Co ona i us disease 2019 (COVID-19) and human
p egnancy: a scoping e iew
In oduc ion
Co ona i us disease 2019 (COVID-19) is caused by an
RNA i us, se e e acu e espi a o y synd ome co ona i us
2 (SARS-CoV-2), which has gene ic simila i ies wi h o he
co ona i uses such as he ba co ona i us (Ba -CoV), SARS-
CoV-1, and he Middle Eas espi a o y synd ome co ona i us
(MERS-CoV) [1]. The la e wo ha e he abili y o in ec hu-
mans. Cases o SARS-CoV-1 we e ini ially diagnosed be ween
2002 and 2004 and his is cu en ly conside ed an e adica ed
i us, whe eas MERS-CoV-1 was ini ially iden i ied in 2012,
and some cases a e s ill epo ed in Saudi A abia [2]. Nei he o
hese i uses eached pandemic s a us, bu in 2013 he WHO
decla ed MERS-CoV a global h ea [3]. Al hough he new i us
is mo e con agious han he p e ious ones, he a e age mo -
ali y is lowe o SARS-CoV-2 (3-4%) han o SARS-CoV-1
(10%) and MERS-CoV (37%) [4-6]. A he ime o w i ing, we
a e acing a e y apid sp ead and a con inuous inc ease in he
numbe o COVID-19 cases wo ldwide, al hough some coun-
ies, such as China, Sou h Ko ea and Japan, a e con olling
new cases and beginning o li es ic ions. Con a y o his,
o he a eas, such as he USA, Cen al and Sou h Ame ica and
he Ca ibbean, a e jus s a ing o epo inc eases in hei num-
be s o cases. Howe e , he numbe o cases does no seem o
be he mos eliable pa ame e o measu ing he magni ude o
i al sp ead, since up o 86% o ca ie s o he i us a e asymp-
oma ic and we e p obably no epo ed as a clinical p oblem [7].
Fu he mo e, he lack o eliable es s, he low capaci y o each
coun y o pe o m es s, and he a e o alse nega i es due o
low quali y es eagen s, do no allow a p ecise es ima ion o
he e olu ion o he pandemic [8,9].
Gene al aspec s o COVID-19
COVID-19 pneumonia has simila clinical cha ac e is ics
o pneumonia p oduced by bac e ia o o he i uses. The as e
Rica do Sa i ón-Co nudella1, I án E. Al ami ano-Ba cia2,3, Pe e Ched aui2,3, Me cedes Andey o-Ga cía1,
Mau icio C. Tajada-Duaso4, Faus ino R. Pé ez-López5
1 Depa men o Obs e ics and Gynecology, Villalba Gene al Hospi al, Collado Villalba, Mad id 28400, Spain; 2 Ins i u o de In es igación e Inno ación
en Salud In eg al, Facul ad de Ciencias Médicas, Uni e sidad Ca ólica de San iago de Guayaquil, Guayaquil, Ecuado ; 3 Hospi al de la Muje Al edo
G. Paulson, Guayaquil, Ecuado ; 4 Depa men o Obs e ics and Gynecology, Miguel Se e Uni e si y Hospi al, Za agoza 50009, Spain; 5 Ins i u o de
In es igación Sani a ia de A agón and Uni e si y o Za agoza Facul y o Medicine, Za agoza 50009, Spain
ABSTRACT
Co ona i us disease 2019 (COVID-19) is caused by in ec ion wi h a co ona i us (SARS-CoV-2). P egnan women show
mild o mode a e symp oms, wi h 5% p esen ing as se e e pneumonia. The p e alence and e olu ion o COVID-19 in
p egnancy, including he isk o ma e nal dea h, a e simila o wha is obse ed in he gene al popula ion. Radiog aphy,
compu ed omog aphy o ul asound imaging examina ions a e pi o al o he diagnosis and pe o med when he e is
clinical suspicion o COVID-19 pneumonia. Lab indings include lymphocy openia, h ombocy openia, leukopenia, and
ele a ion o D-dime and e i in. To da e, he e is no speci ic ea men o accina ion o COVID-19. Clinical manage-
men o p egnan woman is also simila o ha o he gene al popula ion, wi h p ophylac ic an ibio ic ea men o bac e-
ial pneumonia and oxygen suppo . Th ombop ophylaxis should be indica ed in se e e cases, gi en ha p egnancy is a
hype coagulable s a e ha may be exace ba ed by COVID-19. Hospi al managemen should ocus on ea ing he mo h-
e and p o ec ing he newbo n and he heal hca e pe sonnel. As ega ds COVID-19 and pe ina al ou comes, p ema u e
deli e ies a e mainly associa ed wi h ia ogenic p egnancy e mina ion h ough cesa ean sec ion aimed a conse ing
ma e nal well-being. To da e, e ical ansmission o he e us has no been demons a ed, ei he in au e ine o h ough
he bi h canal. The i us has no been de ec ed in aginal luids, o in b eas milk. B eas eeding may be allowed de-
pending on ma e nal and neona al heal h s a us. Al hough he e a e s ill many open issues, scien i ic in o ma ion ela ed
o p egnancy and COVID-19 is being upda ed con inuously.
