Asian Research Journal of Gynaecology and Obstetrics

Background: Pregnancy is a vulnerable period needing more care and attention regarding both the mother and her fetus. Pregnant women are particularly vulnerable to respiratory pathogens and acute pneumonia since they are at an immunosuppressive state because of the physiological changes during pregnancy. The aim of this systematic review was to report the impact of corona virus on the mode of delivery, and the treatment for coronavirus given during pregnancy and its effect on fetal well-being.

Methods: A systematic literature search included COVID-19 severity treatment that can be administered, successful termination and route of termination. Data regarding fetal distress, neonatal death, preterm and stillbirths, and first- and fifth-minute Apgar scores, were also collected for newborn babies. A SARS-CoV-2 positive pregnant woman (mostly in the third trimester) was defined as a patient suffering from COVID-19 pneumonia with a positive lab test of either oropharyngeal swab specimen or polymerase chain reaction.

Findings: Firstly, we note that the rate of delivery by cesarean section is more higher than the rate of vaginal delivery, 95 vaginal deliveries correspond to 34% compared with 159 cesarean deliveries (58%). Regarding the indications for the cesarean section, we have obstetric indications which represent 35.8% including preeclampsia, fetal asphyxia. On the other hand, COVID symptoms indication represents the majority of cesarean indications 64.1% (102 cases). No patients with a vaginal delivery developed severe adverse outcomes, unlike cesarean delivery, there are patients who have developed severe symptoms requiring hospitalization in an intensive care unit reported in the majority of studies. Twelve newborns (12.6%) delivered vaginally and 21 (13.2%) born by cesarean delivery were admitted to the NICU. After adjustment for confounding factors, cesarean birth was not significantly associated with an increased risk of NICU admission.

Interpretation: The choice of delivery mode is based on obstetric indications and COVID symptoms. It is not clear which mode is safer, is vaginal delivery or cesarean delivery. Concerning the indications of cesarean delivery, we note that the infection Covid 19 increases the rate of cesarean section and this can be explained by two factors: either a severe Covid 19 infection requiring urgent extraction to prevent worsening of the maternal condition or the onset of fetal asphyxia, either the association between non-severe symptoms linked to the covid 19 infection and a high obstetrical risk linked to the pregnancy itself. For maternal outcomes, no patients with a vaginal delivery developed severe adverse outcomes, while 8.1% of all cesarean deliveries developed severe outcomes and required ICU admission, this result can be explained by the severity of the symptomatology linked to COVID 19 before delivery which may itself responsible for severe adverse outcomes. Regarding neonatal intensive care unit admission and according to our work, there is no significant difference between newborn by vaginal delivery and cesarean delivery, this result is related to the early decision-making for cesarean section if indicated and avoidance of risk of fetal asphyxia. Finally, we can conclude that the delivery route Appropriate in case of stable maternal and fetal status and mild to moderate symptoms of covid and absence of factors that may lead to a possible worsening is the vaginal route. In the opposite case where there is a severe symptomatology or the risk of aggravation is high, the management must be rapid and early delivery eliminate a risk factor of aggravation and save the patient and the newborn so a caesarean section may be indicated in this case. This management must take into account several elements including the age of the pregnancy, maternal and fetal well-being, which has made it difficult to define a very precise course of action.

Plain English Summary: Pregnant women are vulnerable to respiratory pathogens and acute pneumonia since they are at an immunosuppressive state because of the physiological changes during pregnancy. This systematic review aimed to report the impact of the corona virus on the mode of delivery, and the treatment for coronavirus given during pregnancy and its effect on fetal well-being. To meet this objective, five studies were screened for the eligibility criteria. The results from 279 cases reports are summarized together to facilitate interpretation. Of the 279 respondents: 95 vaginal deliveries correspond to34% compared with 159 cesarean deliveries (58%). Concerning the indications of cesarean delivery, we have: obstetrical indications hold 35.8 % of all cesarean indications (57 cases) and preeclampsia, fetal asphyxia represents an important part of these indications. On the other hand, COVID Symptoms indication represent the majority of cesarean indications 64.1% (102 cases). No patients with a vaginal delivery developed severe adverse outcomes, while 8.1% of cesarean delivery patients developed severe symptoms after delivery and required intensive care admission. Twelve newborns (12.6%) delivered vaginally and 21 (13.2%) born by cesarean delivery were admitted to the NICU. After adjustment for confounding factors, cesarean birth was not significantly associated with an increased risk of NICU admission. In conclusion; the most preferable route of delivery remains the vaginal route in the event of a stable maternal and fetal condition and mild to moderate covid symptoms and absence of factors that may lead to a possible aggravation. On the contrary, case where there is severe symptomatology or the risk of aggravation is high, the management must be rapid and early and the termination of the pregnancy can be proposed more quickly to eliminate a risk factor of aggravation and save the patient and the newborn.