About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024
Logout
Obstetrics and Gynegology2020№12
Pregnancy course, obstetric and therapeutic...

Pregnancy course, obstetric and therapeutic tactics for novel coronavirus infection (COVID­-19) in pregnant women

DOI
https://dx.doi.org/10.18565/aig.2020.12.6-13

Artymuk N.V., Belokrinitskaya T.E., Filippov O.S., Marochko K.V.

1) Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo, Russia; 2) Chita State Medical Academy, Ministry of Health of Russia, Chita, Russia; 3) A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
The novel coronavirus infection (NCI) (COVID-19) pandemic has posed real social, political and health challenges to the entire world. Many aspects of the management and course of this infection are controversial. The physiological characteristics of a pregnant woman's body place her, on the one hand, at risk for a more severe course of NCI, which has been confirmed in some studies. However, other authors point out that COVID-19 in pregnant women occurs in the same fashion or even more easily than in the general population. There are limited data on the prevalence of NCI among pregnant women in the Russian Federation. There are reports of both maternal and neonatal NCI-related deaths worldwide. There is a limited range of drugs used to treat NCI in pregnant women. Etiotropic therapy with a combination of lopinavir and ritonavir can be performed. Some publications have shown the efficacy and safety of hydroxychloroquine in patients with severe NCI. A prevailing number of recommendations indicate that vaginal delivery is preferable for pregnant women with NCI; however, most of them deliver an infant via cesarean section. Spousal presence during childbirth and the possibility of breastfeeding remain controversial: from ban (before having a negative COVID-19 test) to measures to support the women. There are no convincing data on the possibility of COVID-19 vertical transmission, but this issue and the rehabilitation of pregnant women who have experienced NCI (COVID-19) require further investigations.
Conclusion. Pregnancy and childbirth do not worsen the course of NCI (COVID-19). However, there are risks for some pregnancy complications, as well as neonatal ones, during both pregnancy and the long periods after the experienced NCI (COVID-19), especially its severe types. There are no convincing data on the possibility of COVID-19 vertical transmission, but this issue and the rehabilitation of pregnant women who have experienced NCI (COVID-19) require further investigations.

Keywords

COVID-19
coronavirus infection
pregnancy
Full text (in Russian)

