Hepatic manifestations of COVID-19 in the obstetric population

COVID-19 has and continues to affect healthcare across the world. Pregnant women have been identified as a moderate-risk group with regards to clinical susceptibility to COVID-19. Acute liver injury in pregnancy secondary to COVID-19 has been documented sparsely across the world. In this report, we describe the case of a pregnant women who presented with COVID-19 liver injury. A second women with a similar presentation and outcome also presented during the same COVID-19 wave but contact details were lost and consent not gained. Description The cases occurred in December 2020 during which time the predominant reported variant was the alpha strain of COVID-19. Patient A was a multiparous woman, who presented to the labour ward at 37 weeks, a few days after a positive COVID-19 test with vomiting. Investigations revealed significant derangement of liver function tests (LFTs) but with normal bilirubin and clotting. On a working diagnosis of acute fatty liver of pregnancy and with breech presentation, she underwent a caesarean section. Liver enzymes continued to deteriorate with a mild coagulopathy. A non-invasive liver screen and ultrasound did not reveal any significant abnormalities. She was discussed with the tertiary liver centre and started on a Nacetylcysteine infusion with some additional vitamin K. A few days later LFTs began to improve and she was discharged home with follow-up in the community. Her baby was treated with antibiotics for 5 days empirically due to the unknown nature of the transaminitis but remained well. Following further discussion with the tertiary centre, a diagnosis of acute liver injury secondary to COVID-19 was made. Discussion Extra-pulmonary features of COVID-19 have been reported in the literature. A number of theories have been postulated to describe the hepatic effects. This has mainly manifested itself as a transaminitis with varying outcomes. The prevalence in the obstetric population has been more sparsely reported but most isolated cases have been relatively self-limiting with positive outcomes [1]. This case also highlighted the diagnostic difficulties with other severe hepatic diseases of pregnancy. A handful of case reports have already described some of the crossover and difficulty in decisionmaking when these patients present acutely unwell to hospital [2]. The severity and rapid progression of some hepatic disorders in pregnancy not only warrants decisive decision-making but also involvement of the multidisciplinary team.

Severe Respiratory Failure from SARS-CoV-2, Complicated with Pneumothorax in a Pregnant Woman: A Case Report

INTRODUCTION: The first data for COVID-19 in pregnancy showed mild-to-moderate forms of the disease while the current data speak of severe forms in these subjects. Here, we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastinum and pneumothorax, during her hospital stay, in a late stage of disease. CASE PRESENTATION: A 38-year-old multiparous woman was referred to university hospital at 25 weeks of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory insufficiency, which after 12 h progressed further to severe ARDS. She tested positive for SARS-CoV-2 on quantitative real-time polymerase chain reaction. Under these conditions, it was decided that the patient undergoes a cesarean section for termination of pregnancy. Remdesivir 200 mg/day and tocilizumab 8 mg/kg were administered, based on national guidelines. The patient’s fever subsided, but her SpO2 remained at 94%, even with a 15 L/min oxygen mask. After 12 days, the patient complains of a severe back pain and her respiratory condition rapidly worsened and reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastinum and pneumothorax, which deteriorated the patient’s status. Thereafter, tube thoracostomy was performed. There was a clinical and ABG analysis parameter’s improvement. The patient was discharged 34 days after cesarean delivery with a proper general health. CONCLUSION: Our case highlights even more convincingly the fact that, in pregnancy, can be severe to life-threating forms of COVID-19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms cases with COVID-19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.

Pregnant women's perceptions of the COVID-19 vaccine: A French national survey

Introduction: Pregnant women are at increased risk for COVID-19, and COVID-19 vaccine is the most promising solution to overcome the current pandemic. This study was conducted to evaluate pregnant women's perceptions and acceptance of COVID-19 vaccination. Materials and methods: A cross-sectional study was conducted from February 18 to April 5 2021. An anonymous survey was distributed in 7 French obstetrics departments to all pregnant women before a prenatal visit. All pregnant women attending a follow-up consultation were asked to participate in the study. An anonymous web survey was available through a QR code and participants were asked whether or not they would agree to be vaccinated against SARS-CoV-2, and why. The questionnaire included questions on the patients’ demographics and their knowledge of COVID-19 vaccines. Results: Of the 664 pregnant women who completed the questionnaire, 29.5% (95% CI: 27.7–31.3) indicated they would agree to be vaccinated against COVID-19. The main reason for not agreeing was being more afraid of potential side effects of the SARS-CoV-2 vaccine on the fetus than of COVID-19. Factors influencing acceptance of vaccination were: being slightly older, multiparity, having discussed it with a caregiver and acceptance of the influenza vaccine. Discussion: Nearly one-third of pregnant women in this population would be willing to be vaccinated. In addition to studies establishing fetal safety, public health agencies and healthcare professionals should provide accurate information about the safety of COVID-19 vaccines.

