Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: a prospective cohort study
Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: a prospective cohort study
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DOI：
10.1111/1471-0528.16403
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发表时间：
2020-08-13
影响因子：
5.8
通讯作者：
Riley, L. E.
中科院分区：
文献类型：
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作者：
Prabhu, M.;Cagino, K.;Riley, L. E.
目的描述2019冠状病毒病（COVID-19）孕妇与非COVID-19孕妇的结局差异。设计：对连续入院分娩的孕妇进行前瞻性队列研究，并使用逆转录-聚合酶链反应通过鼻咽（NP）拭子普遍检测严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。所有COVID-19母亲的婴儿都接受了SARS-CoV-2检测。设置三家纽约市医院。怀孕20周以上的孕妇入院分娩。方法将数据按SARS-CoV-2结果和症状状态分层，并使用参数和非参数检验进行总结。主要结局指标孕产妇COVID-19的患病率和结局、产科结局、新生儿SARS-CoV-2、胎盘病理学。结果675例产妇中，10.4%为SARS-CoV-2阳性，78.6%为无症状。我们观察到有症状的COVID-10女性与无症状的COVID-19女性与无COVID-19女性在社会人口统计学和合并症方面的差异。在有症状的COVID-19中，剖腹产率为46.7%，在无症状的COVID-19中为45.5%，在无COVID-19的妇女中为30.9%（P = 0.044）。产后并发症（发热、缺氧、再入院）在COVID-19感染妇女中的发生率为12.9%，而在非COVID-19感染妇女中为4.5%（P < 0.001）。没有妇女需要机械通气，也没有产妇死亡。在71名接受检测的婴儿中，没有一人对SARS-CoV-2呈阳性。胎盘病理学显示，患有COVID-19的女性与未患有COVID-19的女性相比，胎儿血管灌注不良的频率增加，表明胎儿血管中存在血栓（48.3% vs 11.3%，P < 0.001）。结论在分娩时感染COVID-19的孕妇中，我们观察到剖腹产率增加，产后产妇并发症发生率增加。此外，胎盘内血栓可能在分娩前对COVID-19产生母体和胎儿影响。分娩时的COVID-19：更多的剖腹产，产后并发症和胎盘内血栓。
Objective To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). Design Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. Setting Three New York City hospitals. Population Pregnant women >20 weeks of gestation admitted for delivery. Methods Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. Main outcome measures Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. Results Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%,P < 0.001). Conclusion Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery. Tweetable abstract COVID-19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.