References

  1. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J. et al. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020; 382(8): 727-33. https://dx.doi.org/10.1056/NEJMoa2001017.
  2. Royal College of Obstetricians and Gynecologists. Restoration and recovery: priorities for Obstetrics and Gynaecology. A prioritisation framework for care in response to COVID-19. Version 2: Published Friday 26 June 2020. 32 p.
  3. Chen H., Guo J., Wang C., Luo F., Yu X., Zhang W. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226): 809-15. https://dx.doi.org/10.1016/S0140-6736(20)30360-3.
  4. Mahase E. Covid-19: most patients require mechanical ventilation in first 24 hours of critical care. BMJ. 2020; 368: m1201. https://dx.doi.org/10.1136/bmj.m1201.
  5. Tan E.K., Tan E.L. Alterations in physiology and anatomy during pregnancy. Best Pract. Res. Clin. Obstet. Gynaecol. 2013; 27(6): 791-802. https://dx.doi.org/10.1016/j.bpobgyn.2013.08.001.
  6. Ghi T., di Pasquo E., Mekinian A., Calza L., Frusca T. Sars-CoV-2 in pregnancy: why is it better than expected? Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 252: 476-8. https://dx.doi.org/10.1016/j.ejogrb.2020.07.025.
  7. Dashraath P., Wong J.L.J., Lim M.X.K., Lim L.M., Li S., Biswas A. et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am. J. Obstet. Gynecol. 2020; 222(6): 521-31. https://dx.doi.org/10.1016/j.ajog.2020.03.021.
  8. Yudin M.H. Risk management of seasonal influenza during pregnancy: current perspectives. Int. J. Womens Health. 2014; 6: 681-9. https://dx.doi.org/ 10.2147/IJWH.S47235.
  9. Breslin N., Baptiste C., Gyamfi-Bannerman C., Miller R., Martinez R., Bernstein K. et al. Coronavirus disease 19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am. J. Obstet. Gynecol. MFM. 2020; 2(2): 100118. https://dx.doi.org/10.1016/j.ajogmf.2020.100118.
  10. Liu D., Li L., Wu X., Zheng D., Wang J., Yang L. et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. AJR. Am. J. Roentgenol. 2020; 215(1): 127-32. https://dx.doi.org/10.2214/AJR.20.23072.
  11. Collin J., Byström E., Carnahan A., Ahrne M. Public Health Agency of Sweden’s brief report: pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden. Acta Obstet. Gynecol. Scand. 2020; 99(7): 819-22. https://dx.doi.org/10.1111/aogs.13901.
  12. Pierce-Williams R.A.M., Burd J., Felder L., Khoury R., Bernstein P.S., Avila K. et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am. J. Obstet. Gynecol. MFM. 2020; 2(3): 100134. https://dx.doi.org/10.1016/j.ajogmf.2020.100134.
  13. Артымук Н.В., Белокриницкая Т.Е., Филиппов О.С., Шифман Е.М. Новая коронавирусная инфекция COVID-19 у беременных Сибири и Дальнего Востока. Вестник интенсивной терапии им. А.И. Салтанова. 2020; 2: 41-8. [Artymuk N.V., Belokrinitskaya T.E., Filippov O.S., Shifman E.M. COVID-19 in pregnant women of Siberia and the Far East. Bulletin of intensive care named after A.I. Saltanov. 2020; 2: 41-8. (in Russian)].
  14. Белокриницкая Т.Е., Артымук Н.В., Филиппов О.С., Шифман Е.М. Особенности течения COVID-19 у беременных Дальнего Востока и Сибири. Проблемы репродукции. 2020; 26(3): 85-91. [Belokrinitskaya T.E., Artymuk N.V., Filippov O.S., Shifman E.M. Characteristics of the COVID-19 in pregnant women of the Far East and Siberia. Problems of reproduction. 2020; 26(3): 85-91. (in Russian)].
  15. Временные методические рекомендации «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-2019)». Версия 7 (утвержденная Министерством здравоохранения РФ 03 июня 2020). 165с. [Temporary guidelines for the prevention, diagnosis and treatment of new coronavirus infection 2019-nCoV. Ministry of Health of Russia. Version 7 from 03.06.2020. 165 p. (in Russian)].
  16. Артымук Н.В., Белокриницкая Т.Е. Дискуссионные вопросы рекомендаций по ведению беременных с COVID-19. Женское здоровье и репродукция. 2020; 2(45). [Artymuk N.V., Belokrinitskaya T.E. Discussion questions of recommendations for managing pregnant women with COVID-19. Women's health and reproduction: online publication. 2020; 2(45). (in Russian)] URL: https://journal.gynecology.school/statyi/diskussionnye-voprosy-rekomendacij-po-vedeniju-beremennyh-s-covid-19/(дата обращения: 15.08.2020).