Characteristics and Outcomes Associated With COVID-19 Infection in Pregnancy

INTRODUCTION: Data on COVID-19 in pregnancy are skewed toward infection at time of labor and delivery, and few studies have controlled for confounding variables. We aimed to explore the sociodemographic and health risk factors for COVID-19 at any point in pregnancy and its impact on maternal outcomes in a diverse cohort during the first year of the pandemic. METHODS: We conducted a retrospective cohort study using data ed from the electronic medical record within Kaiser Permanente Mid-Atlantic States, an integrated health care system, from March 15, 2020, to March 15, 2021. We included women at least 15 years old and pregnant during that timeframe, comparing those who tested positive for COVID-19 to those who did not.We usedmultivariable logistic regression to identify risk factors for COVID-19 infection during pregnancy.We then used propensity score matching to create a comparison group to explore associations between infection and key outcomes. RESULTS: Among 18,285 pregnant members, 1,036 (5.7%) tested positive for COVID-19 during pregnancy, with 26%, 31%, and 43%, respectively, diagnosed in each trimester of pregnancy. Patients with COVID-19 were more likely to be young, Latina, obese, and multiparous;being White or Asian was protective (P<.001). Patients with COVID-19 during pregnancy were more likely to be hospitalized apart from delivery (P=.029). There were no significant differences in fetal demise, cesarean delivery, preterm delivery, gestational diabetes, hypertensive disorders of pregnancy, venous thromboembolism, postpartum readmission, or maternal death between groups. CONCLUSION: Our study was consistent with previously identified disparities in COVID-19 infection. Outcome data were surprisingly reassuring.

Prevalence of and Factors Influencing Breastfeeding Pre- and Post-COVID-19

INTRODUCTION: Current evidence suggests that the benefit of breastfeeding during the pandemic outweighs potential risks and may provide protection for the infant and mother. The purpose of this study was to determine whether the prevalence of breastfeeding changed after the COVID-19 pandemic. METHODS: With Institutional review board approval, a retrospective chart review of 916 randomly selected women seen between April 2019 and February 2020 (pre-COVID-19 cohort) and April 2020 and February 2021 (post-COVID-19 cohort) was conducted investigating demographics, birth history, breastfeeding, and insurance status. Bivariate correlations evaluated the relationships between breastfeeding and the data points. RESULTS: Overall breastfeeding rates between the pre- (72.5%) and post-COVID-19 (74.6%) cohorts were similar. Medicaid patients were less likely to breastfeed pre-COVID-19 (r=20.13, P<.01) but were even less likely to breastfeed post-COVID-19 (r=20.23, P<.001). Privately insured patients were more likely to breastfeed pre-COVID- 19 (r=0.13, P<.01) and more so post-COVID-19 (r=0.22, P<.001). Black mothers were less likely to breastfeed pre- (r=20.16, P<.01) and post-COVID-19 (r=20.10, P<.05) when compared to other racial groups but were more likely to breastfeed post-COVID- 19 than pre-COVID-19. Multiparous mothers were less likely to breastfeed similarly in both cohorts, pre- (r=20.12, P<.05) and post-COVID-19 (r=0.15, P<.01). Factors that did not significantly influence breastfeeding included delivery type and White or Hispanic race. CONCLUSION: Uncertainty surrounding breastfeeding safety after the onset of COVID-19 did not significantly influence the prevalence of breastfeeding in our population. Private insurance and age positively influenced breastfeeding rates pre- and post-COVID-19, while Medicaid, Black race, and a higher number of pregnancies negatively influenced breastfeeding rates.