KEYWORDS
Co ona i us, COVID-19, p egnancy, SARS-CoV-2, se e e acu e espi a o y synd ome co ona i us 2.
A icle his o y
Recei ed 12 May 2020 – Accep ed 18 May 2020
Con ac
Faus ino R. Pé ez-López; aus ino.pe ez@uniza .es
Depa men o Obs e ics and Gynecology, Uni e si y o Za agoza
Facul y o Medicine, Domingo Mi al s/n, Za agoza 50009; Spain.
Tel: +34 976 761734; Fax: +34 976 76 1735
70 Gynecological and Rep oduc i e Endoc inology and Me abolism 2020; 1(2):70-75Licens e ms
71Gynecological and Rep oduc i e Endoc inology and Me abolism 2020; 1(2):70-75
COVID-19 and Human P egnancy
sp ead o SARS-CoV-2, as compa ed o o he co ona i uses
such as SARS-CoV-1, appea s o be ela ed o he ac ha i is
housands o imes mo e con agious, wi h a basic ep oduc ion
a io o 2.5 [10,11]. In e es ingly, unlike SARS-CoV-1, i no only
mul iplies in he lungs, bu also eplica es ac i ely in he h oa
du ing he i s week when symp oms appea [12].
SARS-CoV-2 has an incuba ion pe iod o 5-6 days [13], a -
e which a ious complain s may occu : anosmia, headache,
myalgia, gas o-in es inal symp oms, cough, e e , dyspnea
and pneumonia being some o he mos impo an [14]. Se e e
disease occu s mo e equen ly in pa ien s wi h associa ed
como bidi ies (obesi y, hype ension, ch onic obs uc i e pul-
mona y disease, diabe es melli us) and highe mo ali y a es
(up o 15%) ha e been obse ed in men aged 80 yea s o o e
[15-17]. Mo ali y a es will also depend on a ailable local heal h
esou ces a a gi en momen , which in u n will depend on he
speed o ac ion ega ding disease p e en ion o con ol [18]. The
clinical pic u e is associa ed wi h a cy okine s o m wi h o e -
p oduc ion o umo nec osis ac o , in e leukin (IL) 6, and IL-
1β. The massi e in lamma o y esponse is associa ed wi h mul-
io gan lesions (hea , li e , kidneys among o he s) ha , a he
same ime, po en ia es he in lamma o y eac ion and impai s
an icoagulan mechanisms. Cases wi h se e e pneumonia show
mic o h ombosis, dissemina ed in a ascula coagula ion, and
mul io gan ailu e wi h aised D-dime concen a ions (a poo
p ognos ic ea u e). Dissemina ed in a ascula coagula ion is
common in non-su i o s [19].