  17. Yang Z., Wang M., Zhu Z., Liu Y. Coronavirus disease 2019 (COVID-19) and pregnancy: a systematic review. J. Matern. Fetal Neonatal Med. 2020; April 30: 1-4. https://dx.doi.org/10.1080/14767058.2020.1759541.
  18. Gao Y.J., Ye L., Zhang J.S., Yin Y.X., Liu M., Yu H.B. et al. Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis. BMC Infect. Dis. 2020; 20(1): 564. https://dx.doi.org/10.1186/s12879-020-05274-2.
  19. Zhang L., Dong L., Ming L., Wei M., Li J., Hu R. et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during late pregnancy: a report of 18 patients from Wuhan, China. BMC Pregnancy Childbirth. 2020; 20(1): 394. https://dx.doi.org/10.1186/s12884-020-03026-3.
  20. Yan J., Guo J., Fan C., Juan J., Yu X., Li J. et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am. J. Obstet. Gynecol. 2020; 223(1): 111. e1-111. e14. https://dx.doi.org/10.1016/j.ajog.2020.04.014.
  21. Juusela A., Nazir M., Gimovsky M. Two cases of coronavirus 2019-related cardiomyopathy in pregnancy. Am. J. Obstet. Gynecol. MFM. 2020; 2(2): 100113. https://dx.doi.org/10.1016/j.ajogmf.2020.100113.
  22. Методические рекомендации «Организация оказания медицинской помощи беременным, роженицам, родильницам и новорожденным при новой коронавирусной инфекции COVID-19». Версия 2 (утвержденная Минздравом РФ от 28.05.20). 56c. [Organization of medical care for pregnant women, women in labor, maternity hospitals, and newborns with the new COVID-19 coronavirus infection. Methodical recommendation. Ministry of Health of Russia. Version 2 from 28.05.20. 56 p. (in Russian)].
  23. Mascio D.D., Khalil A., Saccone G., Rizzo G., Buca D., Liberati M. et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2020; 2(2): 100107. https://dx.doi.org/10.1016/j.ajogmf.2020.100107.
  24. Abourida Y., Rebahi H., Oussayeh I., Chichou H., Fakhir B., Soummani A. et al. Management of severe COVID-19 in pregnancy. Case Rep. Obstet. Gynecol. 2020; 2020: 8852816. https://dx.doi.org/10.1155/2020/8852816.
  25. Baergen R.N., Heller D.S. Placental pathology in COVID-19 positive mothers: preliminary findings. Pediatr. Dev. Pathol. 2020; 23(3): 177-80. https://dx.doi.org/10.1177/1093526620925569.
  26. Chen D., Yang H., Cao Y., Cheng W., Duan T., Fan C. et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int. J. Gynaecol. Obstet. 2020; 149(2): 130-6. https://dx.doi.org/10.1002/ijgo.13146.
  27. Zeng H., Xu C., Fan J., Tang Y., Deng Q., Zhang W. et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020; 323(18): 1848-9. https://dx.doi.org/10.1001/jama.2020.4861.
  28. Poon L.C., Yang H., Dumont S., Lee J.C., Copel J.A., Danneels L. et al. ISUOG Interim Guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium: information for healthcare professionals - an update. Ultrasound Obstet. Gynecol. 2020; 55(6): 848-62. https://dx.doi.org/ 10.1002/uog.22061.
  29. Lamouroux A., Attie-Bitach T., Martinovic J., Leruez-Ville M., Ville Y. Evidence for and against vertical transmission for SARS-CoV-2 (COVID-19). Am. J. Obstet. Gynecol. 2020; 223(1): 91. e1-91. e4. https://dx.doi.org/10.1016/j.ajog.2020.04.039.
  30. Peng Z., Wang J., Mo Y., Duan W., Xiang G., Yi M. et al. Unlikely SARS-CoV-2 vertical transmission from mother to child: a case report. J. Infect. Public Health. 2020; 13(5): 818-20. https://dx.doi.org/10.1016/j.jiph.2020.04.004.
  31. Alzamora M.C., Paredes T., Caceres D., Webb C.M., Valdez L.M., La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am. J. Perinatol. 2020; 37(8): 861-5. https://dx.doi.org/ 10.1055/s-0040-1710050.
  32. Groß R., Conzelmann C., Müller J.A., Stenger S., Steinhart K., Kirchhoff F. et al. Detection of SARS-CoV-2 in human breastmilk. Lancet. 2020; 395(10239): 1757-8. https://dx.doi.org/10.1016/S0140-6736(20)31181-8.