The Association Between Social Determinants of Health and Postpartum Length of Stay During the COVID-19 Pandemic

INTRODUCTION: To determine differences in cesarean postpartum length of stay (pLOS) before and during the COVID-19 pandemic as a function of social determinants of health. METHODS: Cesarean birth pLOS data between January 1 and June 30, 2020, were reviewed. Births after March 10, 2020, were considered pandemic births. Primary outcome was early discharge <5,760 minutes (96 hours). Rates of early discharge were analyzed by social determinants of health, with socially vulnerable patients defined as Black or Hispanic, publicly insured, or non-English-speaking. We compared rates of early discharge before and during the pandemic overall and then among socially vulnerable patients using probit regression analysis. RESULTS: There were 1,885 eligible deliveries: 694 before the start of the pandemic and 1,171 after. Median pLOS pre-pandemic was 5,696 (IQR, 4,686-6,060) minutes versus 4,655 (IQR, 3,897- 5,860) minutes during the pandemic. Of the eligible deliveries, 54% had early discharges pre-pandemic compared to 71% afterwards (P<.01). Overall, we found these variables predictive of early discharge pLOS: socially vulnerable (P<.01), payer type (P<.01), English ability (P<.01), and multiparity (P<.01). Race as a variable alone was not found to be significantly predictive of early discharge. CONCLUSION: Socially vulnerable patients are more likely to leave the hospital earlier than their counterparts both before and during the COVID-19 pandemic. Our findings suggest that increased early discharges fall disproportionately on socially vulnerable patients. Further research is needed to determine whether these results are due to provider bias or patient driven.

The Baseline, Clinical, and Laboratory Parameters of Breast Cancer Subjects Infected with COVID-19 in Medan, Indonesia

BACKGROUND: Cancer patients may be susceptible to COVID-19 infection due to decreased immune status. Breast cancer is the most common cancer in Indonesia, still has high admission, which increasing the risk of exposure to COVID-19. AIM: Thus, this study aimed to identify hospitalized breast cancer patients diagnosed with COVID-19 infection 1 year after the pandemic. METHODS: This is a cross-sectional study that was conducted in the Adam Malik General Hospital in Medan, Sumatera Utara, Indonesia. The enrolled subjects were those who previously histopathologically confirmed with breast cancer and having laboratory-confirmed COVID-19 infection The sources of baseline, clinical, and laboratory data were retrieved from the electronic medical records. Statistical analysis was performed using the SPSS 16.0 software (SPSS Inc., Chicago, IL, USA). RESULTS: A total of 17 female breast cancer subjects with COVID-19 infection were enrolled in this study. Mostly subjects were multiparity, highest education was junior high school, housewife, menopause, diagnosed in Stage IV, had metastasis in lung, and categorized luminal B with invasive cancer of non-special type. Most subjects showed mild clinical and radiological severity of COVID-19 infection. Low leukocyte, high neutrophil-to-lymphocyte, and high platelet-to-lymphocyte counts were significantly differed between alive and death outcome in the subjects. CONCLUSION: The baseline and clinical characteristics of female breast cancer subjects with COVID-19 infection were similar to general characteristics in the population. The parameters of leukocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte counts could be a valuable predictive parameters of mortality outcomes.

MATERNITY STAFF PERCEPTIONS OF EFFECTS ON ANTENATAL SCREENING AND SERVICES FOR MENTAL HEALTH AND DOMESTIC VIOLENCE DURING THE COVID-19 PANDEMIC: A SURVEY STUDY

