Parole chiave
abdominal delivery
fetal death
pregnancy
alcohol
Abstract
Introduction
COVID-19 is a complex syndrome caused by SARS-Cov-2. It mainly affects the respiratory system, but it could cause serious harm during pregnancy. An increase in stillbirths and preterm births has been highlighted by many authors. Although WHO and Royal College of Obstetrics and Gynecology don’t recommend elective caesarean section in women with confirmed infection, caesarean sections were performed by many clinicians. The aim of this short narrative review is to analyze pieces of evidence found in literature about the effectiveness of caesarean section in preventing stillbirths in COVID-19 positive mothers.
Methods
Studies included in the present review were retrieved searching MEDLINE (last access January 28th, 2021) with the following keywords: “pregnant woman with covid-19”, “Caesarean section”, “Abdominal Delivery” and “Stillbirth”. Studies regarding the mode of delivery in pregnant women infected with COVID-19 and neonatal outcomes were included. Studies about biology, anesthesiology and necroscopy were excluded. Filters for “human” and “English” were applied.
Results
Searching MEDLINE, 22 references were found. Other 103 articles were found searching bibliography. Two references were excluded after duplicate removal, 77 references after the title screen and 46 after the abstract screen. The final number of references included is 21. Most of the included studies were case reports. Most of them were from China.
Discussion
Many authors highlighted the increased risk of fetal death in pregnancies complicated with SARS-Cov-2 infection, but it is not clear if Caesarean Section could reduce this risk. Pieces of evidence show that most clinicians choose to perform an elective caesarean section mostly because of maternal conditions or the fear of possible vertical transmission. Data show that mode of delivery doesn’t affect the neonatal outcome and Caesarean Section doesn’t reduce the positivity rate among neonates. Different opinions were found about the possible infection of amniotic fluid, cord blood and placenta. The risk of vertical transmission is considered moderate or low by most of the authors. Positivity to SARS-Cov-2 isn’t an indication of elective caesarean section by itself, but this mode of delivery should be optioned in patients with other obstetrical indication or with severe conditions due to COVID. The recent increase in stillbirths could be related to the overall deterioration of maternal conditions.