Al hough he mos p e alen gene al COVID-19 symp-
oms include espi a o y di icul y, cough, myalgia, and loss o
appe i e, some mild o mode a e cases may equen ly epo
ol ac o y and gus a o y dys unc ion. A mul ina ional Eu ope-
an s udy analyzed hese symp oms in he gene al popula ion
using ol ac o y and gus a o y ques ionnai es based on he smell
and as e componen o he Ques ionnai e o Ol ac o y Diso -
de s-Nega i e S a emen s [20]. Facial pain and nasal obs uc ion
we e he mos equen disease- ela ed o o hinola yngological
symp oms. Ol ac o y and gus a o y dys unc ions we e epo -
ed by 85.6% and 88.0% o pa ien s, espec i ely. A signi ican
associa ion was ound be ween he wo diso de s. Ol ac o y
dys unc ion appea ed be o e he o he symp oms in 11.8% o
cases. Among he 18.2% o pa ien s who did no p esen na-
sal obs uc ion o hino hea, 79.7% we e hyposmic o anos-
mic. The ea ly ol ac o y eco e y a e was 44.0%, and sudden
anosmia o ageusia may be sugges i e o COVID-19. Howe -
e , he e is no in o ma ion abou hese symp oms in p egnan
women.
Cu aneous mani es a ions o COVID-19 ha e also been e-
po ed [21]. Vesicula e up ions appea ea ly in he disease, in
some cases e en de eloping be o e o he symp oms. O he pa -
e ns appea la e in he disease e olu ion, such as ac al a eas o
e y hema-edema, usually asymme ical, wi h some esicles o
pus ules wi h small ed o pu ple spo s caused by bleeding un-
de he skin. O he lesions include small mac opapules, some-
imes a ound hai ollicles o simila o pi y iasis osea. I ching
was e y common o u ica i o m (92%) and o maculopapu-
la (57%) lesions [21].
SARS-CoV-2 du ing p egnancy
The espi a o y sys em is mo e ulne able in p egnan
women han in he gene al popula ion [22]. Like he es o he
popula ion, p egnan women can become in ec ed wi h bo h
SARS-CoV-1 and 2, and wi h MERS-CoV [23-24]. Howe e ,
no inc eased suscep ibili y o co ona i us in ec ion has been
demons a ed du ing p egnancy [25] and he clinical e olu ion
is simila o ha seen in non-p egnan women o simila age
[26]. Du ing p egnancy, ma e nal dominan T-helpe 2 (Th2) p o-
ec s he e us, whe eas he Th1 esponse (inc ease o in e leu-
kin 1) is associa ed wi h highe mo ali y isk among hose wi h
COVID-19 [27]. Respi a o y ailu e p og esses apidly among
p egnan women wi h in ol emen o he ca dio espi a o y
sys em [22]. Despi e he ac ha da a on hese aspec s a e accu-
mula ing, he e is no speci ic in o ma ion on he eal incidence
o COVID-19 du ing p egnancy.
Clinical cha ac e is ics du ing p egnancy
and pe ina al ou comes
A high a e o ma e nal a ali ies has been desc ibed in p eg-
nan women in ec ed wi h SARS-CoV-1 and MERS-CoV (up
o 25% and 35% espec i ely) [28,29]. This igu e seems o be
much highe han wha is cu en ly desc ibed o SARS-CoV-2.
The clinical cou se o p egnan women wi h COVID-19 has
been epo ed o be gene ally mild o mode a e, e e and
cough being he wo mos equen symp oms [23,30]. Only 5%
o cases we e se e e [31-33]. The e o e, p egnan women do no
seem mo e suscep ible o COVID-19 o mo e likely o de elop
se e e pneumonia [34]. In gene al, he pe ina al p ognosis will
depend on p ema u i y, o en due o ia ogenesis, and on ma e -
nal well-being a he end o he p egnancy.
