Clinical and Obstetric Aspects of Pregnant Women with COVID-19: A Systematic Review

Abstract Objective To analyze the clinical and obstetric aspects of pregnant women with COVID-19. Methods A systematic literature review in the MEDLINE/PubMed, LILACS, SCIELO, and CNKI databases was performed from March to May 2020, with the descriptors: Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Of those chosen were original titles, without language and period restriction and that addressed pregnant women with a clinical and/or laboratory diagnosis of COVID-19. Revisions, editorials, and duplicate titles were excluded. The Newcastle-Ottawa (NOS) and Murad et al. scales were used to assess the quality of the studies. Results We included 34 articles with 412 pregnant women infected with severe acute respiratory syndrome (SARS-Cov-2), with an average age of 27.5 years of age and 36.0 gestational weeks. The most common symptom was fever (205 [49.7%]), and 89 (21.6%) pregnant women progressed to severe viral pneumonia. Laboratory tests showed an increase in C-reactive protein (154 [37.8%]), and radiological tests showed pneumonia with peripheral ground-glass pattern (172 [51.4%]). Emergency cesarean delivery was indicated for most pregnant women, and the most common gestational complication was premature rupture of ovarian membranes (14 [3.4%;]). We detected 2 (0.5%) neonatal deaths, 2 (0.5%) stillbirths, and 1 (0.2%) maternal death. Conclusion Pregnant women with COVID-19 presented a clinical picture similar to that of non-infected pregnant women, with few obstetric or neonatal repercussions. There was a greater indication of cesarean deliveries before the disease aggravated, and there was no evidence of vertical transmission of the infection.

摘要 目的：分析新型冠状病毒肺炎（COVID-19）感染孕妇的临床与产科特征。方法：2020年3月至5月，针对MEDLINE/PubMed、LILACS、SCIELO以及中国知网（CNKI）数据库开展系统文献综述，检索式包含主题词：妊娠（Pregnancy）、2019新型冠状病毒（2019-nCoV）、冠状病毒（Coronavirus）、严重急性呼吸综合征冠状病毒2型（SARS-Cov-2）、新型冠状病毒肺炎（COVID-19）。纳入无语言与时间限制、针对经临床和/或实验室确诊为COVID-19的孕妇的原创性研究文献，排除综述类文章、社论及重复文献。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale, NOS）与穆拉德等人（Murad et al.）量表对纳入研究的质量进行评估。结果：共纳入34篇文献，涉及412例感染严重急性呼吸综合征冠状病毒2型（SARS-Cov-2）的孕妇，受试者平均年龄为27.5岁，平均孕周为36.0周。最常见的症状为发热（205例，占比49.7%），89例（21.6%）孕妇进展为重症病毒性肺炎。实验室检测显示C反应蛋白（C-reactive protein）水平升高者共154例（37.8%）；影像学检查显示外周磨玻璃样肺炎表现者共172例（51.4%）。多数孕妇接受了急诊剖宫产术，最常见的产科并发症为卵巢膜早破（14例，占比3.4%）。本研究共检出新生儿死亡2例（0.5%）、死胎2例（0.5%），孕产妇死亡1例（0.2%）。结论：COVID-19感染孕妇的临床表型与未感染孕妇相似，产科与新生儿不良结局发生率较低。在病情加重前，剖宫产术的临床指征更为常见，且未发现病毒存在垂直传播的证据。