  33. Dong L., Tian J., He S., Zhu C., Wang J., Liu C. et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020; 323(18): 1846-8. https://dx.doi.org/10.1001/jama.2020.4621.
  34. Kotlyar A., Grechukhina O., Chen A., Popkhadze S., Grimshaw A., Tal O. et al. Vertical transmission of COVID-19: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2020 July 30; S0002-9378(20)30823-1. https://dx.doi.org/10.1016/j.ajog.2020.07.049.
  35. Karami P., Naghavi M., Feyzi A., Aghamohammadi M., Novin M.S., Mobaien A. et al. WITHDRAWN: Mortality of a pregnant patient diagnosed with COVID-19: a case report with clinical, radiological, and histopathological findings. Travel Med. Infect. Dis. April 13 2020; 101665. https://dx.doi.org/10.1016/j.tmaid.2020.101665.
  36. Liu Y., Chen H., Tang K., Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J. Infect. March 4 2020. https://dx.doi.org/ 10.1016/j.jinf.2020.02.028.
  37. Juan J., Gil M.M., Rong Z., Zhang Y., Yang H., Poon L.C. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound Obstet. Gynecol. 2020; 56(1): 15-27. https://dx.doi.org/10.1002/uog.22088.
  38. Hantoushzadeh S., Shamshirsaz A.A., Aleyasin A., Seferovic M.D., Aski S.K., Arian S.E. et al. Maternal death due to COVID-19 disease. Am. J. Obstet. Gynecol. 2020; 223(1): 109. e1-109. e16. https://dx.doi.org/10.1016/j.ajog.2020.04.030.
  39. Nayak A.H., Kapote D.S., Fonseca M., Chavan N., Mayekar R., Sarmalkar M. et al. Impact of the coronavirus infection in pregnancy: a preliminary study of 141 patients. J. Obstet. Gynaecol. India. 2020; 70(4): 256-61. https://dx.doi.org/ 10.1007/s13224-020-01335-3.
  40. Liu H., Liu F., Li J., Zhang T., Wang D., Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: focus on pregnant women and children. J. Infect. 2020; 80(5): e7-e13. https://dx.doi.org/10.1016/j.jinf.2020.03.007.
  41. Wang S.S., Zhou X., Lin X.G., Liu Y.Y., Wu J.L., Sharifu L.M. et al. Experience of clinical management for pregnant women and newborns with novel coronavirus pneumonia in Tongji Hospital, China. Curr. Med. Sci. 2020; 40(2): 285-9. https://dx.doi.org/10.1007/s11596-020-2174-4.
  42. Gautret P., Lagier J.C., Parola P., Hoang V.T., Meddeb L., Mailhe M. et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int. J. Antimicrob. Agents. 2020; 56(1): 105949. https://dx.doi.org/10.1016/j.ijantimicag.2020.105949.
  43. Million M., Lagier J.C., Gautret P., Colson P., Fournier P.E., Amrane S. et al. Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: a retrospective analysis of 1061 cases in Marseille, France. Travel Med. Infect. Dis. 2020 May-Juny; 35: 101738. https://dx.doi.org/10.1016/j.tmaid.2020.101738.
  44. Capobianco G., Saderi L., Aliberti S., Mondoni M., Piana A., Dessole F. et al. COVID-19 in pregnant women: a systematic review and meta-analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 252: 543-58. S0301-2115(20)30446-2. https://dx.doi.org/10.1016/j.ejogrb.2020.07.006.
  45. Ashraf M.A., Keshavarz P., Hosseinpour P., Erfani A., Roshanshad A., Pourdast A. et al. Coronavirus disease 2019 (COVID-19): a systematic review of pregnancy and the possibility of vertical transmission. J. Reprod. Infertil. 2020; 21(3): 157-68.
  46. Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection in pregnancy. Information for healthcare professionals. Version 11: Published Friday 24 July 2020. 68p. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-24-coronavirus-covid-19-infection-in-pregnancy.pdf
  47. Salvatore C.M., Han J.Y., Acker K.P., Tiwari P., Jin J., Brandler M. et al. Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. Lancet Child Adolesc. Health. 2020; 4(10): 721-7. https://dx.doi.org/10.1016/S2352-4642(20)30235-2.
  48. Pan American Health Organization. World Health Organization. Rehabilitation considerations during the COVID-19 outbreak. 2020. 22p. Available at: https://www.who.int/docs/default-source/searo/ncd/rehabilitation-considerations-during-the-covid-19-outbreak