Qiancheng e al. [26] epo ed a e ospec i e s udy o he
se e i y o COVID-19 in p egnan (n=28) and non-p egnan
(n=54) women o simila ep oduc i e age hospi alized a
he Cen al Hospi al o Wuhan du ing a wo-mon h pe iod in
2020. They de e mined ha he e was no isk o i al e ical
ansmission du ing he hi d imes e o p egnancy including
du ing aginal deli e y. Como bidi ies we e no equen ly
epo ed in ei he o he wo g oups. The majo i y o women
we e classi ied as ha ing mode a e pneumonia: 85.7% o he
p egnan women, and 98% o he non-p egnan ones. Only 2
p egnan women and 1 non-p egnan woman had se e e pneu-
monia. The au ho s acknowledged among he limi a ions o he
s udy ha (i) mo e se e e pa ien s migh ha e been admi ed o
o he hospi als, o he han he s udy cen e , and (ii) he p egnan
women s udied we e in ec ed wi h SARS-CoV-2 in he la e
s age o p egnancy, and he p obabili y o e ical ansmission
du ing he i s hal o p egnancy could no be assessed.
A e ospec i e s udy analyzed he clinical eco ds o p eg-
nan women wi h COVID-19 pneumonia ea ed a 25 hospi als
in China be ween Janua y 20 and Ma ch 24, 2020. Possible
e ical ansmission o he i us was s udied by es ing o
SARS-CoV-2 in amnio ic luid, co d blood, and neona al pha -
yngeal swab samples [35]. All es s we e nega i e and he e we e
no cases o e al dea h. In addi ion, aginal sec e ion samples
we e collec ed om he lowe hi d o he agina upon admis-
sion and we e nega i e.
72
Zaigham and Ande sson [30] pe o med a sys ema ic e iew
o pee - e iewed publica ions bo h in English and Chinese o
summa ize he clinical mani es a ions o 108 p egnancies wi h
COVID-19, as well as ma e nal and pe ina al ou comes. Cases
o SARS-CoV-2 in ec ion we e con i med by a labo a o y es
( epo ed in 18 a icles). Women s a ed o ha e symp oms in he
hi d imes e o ges a ion, e e (68%) and coughing (34%) be-
ing he mos equen . Women p esen ed lymphocy openia (59%)
and ele a ed C- eac i e p o ein (CRP) (70%). Deli e y by ce-
sa ean sec ion was pe o med in 91% o g a idas. Th ee ma e -
nal in ensi e ca e uni admissions we e no ed bu he e we e no
ma e nal dea hs. One neona al dea h and one in au e ine dea h
we e epo ed. The au ho s concluded ha al hough he majo i y
o mo he s we e discha ged wi hou majo complica ions, se e e
ma e nal mo bidi y and pe ina al dea hs as a esul o COVID-19
we e also epo ed. Ve ical ansmission o COVID-19 could no
be uled ou . Ca e ul moni o ing o p egnancies wi h COVID-19
and measu es o p e en neona al in ec ion a e equi ed.
Di Mascio e al. [23] pe o med ano he sys ema ic e iew
o p egnancy and pe ina al ou comes o 79 co ona i us spec-
um in ec ions, pa icula ly SARS-COV-2. Pneumonia was
diagnosed in 91.8% o cases, he mos common symp oms be-
ing e e (82.6%), cough (57.1%) and dyspnea (27.0%). Fo
all co ona i us in ec ions, he a e o misca iage was 39.1%;
he a e o p e e m bi h < 37 weeks was 24.3%), while p e-
ma u e p elabo up u e o memb anes was epo ed in 20.7%,
p eeclampsia in 16.2%, and e al g ow h es ic ion in 11.7%.
Deli e y was by cesa ean sec ion in 84% o women; pe ina al
dea h occu ed in 11.1%, and 57.2% o newbo ns we e admi -
ed o he neona al in ensi e ca e uni (NICU). When ocusing
on COVID-19 in ec ions, he mos common ad e se p egnancy
ou come was p e e m bi h < 37 weeks, occu ing in 41.1%
(95% CI 25.6-57.6) o cases, while he a e o pe ina al dea h
was 7.0% (95% CI 1.4-16.3). None o he 41 assessed new-
bo ns showed clinical signs o e ical ansmission.
