Introduction
The World Health Organisation (WHO) was alerted on the 31st of December 2019 by Chinese authorities of a series of pneumonia-like cases in the city of Wuhan 11WHO. Pneumonia of unknown cause—China. 2020.https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/.The Chinese Centre for Disease Control and Prevention identified this infection as a novel coronavirus infection on Jan 7, 2020 and on Feb 11, 2020, the WHO announced a new name for the epidemic disease as 2019-new coronavirus disease (2019-nCoV and now known as COVID-19). Symptoms of the infection had included fever, malaise, dry cough, shortness of breath and respiratory distress 22Organization, W.H. Vol. 28. 2020. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. Published January..
Data from China have indicated that older adults, particularly those with serious underlying health conditions, are at higher risk for severe COVID-19–associated illness and death than younger persons. Although most reported COVID-19 cases in China were mild (81%), approximately 80% of deaths had occurred among adults population older than 60 years of age; only one (0.1%) death had occurred in a person under 19 years of age 33Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China [Chinese]. Chinese Center for Disease Control and Prevention Weekly 2020; 41:145–5..
It is reasonable to anticipate that pregnant women might be at greater risk for severe illness, morbidity or mortality, compared to the general population due to immunologic and physiologic changes. This is observed with other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)]. Data from MERS-CoV and SARS-CoV, although limited, suggest that infection in pregnancy is associated with severe infection and adverse neonatal outcomes, including increased risk of miscarriage, fetal growth restriction, and preterm birth, 44Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections [J]. Viruses, 2020,12 (2). pii: e194. DOI: 10.3390 / v12020194.,55Chen HJ, Guo JJ, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records [J / OL]. Lancet. [2020-02-12]. DOI: 10.1016 / s0140-6736 (20) 30360-3., 66Qiao J. What are the risks of COVID-19 infection in pregnant women. Lancet. [2020-02-13]. DOI: 10.1016 / S0140-6736 (20) 30365-2., 77Di Mascio D, Khalil A, Saccone G. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. however, data specific to COVID-19 are not yet available. At present, there are few reports of COVID-19 infection in pregnancy, including clinical characteristics, maternal and neonatal outcomes; while the risk of an intrauterine vertical transmission is inconclusive4,6.
The Royal College of Obstetrics and Gynaecology (RCOG) developed a guidance for delivery and neonatal care in pregnancies affected by COVID-19, which recommends that delivery mode be determined primarily by obstetric indication and recommends against routine separation of affected mothers and their babies. 88Royal College of Obstetricians and Gynaecologists (RCOG). COVID 19 Pregnancy Guidelines RCOG, United Kingdom (2020) Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-21-covid19-pregnancy-guidance-2118.pdf Concurrently, our institution issued an updated guidance for use of PPE in view of the COVID-19 pandemic. We started prospective data collection based on the developed guidance. We aim to analyse the clinical characteristics of pregnant women with 2019-nCoV infection, to report maternal and neonatal outcomes and to evaluate intrauterine vertical transmission.