Background: Domestic and family violence (DFV) and mental health screening are core components of antenatal care. However, the COVID-19 pandemic both increased the prevalence of DFV and mental health issues and resulted in many antenatal visits becoming telehealth. DFV and mental health screening were consequently often delayed, potentially resulting in insufficient time to establish support systems before birth. This study assessed pandemic effects on DFV and mental health screening from the perspective of local maternity service providers. Methods: Maternity staff (midwives, doctors, allied health) at three Sydney metropolitan hospitals were surveyed regarding perceived impact of COVID-19 on the delivery, timeliness, and quality of overall pregnancy care, DFV and mental health screening and care, and their telehealth perceptions. Responses by hospital and maternity care provider subtype were compared. Results: Of 109 respondents, most felt the pandemic negatively impacted overall pregnancy care (60%), DFV screening/care (57%), and mental health screening/care (57%), significantly more believing COVID-19 'extremely' negatively impacted DFV screening (p = 0.02). Staff at the hospital with highest sociodemographic diversity were significantly more concerned about DFV screening/ care. Nominated telehealth advantages e.g. reduced travel (69%) and clinic overcrowding (62%) were fewer than disadvantages including no physical examinations (90%), difficulties picking up non-verbal cues (84%), and certain questions unsafe (62%). Fiftysix percent believed telehealth should be used for some antenatal care for select women (low-risk, multiparous). Conclusions: Telehealth may have an ongoing limited role in maternity care in Australia for low-risk women. Staff considered those high-risk for physical and/or psychosocial reasons unsuited to telehealth care.

Clinical Manifestations Of Mild And Moderate Novel Coronavirus Disease In Pregnant Women In Epidemic Dynamics

Objective: To investigate the clinical manifestations of novel coronavirus infection (COVID-19) in pregnant women in epidemic dynamics. Materials and methods: This is a single-center prospective comparative study of three independent groups. The study enrolled 823 pregnant and postpartum women with mild to moderate COVID-19. Patients in Group 1 (n=186), Group 2 (n=412), and Group 3 (n=225) were hospitalized during the first, second, and third waves of the epidemic, respectively. The groups were comparable in age and gestational age. Results: During the epidemic, women of higher parity were exposed to infection. During the first, second, and third waves of the epidemic, 56.45%, 70.29%, and 78.22% of the multiparous women were infected, which could be explained by the possibility of the spread of infection among family members from children. Distinctive features of COVID-19 clinical manifestations included the predominance of pneumonia with scanty clinical symptoms in the second wave increase of exudative symptoms of the respiratory and gastrointestinal tract. The incidence of mild to severe disease progression was increasing: 1/186 (0.5%), 9/412 (2.2%), and 18/225 (8%) pregnant women during the first, second, and third waves, respectively. There was an increased risk of hospitalization for pregnant women with the moderate COVID-19 during the second and third waves (OR=3.9 (95% CI 1.7;8.8);p<0.05). There was an acceleration of the progression of the disease in female patients with each new phase of the epidemic: on the average, by day 9, 6, and 4 days during the first, second, and third waves, respectively, which may indicate an increase in the virus pathogenicity in the epidemic dynamics. Conclusion: In pregnant women, COVID-19 tends to increase the rate of progression and severity of the disease in the dynamics of the epidemic process.

Risk factor modeled microenvironment effects lymphatics activity and IBC invasiveness and progression