Elsha eey e al. [36] epo ed a sys ema ic e iew and me-
a-analysis o COVID-19 du ing p egnancy and childbi h. They
summa ized he clinical p esen a ion and obs e ic ou comes o
33 s udies including da a om 385 cases o which 14 (3.6%)
we e se e e and 3 (0.8%) we e c i ical. These 17 women we e
admi ed o he in ensi e ca e uni ; 6 o he 17 we e mechani-
cally en ila ed and one case died. A o al o 252 women ga e
bi h, 175 (69.4%) by cesa ean sec ion and 77 (30.6%) h ough
aginal deli e y. Ou comes o 256 newbo ns included ou e-
e se- ansc ip ion polyme ase-chain- eac ion (PCR) posi i e
cases, wo s illbi hs, and one neona al dea h. The au ho s con-
cluded ha he clinical cha ac e is ics and se e i y o he disease
we e simila o wha is obse ed in non-p egnan women o men.
In addi ion, he e iew o 256 newbo ns showed ha 8 we e ad-
mi ed o he NICU (3.1%), 3 needed neona al mechanical en-
ila ion (1.2%), 12 had espi a o y dis ess synd ome (4.7%), 3
had pneumonia (1.2%), and 3 dissemina ed in a ascula coagu-
la ion (1.2%). Mo ali y occu ed in 3 cases and he e we e wo
s illbi hs in ol ing wo c i ical women (one case o ma e nal
mo ali y and one woman on ex aco po eal memb ane oxygen-
a ion). In addi ion, he e was one ea ly neona al dea h, which
occu ed due o complica ions o p ema u i y ollowing cesa ean
deli e y a 34 weeks a e an epa um hemo hage.
Respi a o y assessmen
Ches adiog aphy, compu ed omog aphy (CT) and/o ches
ul asound o pa ien s wi h COVID-19 pneumonia a e e y
impo an o ea ly diagnosis and ollow-up. Radiog aphic im-
ages o hese pa ien s show inc eased opaci ies wi h bila e al
lowe lobe p edominan dis ibu ion, whe eas lung ul asound
shows hickened pleu al lines and pa chy consolida ions, and
CT shows consolida ions [14,37-39]. These indings we e consis -
en wi h he expe ience epo ed by Peng e al. [40] and Poggiali
e al. [41], con i ming he impo an ole o lung ul asound in
he managemen o pa ien s wi h SARS-CoV-2, gi en ha i al-
lows apid diagnosis and moni o ing o COVID-19 pneumonia
and i s e olu ion owa d acu e espi a o y dis ess synd ome
(ARDS) in c i ically ill pa ien s. Ul asound ches exam may be
p e e ed in p egnan women. As men ioned abo e, his shows
hickened pleu al lines and pa chy consolida ions. These ypes
o image ha e epea edly been epo ed by adiologis s as a
undamen al pa o he ea ly diagnosis and moni o ing o he
e ec s o ea men in COVID-19 pneumonia [37,38].
Labo a o y indings and diagnos ic es du ing
p egnancy
Labo a o y es indings include lymphocy openia, h ombocy-
openia, leukopenia, and ele a ion o D-dime and e i in [14].
Lymphocy openia (59%) and ele a ion o CRP (70%) a e among
he mos equen labo a o y abno mali ies obse ed in g a idas
[30]. In p egnancy, D-dime canno be conside ed a ma ke o se-
e i y due o i s physiological ele a ion du ing ges a ion [42].
Xu e al. [17] epo ed e ospec i e esul s o i e p egnan
women a > 34 weeks’ ges a ion wi h a posi i e PCR es o
SARS-CoV-2. These women displayed lymphopenia (<1.1 ×
109/L) and eosinopenia (<0.02 × 109/L) a he onse o e e .
The iming o eosinopenia la gely ma ched ha o lymphope-
nia. Lymphopenia and eosinopenia pe sis ed un il he pa ien s’
illness clinically and adiog aphically imp o ed a e an i i al/
an ibac e ial ea men . In con as , leukopenia was obse ed in
only one pa ien , while all he women had anemia, dec eased
albumin, and inc eased CRP and D-dime le els.
