Objective: To evaluate if SARS-CoV-2 is detectable in vaginal swabs and whether antibodies against SARS-CoV-2 are present in maternal and umbilical cord blood of pregnant women with COVID-19. Design: Prospective cohort study. Setting: Department of Obstetrics and Gynaecology, Copenhagen University Hospital – North Zealand, Denmark. Population: Pregnant women tested positive for SARS-CoV-2 in a pharyngeal swab between August 20th, 2020 and March 1st, 2021 who gave birth during the same period. Methods: Maternal blood sample and vaginal swabs were collected at inclusion. If included during pregnancy, these samples were repeated at delivery in addition to an umbilical cord blood sample. Swabs were analysed for SARS-CoV-2 and blood samples for SARS-CoV-2 total antibodies. Placental and neonatal swabs were performed on clinical indications. Main outcome measures: SARS-CoV-2 in vaginal swabs and SARS-CoV-2 total antibodies in maternal and umbilical cord blood. Results: We included 28 women, hereof 4 serious maternal or fetal outcomes including 1 neonatal death. Within the first eight days after a maternal positive pharyngeal swab, SARS-CoV-2 was detectable in two vaginal (2/28) and two placental swabs (2/4), whereas SARS-CoV-2 antibodies were detected in 1/13 women. After eight days, SARS-CoV-2 was not detectable in vaginal swabs and SARS-CoV-2 antibodies were observed in 19/21 of women. Antibodies in cord blood of seropositive mothers appeared after 16 days. Conclusion: Vertical transmission of SARS-CoV-2 seems plausible since SARS-CoV-2 is detectable in the vagina up to eight days after a positive pharyngeal swab at which time the neonate is not yet protected by antibodies.

Objective: To gain insight into pregnant women’s preference if given a choice between getting antibiotic prophylaxis before or after cord clamping during caesarean delivery. Design: A qualitative semi-structured interview-study Setting: The interviews were conducted at a Danish Hospital, with about 4000 births a year. Sample: Fourteen pregnant women, either considering or having a planned caesarean section, or scheduled for induction due to post-term gestational age. Methods: Fourteen individual semi-structured interviews were conducted, and a systematic text condensation approach was used to analyse the transcribed interviews. Main Outcome Measures: Patient perspectives. Results: Ten of the fourteen women favoured antibiotic administration after cord clamping. Despite any adverse effects to the infant’s microbiota and increased risk of long-term health outcomes were only hypothetical and the risk reduction in postpartum infections being well documented, they did not want to expose their offspring to antibiotics. Those who preferred antibiotic prophylaxis before cord clamping were concerned, if they would be able to care for the infant in case of a maternal infection. Three of the women preferring antibiotics after cord clamping said they would potentially change preference, if the maternal risk was higher. Most women preferred to be informed of the use of prophylactic antibiotic and that the timing has consequences for trans-placental exposure to the infant. Conclusions: With most of the interviewed women preferring antibiotic administration after cord clamping, we suggest patients should be involved in the decision regarding timing of prophylactic antibiotics before caesarean section. Funding: None.

Title pageTitle: ”Case report of COVID-19 in pregnancy and viral presence in the vagina – recommendations for obstetric practice”