Background. Lymphovascular invasion (LVI) and breast tumor emboli within dermal and breast lymphatic vessels are prognostic for metastatic spread and poor outcomes, and are abundant in Inflammatory breast cancer (IBC). IBC is an aggressive breast cancer that presents suddenly with breast swelling and redness due to tumor emboli in lymphatics. Lack of breast-feeding and obesity are IBC risk factors. We sought to demonstrate the combinatorial effects of a high-fat diet and nursing on lymphatic function and compare these to IBC tumor induced changes in lymphatic function. We hypothesize that risk factors for aggressive breast cancer may alter lymphatic function in the normal gland prior to tumor initiation. Methods. Following two rounds of pregnancy in 20 multiparous SCID Beige immunocompromised mice, half of the mice were force weaned while half nursed pups. Prior to forced weaning, half of each of these groups were fed a high fat diet (HFD: 60 Kcal %, N = 10) while the other half received a low-fat diet (LFD: 10 Kcal %, N = 10). Consecutive dynamic near-infrared fluorescence (NIRF) lymphatic imaging was performed at 6-7 months (covid interruption) and 14 months after initiating the diet by injecting a near-IR fluorophore into the mammary fatpad and recording lymphatic pulsing over 8 minutes using V++. Matlab and ImageJ were used to quantify pulsing rates on the ventral lymphatics in each animal. Fatpads were Ssubsequently inoculated with SUM149 IBC cells and imaging was repeated 16 months post diet initiation. Lymphatic imaging over time by HFD vs LFD was further studied in nulliparous animals. Tissues were collected for further analyses. ResultsData analysis prior to tumor injection, demonstrated lymphatic pulsing (pulses/4 minutes) increased over time in HFD force weaned (HFFW) and HFD nursing (HFN) animals only (65.5 vs 72.6, P=0.059;60.1 vs 76.6, P=0.0099, respectively). Comparing HFFW and HFN to matched LFD groups (LFFW and LFN), at 14 weeks HFD was associated with increased pumping after forced weaning (62.3 vs. 72.6, P=0.074), and nursing (62.5 vs 76.6, P=0.0023). There was an increase in pulsing after tumor initiation (16 months after initiation of diet) in all groups (80.1, 84.1, 83.2, 82.4, P > 0.05 all comparisons to initial timepoint). In a separate experiment examining HFD (N=5) vs LFD (N=5) in nulliparous mice, lymphatic contractile activity increased in all animals over. time, average ventral lymphatic contractile frequency for LFD and HFD at week 8, 11 and 14 weeks after diet initiation were 5, 8.64, 15.9 pumps/4 mins vs 11.8, 18.5, 28.2 pumps/4 mins, (P = 0.01, 0.05, and 0.0005 respectively). ConclusionsHFD increased lymphatic pulsing rate over time to a significantly greater extent than LFD continuing over 14 months independent of reproductive and nursing status. Tumor initiation prompted further increased pulsing rates beyond that observed after HFD across all groups. The magnitude of the effect of HFD on lymphatic pulsing approached the rate after tumor initiation, while reproductive variables did not impact lymphatic pulsing. Further studies are warranted to demonstrate the relationship if any between lymphatic pumping pre-initiation and LVI after tumor initiation and examine the role of intervention on reducing LVI.

A case study project to establish effective delivery of physiotherapy-led pelvic health education among women during the childbearing year

Keywords: Pelvic Health Education, Childbearing Year Purpose: This project was undertaken as the final part of my MSc in Professional Practice at the University of Kent. The project aim was to establish whether current timing and method of physiotherapy-led pelvic health education (PPHE) was effective in engaging women with the education and advice provided. Methods: This project was undertaken using a case study methodology. Semi-structured interviews were undertaken via video (due to Covid-19 restrictions) with five purposively selected participants. Participants all met the bound ‘case’ of being postnatal, multiparous women who had experienced PPHE during their recent childbearing year, but not during previous childbearing years. These five interviews were then analysed using the inductive, four-stage thematic analysis framework (Green et al., 2007). Results: Thematic analysis identified three key themes: ‘ability to assimilate the PPHE message’, ‘timing of the PPHE message’ and ‘method of delivering the PPHE message’. Three factors- ‘assimilation’, ‘timing’ and ‘delivery of the message’- emerged from these themes as influences on the effectiveness of PPHE. ‘Assimilation’ was identified as the overarching influence, as timing and delivery of the message are less important if the information cannot be assimilated by the recipient. However, ‘timing’ and ‘delivery of the message’ remain significant influences and all three themes continue to relate to one another. Conclusion(s): ‘Assimilation’- Provision of education is not the same as client understanding and physiotherapists should consider women's current circumstances and past experiences, while utilising effective communication and appropriate attitudes that are suited to each individual situation. This may enhance women's ability to assimilate the PPHE message, and consequently, its effectiveness. ’Timing’- Consensus among the five participants was that antenatal provision of PPHE may be most effective. However, advantages and disadvantages of were identified for all timings across the childbearing year. Some topics within the scope of PPHE may also be better suited to specific timings, enabling assimilation of that particular information. Current timing of PPHE (acute postnatal with later postnatal follow-up at 4-6 weeks) was considered by some as effective. ’Delivery of the PPHE Message’- Consensus among the five participants was that PPHE was effective when provided verbally and supported with written information. Some participants suggested that alternative sources, such as apps, may aid effective provision. Group and individual provision of PPHE was also discussed by participants, and preferences varied depending on the timing of provision. For example, groups may be preferred antenatally, whereas one-to-one may be preferred acutely postnatally. Impact: The results of this project are not generalisable due to its methodology. However, the researcher has a greater understanding of factors influencing women's engagement with PPHE during the childbearing year. and will be used to inform practice and service development locally. This should lead to discourse among clinicians, managers and commissioners within maternity care regarding factors that influence the effectiveness of education provided during the childbearing year. It adds to the paucity of current evidence, and may inspire further research within physiotherapy and, potentially, midwifery. Funding acknowledgements: Funding for the module where I undertook project proposal was supported by the therapy department at Medway NHS Foundation Trust, and funding for the module that supported project execution was funded by Maidstone and Tunbridge Wells NHS Trust.