Diagnos ic es s pe o med o SARS-CoV-2, an ibodies
and/o PCR, whe he an epa um, in apa um o pos pa um,
will depend on he possibili ies o each cen e o heal hca e sys-
em. Howe e , gi en he possibili y o alse nega i es i is im-
po an also o ake in o accoun he symp oms o he pa ien [43].
This app oach would allow us o classi y hem as con i med,
possible, imp obable, o unin ec ed, and ac acco dingly.
Based on da a om se e al publica ions, Se hu aman e al. [44]
ha e desc ibed how o in e p e diagnos ic es s used o SARS-
CoV-2 and sugges mo e es o be done. Despi e his, hey
speci y ha he epo ed ime in e als should be conside ed
app oxima ions and may in ac a y o e ime. Thus, hei sug-
ges ion is only applicable i pa ien s a e p oac i ely ollowed
since he ime o exposu e, which is no easy in clinical p ac-
ice, and expensi e when aking in o accoun all he echniques
equi ed and all he se ings in ol ed. The mos commonly
used and eliable es o diagnosis o COVID-19 has been he
e e se- ansc ip ion polyme ase PCR es , pe o med om na-
sopha yngeal swabs o o he uppe espi a o y ac specimens,
including h oa swabs o , mo e ecen ly, sali a samples. The
Pe ez-Lopez FR e al
Gynecological and Rep oduc i e Endoc inology and Me abolism 2020; 1(2):70-75
73
COVID-19 and Human P egnancy
Gynecological and Rep oduc i e Endoc inology and Me abolism 2020; 1(2):70-75
i us can be de ec ed a day 1 o symp oms and peaks wi hin
he i s week o symp om onse ; he posi i i y declines by 3
weeks and om hen on i becomes unde ec able. A “posi i e”
PCR esul e lec s only he de ec ion o i al RNA and does
no necessa ily indica e he p esence o iable i us.
Managemen o COVID-19 and p egnancy
The ini ial managemen o COVID-19 p egnan cases was no
associa ed wi h se e e ma e nal mo bidi y o mo ali y. Howe -
e , mo e ecen epo s sugges ha a subse o p egnan wom-
en may su e o gan ailu e o e en die. P egnan women ha e
a s a e o inc eased h ombin and p o h ombin sec e ion ha
enhances he h ombosis isk when hey a e a ec ed by COV-
ID-19. Hospi al managemen should be ocused on ea ing he
mo he and p o ec ing he newbo n and heal h pe sonnel. In gen-
e al, managemen is also ex apola ed om ha used o he gen-
e al popula ion, and consis s o moni o ing i al signs, oxygen
he apy, moni o ing e al well-being and p ophylac ic an ibio ic
use o bac e ial pneumonia. Some cen e s ha e used an i i al
he apies (i.e. lopina i , i ona i and hyd oxychlo oquine) bu ,
o da e, he e is no clea e idence o hei e ec i eness.
A p ophylac ic dose o a low molecula weigh hepa in
(LMWH) is ecommended o hospi alized pa ien s wi h COV-
ID-19 o p e en enous h omboembolism, and a ea men
dose o LMWH is con empla ed o hose wi h signi ican ly
aised D-dime concen a ions due o conce ns o h ombin in
he pulmona y ci cula ion; LMWH also has an i-in lamma o y
p ope ies ha migh be bene icial in COVID-19 pa ien s. The
In e na ional Socie y o Th ombosis and Hemos asis has gen-
e a ed a simple algo i hm o he managemen o COVID-19
coagulopa hy [45]. The use o LMWH has been ecommended
in all such pa ien s [46]. This body o e idence should be con-
side ed by obs e icians ca ing o p egnan women a ec ed by
COVID-19. A coagula ion p o ile o de ec he p esence o sub-
clinical dissemina ed in a ascula coagula ion and he use o
LMWH o he p e en ion o h omboembolic diso de s should
be conside ed and discussed be ween clinicians and pa ien s [46].
