Placenta histological features in three cases of supposed SARS-CoV-2 vertical transmissions in second and third trimester of pregnancy

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.

First wave of COVID-19 pandemic and caesarean delivery rate in Italy

INTRODUCTION When COVID-19 first spread in Europe, it was unclear if the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could be transmitted from mother to fetus. Hence, doubts arose as the best way to deliver considering that caesarean delivery (CD) indeed could prevent vertical transmission. METHODS We calculated CD rate in 5 Italian regions (Lombardy, Emilia-Romagna, Tuscany, Umbria, Sardinia) differently affected by the first wave of the pandemic. Data were retrospectively obtained from each birth center and aggregated by areas (provinces). Data related to March-April 2020, corresponding to first COVID-19 peak in Italy, were compared with the March-April 2019 as well with November-December 2019, and odds ratio (ORs) were calculated. RESULTS A total of 24 provinces were included, covering 21.8% of the Italian population. Overall CD rate did not differ in the three examined periods: neither in the comparison of March-April 2019 (reference period) versus November-December 2019 (OR: 0.98 95% CI 0.93-1.05) nor in the comparison of the reference period versus March-April 2020 (OR: 1.03;95 % CI 0.98-1.09). CD rate did not change even in areas with the highest incidence of COVID-19. Only 17 out of 3.257 CDs was due to direct COVID-19 complications (0.5%;95% CI 0.3-0.8). No pregnant women with COVID-19 proven infection died. CONCLUSIONS The first wave of COVID-19 pandemic did not significantly affect delivery mode in Italy, even in areas with the highest infection rates.

Childbirth Care among SARS-CoV-2 Positive Women in Italy

The new coronavirus emergency spread to Italy when little was known about the infection's impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother-child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother-newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room;the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother's milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to "better safe than sorry" care choices. An improvement of the peripartum care indicators was observed over time.

Clinical findings and disease severity in hospitalized pregnant women with coronavirus disease 2019 (COVID-19)

OBJECTIVE: To investigate the clinical evolution of coronavirus disease 2019 (COVID-19) in hospitalized pregnant women and potential factors associated with severe maternal outcomes. METHODS: We designed a prospective multicenter cohort study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to 12 Italian maternity hospitals between February 23 and March 28, 2020. Clinical records, laboratory and radiologic examinations, and pregnancy outcomes were collected. A subgroup of patients with severe disease was identified based on intensive care unit (ICU) admission, delivery for respiratory compromise, or both. RESULTS: Seventy-seven patients were included, 14 of whom had severe disease (18%). Two thirds of the patients in the cohort were admitted during the third trimester, and 84% were symptomatic on admission. Eleven patients underwent urgent delivery for respiratory compromise (16%), and six were admitted to the ICU (8%). One woman received extracorporeal membrane oxygenation;no deaths occurred. Preterm delivery occurred in 12% of patients, and nine newborns were admitted to the neonatal intensive care unit. Patients in the severe subgroup had significantly higher pregestational body mass indexes (BMIs) and heart and respiratory rates and a greater frequency of fever or dyspnea on admission compared with women with a nonsevere disease evolution. CONCLUSION: In our cohort, one in five women hospitalized with COVID-19 infection delivered urgently for respiratory compromise or were admitted to the ICU. None, however, died. Increased pregestational BMI and abnormal heart and respiratory rates on admission were associated with severe disease.

The effects of COVID-19 pandemic on elective post-bariatric surgery waiting list: a single Plastic Surgery Center investigation.

OBJECTIVE: After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. PATIENTS AND METHODS: A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. RESULTS: 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. CONCLUSIONS: The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased.

Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis.

OBJECTIVE: To report mode of delivery and immediate neonatal outcome in women infected with COVID-19. DESIGN: Retrospective study. SETTING: Twelve hospitals in northern Italy. PARTICIPANTS: Pregnant women with COVID-19-confirmed infection who delivered. EXPOSURE: COVID 19 infection in pregnancy. METHODS: SARS-CoV-2-infected women who were admitted and delivered from 1 to 20 March 2020 were eligible. Data were collected from the clinical records using a standardised questionnaire on maternal general characteristics, any medical or obstetric co-morbidity, course of pregnancy, clinical signs and symptoms, treatment of COVID 19 infection, mode of delivery, neonatal data and breastfeeding. MAIN OUTCOME AND MEASURES: Data on mode of delivery and neonatal outcome. RESULTS: In all, 42 women with COVID-19 delivered at the participating centres; 24 (57.1%, 95% CI 41.0-72.3) delivered vaginally. An elective caesarean section was performed in 18/42 (42.9%, 95% CI 27.7-59.0) cases: in eight cases the indication was unrelated to COVID-19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI 29.8-61.3) cases: of these, 7/19 (36.8%, 95% CI 16.3-61.6) required oxygen support and 4/19 (21.1%, 95% CI 6.1-45.6) were admitted to a critical care unit. Two women with COVID-19 breastfed without a mask because infection was diagnosed in the postpartum period: their newborns tested positive for SARS-Cov-2 infection. In one case, a newborn had a positive test after a vaginal operative delivery. CONCLUSIONS: Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn. TWEETABLE ABSTRACT: This study suggests that vaginal delivery may be associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn.