ABSTRACT
Objective. We described three cases of SARS-CoV-2 positive new-borns with both symptomatic and asymptomatic mothers. Materials and Methods. Placentas were analyzed in the pathology department and showed chronic histiocytic intervillositis with presence of CD68+ macrophages, syncytiotrophoblast necrosis and positivity of the syncytiotrophoblast for SARS-CoV-2 antigen or RNA. Results. The first case dates back to March 2020, when a symptomatic COVID-19 positive patient gave birth to a healthy neonate at 37.6 weeks of gestation. Skin to skin contact was not permitted but breastfeeding with a face mask was allowed. The newborn, that remained asymptomatic throughout the entire hospital stay, resulted positive to SARS-CoV-2 immediately after birth, at 24 hours of life and after 7 days. The second was delivered at 35.1 weeks of gestation by caesarean section for non-reassuring fetal status. The mother presented with fever, cough and a positive COVID-19 swab test. The newborn resulted positive on day 7, despite not having contact with the mother. No neonatal complications were observed. The third positive mother was admitted asymptomatic to the obstetric department in September 2021 due to preterm premature rupture of membranes at 20 weeks of gestation in a high-risk twin pregnancy. At 21.4 weeks of gestation her clinical conditions deteriorated, and she delivered two stillborn fetuses: SARSCoV- 2 was detected in all tissues samples. The lung of the first fetus only showed interstitial pneumonia features. Conclusions. We detected SARS-CoV-2 in placentas of both the second and third trimester, implying the passage of the virus through the placenta to the fetuses as the presence of SARSCoV- 2 RNA was demonstrated in swabs and foetal tissues.
ABSTRACT
INTRODUCTION One of the main implemented provisions to contain the spread of COVID-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. The lifestyle of pregnant women has a fundamental impact on maternal health and fetal development. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. Stressful situations, such as those caused by this new confinement, could be also the cause of overeating and of weight gain. Indeed, some studies suggested that psychological and emotional responses to the COVID-19 outbreak may have also increased the risk of developing dysfunctional eating behaviors and overeating as a consequence of boredom. Moreover, Body Mass Index (BMI) and maternal weight gain during pregnancy could be related to a higher rate of breech presentations. Fetal malpresentation is one of the main causes of the high rate of cesarean delivery. This pandemic could also influence women's attitude to routine checkups and pregnancy scans, antenatal appointments and consultations. METHODS This is a retrospective study including all consecutive patients who delivered at University Hospital Maggiore della Carità in Novara, Italy, in April-May 2017 (group 1, n=294), a period prior to the pandemic, and during the same months in 2020 (group 2, n=256) during and immediately after lockdown. Clinical data were extracted from The Report 'Childbirth Assistance Certificate (CedAP) - Birth Event Analysis'. RESULTS Demographic characteristics were similar between the two study groups, except for a decreased number of married couples in group 2 (p-value .018) and an increased percentage of patients with clinical checkups at Family Planning facilities in 2020 (p-value .04). The number of hospitalizations during pregnancy was 26 (8.9%) vs 10 (3.9%) with a significative reduction during 2020 (p-value .004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs 35.9%;p-value . 002), a reduction of amniorrhexis (11.3% vs 5.5% p-value .015), a reduction of supine positions with an increase of vertical and all fours positions in 2020 (49.3% vs 61.9% and 9.5% vs 12.4% respectively, p .023), and a reduction of left occipito-anterior presented part (63.2% vs 55.4%) in favor of right occipito-anterior (34.7% vs 41.2%, p-value .019) as shown in Table 1. CONCLUSIONS It is the first time in modern, age that humankind faces a lockdown, so the short- and long-term effects are unknown. There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate possible psychological, behavioral, and epigenetic effects on obstetric outcomes.