Misca iage and p e e m bi h isk
Al hough misca iage and second imes e losses ha e
been desc ibed in SARS-CoV-1 and MERS-CoV in ec ed
p egnancy [28,47], no di ec associa ion could be demons a ed
[48]. To da e, he ela ionship wi h SARS-CoV-2 has no been
demons a ed ei he [32], al hough he i s case o pe ina al
mo ali y in a p ema u e newbo n has al eady been desc ibed
[30]. A ecen sys ema ic e iew by Di Mascio e al. [23] epo ed
ha co ona i us in ec ed p egnan women (including SARS-
CoV-1, SARS-CoV-2 and MERS-CoV) p esen misca iages,
p ema u i y, p obably due o ia ogenesis, and pe ina al dea h
among he > 90% who also had pneumonia. As ega ds he e-
la ionship be ween SARS-CoV-2 and p e e m bi h, his e en
has been mainly associa ed wi h ia ogenesis, being due o he
e mina ion o p egnancy o main ain ma e nal well-being [23,49].
The isk o e al hypoxia is p obably seconda y o ma e nal hy-
poxia due o COVID-19 pneumonia, a he han o di ec i al
in ol emen which has no been demons a ed.
New in o ma ion has come om a single p egnan woman
wi h symp oma ic COVID-19 associa ed wi h se e e p eec-
lampsia and placen al ab up ion, in whom i al p esence was
demons a ed by molecula and immunohis ochemical assay
and elec on mic oscopy [50]. SARS-CoV-2 was localized in he
ma e nal in e phase o syncy io ophoblas ic cells, sugges ing
ha in some g a idas he i us can a ec he placen a.
Deli e y
Du ing he pandemic, i is impo an pe o m a PCR sc een-
ing a deli e y in o de o know who is i ally ac i e o he
SARS-CoV-2. This is necessa y o imp o e he clinical ca e
o p egnan women and newbo ns, and o p o ec heal hca e
pe sonnel, who mus also be equipped wi h pe sonal p o ec i e
equipmen (PPE). I sc eening is no possible, he decision o
ake hese p o ec i e measu es would ha e o be based on he
p esence o symp oms compa ible wi h he disease. Cau ion
should also be exe cised wi h asymp oma ic cases who had
symp oms in he pas wo weeks, who ecen ly had a isky con-
ac , o who a e unde i al sc eening. A he ime o deli e y,
p egnan women wi h COVID-19 may ha e e iden clinical
symp oms o he espi a o y synd ome and PPE mus be wo n
o assis hem. Howe e , he e a e also cases wi hou clinical
symp oms o signs o he disease who may subsequen ly be
diagnosed wi h COVID-19. Managing e e y ype o pa ien as
a high- isk case may gene a e huge heal hca e cos s.
Vin zileos e al. [51] sc eened, o COVID-19 immune s a-
us, 161 p egnan women admi ed o he labo and deli e y
a ea. They ound ha 19.9% we e COVID-19 posi i e (32/161
pa ien s). O hese, 34% (n=11) we e asymp oma ic and 66%
(n=21) we e symp oma ic. The au ho s epo ed se e al ind-
ings ela ed o ou ine COVID-19 es ing: (i) ou ine es ing
would ha e shown he need o PPE use in an addi ional 21
(asymp oma ic) pa ien s; (ii) he e we e 5 pa ien s wi h clinical
symp oms who had a nega i e es ; (iii) es ing would inc ease
by 10% he iden i ica ion o in ec ed g a idas (16/161); and
(i ) all 32 COVID-19-posi i e mo he s had nega i e COV-
ID-19 es ed neona es. Ma e nal es ing du ing labo makes i
possible o iden i y g a idas needing o be ca ed o using PPE,
and o be e alloca e clinical esou ces such as ches imaging,
oxygen use, and ans e s o nega i e-p essu e ooms. In addi-
ion, es ing may o e come he p oblem o mo he s ending o
“downplay”/deny hei symp oms in o de no o be sepa a ed
om hei newbo ns. This ype o s udy should be con i med in
di e en clinical scena ios and coun ies.
