In our study, the most common complication for the mothers who had confirmed infection in the 3rd trimester was preterm delivery, which occurred in 7/19 (36.4%) of patients; with a gestation age of 29 weeks 3 days and up to 36 weeks 3 days; Four of these patients were preterm delivery following preterm pre-labour rupture of membrane (PPROM) prior to 37 weeks. The other three patients required early delivery with a gestation age of 30 weeks 4 days to 34 weeks 5 days due to severe respiratory symptoms.

Two patients had respiratory distress syndrome 2/19 (10.5%), which was followed by admission to ICU, intubation and ventilation prior to delivery; and one asthmatic patient developed severe respiratory symptoms and required early delivery due to fetal growth restriction following confirmed infection. Antenatal steroids were not administrated in patients with severe signs of sepsis for the purpose improving neonatal mortality and morbidity.

Furthermore, pre-eclampsia occurred in 2/19 of patients (10.5%), one of which progressed to develop coagulopathy accompanied by liver dysfunction, HELLP and disseminated intravascular coagulation (DIC).

We also had 6/19 (31.6%) of our patients with confirmed COVID-19 infection complaining of reduced fetal movement (RFM), however, fetal monitoring showed fetal distress in only one of these patients (Table 1).

Amongst 23 confirmed COVID-19 cases with known outcome, there was one case of maternal death to a 29-year-old Asian lady with a known history of diabetes. She developed severe infection which was complicated by diabetic ketoacidosis, right lower lobar pulmonary embolism with evidence of right heart strain. She was admitted to ICU, intubated and ventilated. Following ventilation, she had a preterm C-section delivery at 30 weeks 6 days. Maternal death occurred almost two weeks following delivery due to basilar artery thrombosis which was confirmed on CT head.

Out of the 19 pregnant patients who were hospitalised in their 3rd trimester, the majority had caesarean deliveries 13/19 (68.4%) (Table 1). The indication for C-section varied amongst patients with the majority being an emergency C-sections 13/16 (81%), and only 3/16 (11.8%) being an elective C-sections and. Indications for C-section varied (2 fetal distress, 4 failure to progress, 7 maternal request/PPROM/sepsis) (Table 1).

The clinical characteristics, maternal outcomes of pregnant women with COVID-19 infection in the second trimester:

We had 4/23 women with confirmed COVID-19 in the second trimester, one pregnancy to an Asian lady presenting with mild manifestation ended up with missed miscarriage at 13 weeks. Three women had mild symptoms, and ¼ (25%) had severe sepsis, and was complicated with pyelonephritis.

For all 23 patients, chest radiography showed scattered multiple patchy infiltrates in both lungs.

Neonatal outcomes of pregnant women with COVID-19 infection:

In total, 20 infants were delivered from 19 pregnant women who tested positive for COVID-19 (one set of dichorionic diamniotic twins).

The majority of infants 19/20 (95%) had good neonatal outcome with 1 minute Apgar scores of 8 to 9, and 5 minute Apgar scores of 9 to 10. One infant 1/20 (5%) had an Apgar score at 1 and 5 minutes of 3, and 5 (Table 1). The baby was delivered at 34 weeks 5 days by emergency C-section under general anaesthetic to black African woman who had severe COVID-19 symptoms, and was intubated and ventilated. The baby was resuscitated with positive oxygen pressure using an endotracheal tube, and admitted to a special care baby unit, however, the infant has been discharged from hospital with all the test indicators up to standard, and had good recovery with no serious adverse mother-infant outcomes have been found.

Four infants 4/19 (21%) with suspected infection were screened for COVID-19, and were started on broad spectrum antibiotics following delivery. Indicators for suspected infection included either mildly raised white cell count, raised inflammatory markers, or temperature. Neonatal throat swabs and blood samples were tested, all swabs had negative RT-PCR.

None of the infants presented any symptoms as of 30th April 2020.

In view of the ongoing pregnancy for COVID-19 patients in their 2nd trimester, no neonatal information is available for these patients.

The compliance in the use of personal protective equipment amongst healthcare workers when reviewing pregnant women with COVID-19 infection:

All mothers with confirmed COVID-19 infection wore masks, and all medical staff wore protective suits (including plastic aprons, goggles and gloves), and surgical masks when reviewing confirmed COVID-19 patients.

PPE was only used in theatre by medical and nursing staff. The infants were not routinely isolated from their mothers after delivery.

Health care workers did not wear proper PPE when reviewing 80 patients who presented with suspected COVID-19 infection, out of which 23/80 (28.8%) patients had confirmed infection on nasopharyngeal swabs that were performed on the same day.