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.