All heal hca e pe sonnel a ending women in ac i e labo
should wea ull PPE. Ashokka e al. [45] ha e gi en some gen-
e al/s anda d ecommenda ions abou ma e nal ca e du ing de-
li e y o educe he isk o in ec ion. Due o he possibili y o
i al dissemina ion du ing in ense exhaling ela ed o he pain
o ac i e labo , ea ly epidu al analgesia o pain con ol should
be conside ed. Ad anced en ila o y and ci cula o y suppo ,
in an in ensi e ca e uni , should be p o ided, by specialis s, o
cases p esen ing wi h se e e complica ions such as pneumonia,
ARDS, and mul i-o gan dys unc ion synd ome..
Up o 93% o desc ibed COVID-19 p egnancy cases ha e
74
been deli e ed by cesa ean sec ion, he majo i y due o he e -
ec s o COVID-19 du ing ges a ion and he isk o impai ed
e al well-being [30,52]. In o he cases cesa ean sec ion has been
indica ed o main enance o ma e nal well-being, which can
lead o ia ogenic p ema u i y [23,24,49]. In some elec i e cases i s
jus i ica ion should be ques ioned [53].
Pue pe ium and e ical ansmission
The i s se ies o p egnan SARS-CoV-2 cases ailed o
demons a e e ical ansmission o he e us, ei he in au e -
ine o h ough he bi h canal. Fu he mo e, he i us has no
been de ec ed in aginal luid o in ma e nal milk [24,54-58], al-
hough i appea s o ha e been de ec ed in s ool [9].
Six newbo ns wi h ele a ed IgG an ibodies in he blood and
some cases wi h ele a ed IgM ha e been desc ibed, al hough
none o hese cases yielded a posi i e PCR es [59,60]. The e is a
need o mo e co ela ional s udies. The e is one case in which
SARS-CoV-2 was diagnosed by PCR in a newbo n a 36 hou s
o li e, bu he au ho s hemsel es indica ed ha al hough his
could be a case o e ical ansmission, con i ma ion was no
possible and his possibili y s ill needs o be con i med [61].
Rod igues e al. [62] ca ied ou a sys ema ic e iew o 30 o ig-
inal s udies wi hou language es ic ion, and i espec i e o
s udy quali y. These s udies epo ed 182 deli e ies esul ing
in one s illbi h and 185 li e bi hs. In all cases amnio ic luid,
placen a and/o co d blood we e analyzed and ound o be neg-
a i e o COVID-19. In addi ion, b eas milk samples om 13
mo he s showed no e idence o p esence o he i us.
B eas eeding may be allowed depending on ma e nal and
neona al heal h s a us, and i s p ohibi ion should be decided
on an indi idual case basis, a e discussion wi h a physician
(in ec ious disease specialis ) and neona ologis [63].
Fu u e di ec ions
COVID-19 has changed he way medical p ac ice should
be add essed in he nea u u e. The e is no speci ic ea men
o COVID-19 and cu en managemen is ocused on main-
aining en ila o y and ca dio ascula unc ions and p e en ing
h omboembolism. Fo he momen , he e is no clea e idence
o any speci ic co ona i us an i i al he apy. Fu u e p og ess
may be ela ed o he de elopmen o a speci ic accine o p e-
en he in ec ion.
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Funding in o ma ion: his e iew was pa ially suppo ed by he Sis ema de
In es igación y Desa ollo and he Vice-Rec o ado de In es igación & Pos g ado
o he Uni e sidad Ca ólica de San iago de Guayaquil, Guayaquil, Ecuado .
Con lic o In e es : None
ORCID Iden i ica ions
RSC, h ps://o cid.o g/0000-0001-9585-0187
IAB, h ps://o cid.o g/0000-0001-6381-5758
PC, h ps://o cid.o g/0000-0002-1556-3979
MAG, h ps://o cid.o g/0000-0003-3500-8822
MCTD, h ps://o cid.o g/0000-0003-4720-8231
FRPL, h ps://o cid.o g/0000-0002-2801-416X