Impact of COVID-19 disease on obstetric outcomes in the third trimester of pregnancy

Objectives: The aim of this study is to evaluate the effect of coronavirus disease 2019 (COVID-19) diagnosed in the third trimester of pregnancy on maternal, fetal, and obstetric outcomes. Methods: This retrospective study included 109 pregnant women hospitalized with a diagnosis of COVID-19 during the third trimester of pregnancy (28-40 weeks) in a tertiary center between March 1 and December 31, 2020. Demographic characteristics, clinical signs, and obstetric outcomes of the patients were searched for analysis. Laboratory and x-ray results were reported, and treatment methods were summarized. Finally, mother-newborn results were recorded. Results: We included one hundred nine pregnant women in this study. We divided the patients into two groups as those with positive PCR test (n = 59) and negative PCR test and possible covid patients (n = 50) whose symptoms and histories meet the covid criteria. The mean age of the patients was 28.90 ± 6.21 years, and the mean week of gestation was 37.45 ± 2.29 weeks. Half of the patients were asymptomatic (n = 57, 47.7%), and 69% of all patients were delivered by cesarean section. The hospitalization time of antigen-positive cases was between 2-9 days. The mean lymphocyte count was 1.37 ± 0.45 ×103/mL in the PCR positive patient group, and this value was 1.67 ± 0.54 103/mL in the PCR negative patients (p = 0.007). While the mean neutrophil count was 8.13±3.16 ×103/mL in the PCR positive patient group, this value was 10.99 ± 4.14 ×103/mL in the PCR negative patients (p < 0.001). Fifteen patients required intensive care unit follow-up, and 2 of them died while receiving mechanical ventilator support. Conclusions: COVID-19 infection in the third trimester of pregnancy does not affect fetal and maternal outcomes if the disease is under control at an early stage. In hospitalized patients, symptoms are more precious than antigen testing.

Keywords:

COVID-19, pregnancy and SARS CoV-2 prenatal diagnosis, third trimester,

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1. Amankwah-Amoah J. COVID-19 pandemic and innovation activities in the global airline industry: a review. Environt Int 2021;156:106719.
2. Jogalekar MP, Veerabathini A, Gangadaran P. Novel 2019 coronavirus: genome structure, clinical trials, and outstanding questions. Exp Biol Med (Maywood) 2020;245:964-9.
3. Bhatti JS, Bhatti GK, Khullar N, Reddy AP, Reddy PH. Therapeutic strategies in the development of anti-viral drugs and vaccines against SARS-CoV-2 infection. Mol Neurobiol 2020;57:4856-77.
4. Allmer J. Special issue on COVID-19 data integration opportunities and vaccine development strategies. J Integr Bioinform 2021;18:1-2.
5. Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020;2:100107.
6. Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020;223:111.e1-111.e14.
7. Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound Obstet Gynecol 2020;56:15-27.
8. Khalil A, Kalafat E, Benlioglu C, O’Brien P, Morris E, Draycott T, et al. SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis of clinical features and pregnancy outcomes. EClinicalMedicine. 2020;25:100446.
9. McIntosh K, Hirsch MS, Bloom A. COVID-19: Epidemiology, virology, and prevention. UpToDate. Dec 09, 2022. https://www.uptodate.com/contents/covid-19-epidemiology-virology-and-prevention
10. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
11. Cunningham FG. UpToDate. Aug 09, 2021. https://www.uptodate.com/contents/normal-reference-ranges-for-laboratory-values-in-pregnancy.
12. Moro F, Buonsenso D, Moruzzi MC, Inchingolo R, Smargiassi A, Demi L, et al. How to perform lung ultrasound in pregnant women with suspected COVID-19. Ultrasound Obstet Gynecol 2020;55:593-8.
13. Shimizu K, Kondo K, Osugi Y, Negita M, Mase H, Kondo T, et al. Early COVID-19 testing is critical to end the pandemic. J Gen Fam Med 2021;22:67.
14. Abaluck J, Kwong LH, Styczynski A, Haque A, Kabir MA, Bates-Jefferys E, et al. Impact of community masking on COVID-19: a cluster-randomized trial in Bangladesh. Science 2022;375:eabi9069.
15. Türk Toraks Derneği. COVID-19 Tanı ve Tedavisinde Kanıta Dayalı Öneriler ve Türk Toraks Derneği COVID-19 Görev Grubu Görüş Raporu. 2020;149-59.
16. Mahajan NN, Pophalkar M, Patil S, Yewale B, Chaaithanya IK, Mahale SD, et al. Pregnancy outcomes and maternal complications during the second wave of coronavirus disease 2019 (COVID-19) in India. Obstet Gynecol 2021;138:660-2.
17. Gajbhiye RK, Modi DN, Mahale SD. Pregnancy outcomes, newborn complications and maternal-fetal transmission of SARS-CoV-2 in women with COVID-19: a systematic review of 441 cases. MedRxiv 2020. doi: 10.1101/2020.04.11.20062356.
18. Sun S, Savitz DA, Wellenius GA. Changes in adverse pregnancy outcomes associated with the COVID-19 pandemic in the United States. JAMA Netw Open 2021;4:e2129560.
19. PrabhuDas M, Bonney E, Caron K, Dey S, Erlebacher A, Fazleabas A, et al. Immune mechanisms at the maternal-fetal interface: perspectives and challenges. Nat Immunol 2015;16:328-34.
20. la Cour Freiesleben N, Egerup P, Hviid KVR, Severinsen ER, Kolte AM, Westergaard D, et al. SARS-CoV-2 in first trimester pregnancy: a cohort study. Hum Reprod 2021;36:40-7.
21. Rizzo G, Mappa I, Maqina P, Bitsadze V, Khizroeva J, Makatsarya A, et al. Effect of SARS-CoV-2 infection during the second half of pregnancy on fetal growth and hemodynamics: a prospective study. Acta Obstet Gynecol Scand 2021;100:1034-9.
22. Fontanella F, Hannes S, Keating N, Martyn F, Browne I, Briet J, et al. COVID-19 infection during the third trimester of pregnancy: current clinical dilemmas. Eur J Obstet Gynecol Reprod Biol 2020;251:268-71.
23. Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, et al. Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2021;137:571-80.
24. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320.
25. Huntley BJF, Mulder IA, Di Mascio D, Vintzileos WS, Vintzileos AM, Berghella V, et al. Adverse pregnancy outcomes among individuals with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a systematic review and meta-analysis. Obstet Gynecol 2021;137:585-96.
26. Woodworth KR, Olsen EO, Neelam V, Lewis EL, Galang RR, Oduyebo T, et al. Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy - SET-NET, 16 Jurisdictions, March 29-October 14, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1635-40.