Received 24.08.2020

Accepted 02.09.2020

About the Authors

Natalya V. Artymuk, MD, PhD, Professor, Head of the G.A. Ushakova Department of Obstetrics and Gynecology, Kemerovo State Medical University, Ministry of Health
of Russia. Tel.: +7(3842)73-48-56. E-mail: artymuk@gmail.com. ORCID: 0000-0001-7014-6492. 22a Voroshilova str., Kemerovo, 650056, Russian Federation.
Tatiana E. Belokrinitskaya, MD, PhD, Professor, Head of the the Obstetrics and Gynecology Department, Chita State Medical Academy, Ministry of Health of Russia.
Tel.: +7(3022)32-30-58. E-mail: tanbell24@mail.ru. ORCID: 0000-0002-5447-4223. 39a Gorky str., Chita, 672000, Russian Federation.
Oleg S. Filippov, MD, PhD, Professor, Professor of the Department of Obstetrics and Gynecology, Moscow State Medical and Dental University named after A.I. Evdokimov, Ministry of Health of Russia; Deputy Director of the Department of Medical Assistance to Children and Obstetrics Aid of the Ministry of Health of Russia.
Tel.: +7(495)609-67-00. E-mail: filippovolsem@yandex.ru. ORCID: 0000-0003-2654-1334. 3 Rakhmanovsky str., Moscow, 127994, Russian Federation.
Kristina V. Marochko, PhD, assistant of the G.A. Ushakova Department of Obstetrics and Gynecology, Kemerovo State Medical University, Ministry of Health of Russia.
Tel.: +7(3842)73-48-56. E-mail: marochkokv@mail.ru. ORCID: 0000-0003-2832-6638. 22a Voroshilova str., Kemerovo, 650056, Russian Federation.

For citation: Artymuk N.V., Belokrinitskaya T.E., Filippov O.S., Marochko K.V. Pregnancy course, obstetric and therapeutic tactics for novel coronavirus infection (COVID-19) in pregnant women.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 12: 6-13 (in Russian)
https://dx.doi.org/10.18565/aig.2020.12.6-13

Similar Articles

№7 / 2024
Lyushnina D.G., Tetruashvili N.K., Shubina Je., Rogacheva M.S., Zaretskaya N.V., Bolshakova A.S., Barkov I.Yu., Sadelov I.O., Pak V.S., Bokeriya E.L., Trofimov D.Yu.
Chromosomal abnormalities in nonimmune hydrops fetalis: diagnosis and management of pregnancy
№9 / 2024
Chekeneva N.A., Dumanovskaya M.R., Chuprynin V.D., Asaturova A.V., Buralkina N.A.
Comprehensive approach to the management of patients with endometriosis‑associated infertility using the fertility index
№9 / 2024
Tyutyunnik V.L., Mirzabekova D.D., Mikhailova O.I., Kan N.E., Krasnyi A.M.
Correlation of perinatal outcomes in preeclampsia with the dynamics of CD16+ monocyte content in peripheral blood
№10 / 2024
Zalozniaia I.V., Kopteeva E.V., Milyutina Yu.P., Korenevsky A.V., Arutjunyan A.V., Shelaeva E.V., Kapustin R.V., Kogan I.Yu.
The levels of oxidative stress markers in maternal and umbilical cord blood of pregnant women with diabetes mellitus in terms of blood flow redistribution in the fetal venous system
№10 / 2024
Keshchyan L.V., Lyalichkina N.A., Shuginin I.O.
Psychological aspects of obstetric and perinatal pathology
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.