publication Date: May 22, 2020
Key Takeaway: Sixteen placentas from patients with severe acute respiratory syndrome from COVID-19 were examined (15 with live birth in the third trimester, 1 delivered in the second trimester after intrauterine fetal demise). Relative to controls, COVID-19 placentas show increased prevalence of decidual arteriopathy and other features of MVM, a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders & preeclampsia. Changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.
Title: Clinical Implications of Universal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Testing in Pregnancy
Publisher: Obstetrics & Gynecology
Publication Date: May 19, 2020
Key Takeaway: Pregnant women with SARS-CoV-2 infection on admission do not seem to be reliably identified using symptom screening alone. Observed SARS-CoV-2 infection prevalence identified with universal screening (3.6%, 95% CI 2.3–5.4%) is sixfold higher than prevalence rates based on reported rates for our county (0.6%) during this period.
Title: Interim Guidance on Breastfeeding and Breast Milk Feeds in the Context of COVID-19, CDC
Publication Date: April 28, 2020
Key Takeaway: No definitive data if COVID is spread through breast milk
Title: Obstetric Anesthesia During the COVID-19 Pandemic
Publisher: Anesthesia & Analgesia
Publication Date: April 6, 2020
Key Takeaway: Anesthetic recommendations for COVID patients on L&D.
Title: Outpatient Assessment and Management for Pregnant Women with Suspected or
Confirmed Novel Coronavirus (COVID-19)
Publisher: Society for Maternal-Fetal Medicine
Publication: April 22, 2020
The Society for Maternal-Fetal Medicine (SMFM) and the American College of Obstetricians and Gynecologists (ACOG) have developed an algorithm for assessment and management of pregnant women with COVID-19 (available in English and Spanish).
Title: Clinical Characteristics of Pregnant Women with COVID-19 in Wuhan China,
NEJM, April 17, 2020
Publisher: New England Journal of Medicine
Publication: April 17, 2020
● On this review of pregnant women treated for COVID-19 in December 2019-March 2020 in Wuhan, the risk of severe disease appeared to be similar to that in the general population. Nine of 118 patients had severe disease and only one required ventilation.
Title: Universal Screening for SARS-CoV-2 in Women Admitted for Delivery
Publication: New England Journal of Medicine, April 13, 2020
Key Takeaway: This letter reports the experience of 215 pregnant women who delivered infants at the New York–Presbyterian Allen Hospital and Columbia University Irving Medical Center. 87.9% of SARS-CoV2 positive women were asymptomatic at presentation. Four women (1.9%) had fever or other symptoms of Covid-19 on admission, and all 4 women tested positive for SARS-CoV-2 (Figure 1). Of the 211 women without symptoms, all were afebrile on admission. Nasopharyngeal swabs were obtained from 210 of the 211 women (99.5%) who did not have symptoms of Covid-19; of these women, 29 (13.7%) were positive for SARS-CoV-2. Thus, 29 of the 33 patients who were positive for SARS-CoV-2 at admission (87.9%) had no symptoms of Covid-19 at presentation.
Title: Joint Statement: Recent Developments Regarding COVID-19 and Pregnant Women
Publication: American College of Obstetricians and Gynecologists, April 6, 2020
Key Takeaway: ACOG and SMFM statement regarding CDC’s removal of pregnant women from the list of those at higher risk of COVID-19 severe illness; recommend precautions to minimize exposure.
Title: Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings
Key Takeaway: This is an April 4, 2020 update of CDC Guidance related to:
PRIORITY (Pregnancy Coronavirus Outcomes Registry)
WHO-China Joint Mission on COVID-19 Report
Coronavirus (COVID-19) Infection in Pregnancy
COVID-19 in Pregnancy: Early Lessons
Labor and Delivery