SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

OBJECTIVE: To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN: Multicentric case-control study. DATA SOURCES: Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION: All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY: Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS: Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS: A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION: Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Breastfeeding and Contraceptive Methods in Women With Severe Acute Respiratory Syndrome Coronavirus- 2 (SARS-COV-2) Infection in Peripartum Period

Objective: This study aimed to assess the exclusive breastfeeding and contraceptive methods among women delivering within 1-week of a positive test for severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) infection. Materials and methods: In this study, 106 women with SARS-CoV-2 infection who were either asymptomatic or had mild disease were included. They were admitted for maternity care at a tertiary center between May to September 2020. The data was collected during their hospital stay and subsequently by telephonic or in-person interviews at 4-6 weeks and 8-10 weeks postpartum for contraceptive use, breastfeeding and use of facemask and hand-hygiene. Results: Sixty-three (59.4%) women had vaginal delivery and 43 (40.6%) required cesarean-section. Only one of the 98 newborns who were tested for SARS-CoV-2 turned out positive. Initiation of breastfeeding was delayed by an average of three days due to preparing the Reverse transcription polymerase chain reaction (RT-PCR) report. Exclusive breastfeeding was practiced by 69% and mixed feeding by 26%.Pre breastfeeding hand hygiene and facemask use declined after discharge (100% to 53.75% at 8-10 weeks postpartum). Out of 106, 86 (81%) women used no contraception at 8-10 weeks postpartum, continued with post-placental-IUD in 8/106 (7.5%) and tubal-sterilization during cesarean in 8/106 (7.5%) cases. Only 4/106 (4%) adopted alternative methods like barrier contraception. Conclusion: The practice of exclusive breastfeeding remains unchanged among women who suffered from SARS-CoV-2 infection in the peripartum period while uptake of postpartum contraception was minimal except for the women who opted for long term contraceptive methods in the immediate postpartum period.