Characteristics of Pregnancy with Suspect and Confirmed COVID-19 at Sebelas Maret University Hospital Surakarta

In pregnancy, any changes within the body allows an increased risk of COVID-19 infection. This may cause risks of complications and unwanted maternal and fetal outcomes during pregnancy. This study aims to describe the characteristics of pregnant women with confirmed COVID-19 at UNS Surakarta Hospital. This study is a descriptive-analytic study that was conducted in 2020 among 45 patients who were treated at UNS Surakarta Hospital. This research aims to see the characteristics of pregnant patients with suspicion and confirmed cases of COVID-19 at UNS Surakarta Hospital. It was found that most of patients who were confirmed with COVID-19 were at high school level (59.09%). The types of occupation most often found in confirmed patients were housewives and private employees (40.91%). Most of the patients came from the group age of less than 30 years (63.64%). Patients with gestational age of above 28 weeks were more likely to be diagnosed with COVID-19 (81.82%) with the majority of them as multigravida patients (63.64%). Both suspected and confirmed COVID-19 pregnant patients may be asymptomatic or symptomatic. The characteristics of pregnant women with COVID-19 at the UNS Surakarta Hospital are mostly high school students, multiparous and work as a housewife.

Hair cortisol levels in pregnant women in relation with stress and pregnancy anxiety during a coronavirus pandemic

Background: The research aimed to examine the biological and psychological aspects of stress in pregnant women during a coronavirus pandemic. Specifically, we focused on hair cortisol levels that reflect the second and third trimester of pregnancy, perceived stress, pregnancy anxiety and fear of coronavirus. Methods: Research group consisted of 40 pregnant women (21 primiparous and 19 multiparous women). A battery of questionnaires consisting of PSS-10, PRAQ-R2, FCV-19S. Results: The results showed that pregnant women had significantly higher levels of hair cortisol in the 3rd trimester compared to the 2nd trimester (z=-2,850, p=0,004, d=-0,45). In pregnancy anxiety, multiparous women had significantly higher scores compared to primiparous women (t(28,81)=- 2,90, p=0,007, d=0,48 especially in the subscale concerns about changes in appearance. There was no relationship between fear of coronavirus and pregnancy anxiety (r=0,301, p=0,059). Conclusion: In the 3rd trimester demonstrated significantly higher levels of hair cortisol in pregnant women compared to with the 2nd trimester, and these findings are consistent with other studies.

Factors associated with cesarean section in patients with COVID

Objective: Experts have suggested that earlier delivery, even in non-severe cases, may be beneficial for patients with COVID, and that patients with COVID have higher rates of cesarean section. Factors associated with this increase are currently unclear. We sought to assess demographic and clinical factors associated with cesarean section (CS) in pregnant patients diagnosed with COVID. Study Design: Retrospective cohort of PCR-confirmed COVID positive pregnant patients in a single health system who delivered between March-December of 2020. Fetal death or planned CS excluded. Demographic data, pregnancy characteristics, and specifics of COVID infection ed and compared between patients who had vaginal delivery(SVD) and CS. Secondary analysis performed for symptomatic(sx) and asymptomatic(asx) patients separately. Bivariate statistics used to analyze the data. Multivariate Poisson regression performed to estimate adjusted relative risks. Results: Of 109 COVID positive patients, 19(17.4%) had planned CS. Of 91 with labor, 22(24%) had CS. CS was associated with overall BMI > 39.9(Table1). Non-private insurance and higher maternal age were associated with significantly higher rates of CS. Multiparity was not associated with SVD. Hypertensive disorders(PEC) of pregnancy and intraamniotic infection(IAI) were also associated with CS(Table 1). In regression analyses, symptomatic disease was associated with SVD [aRR 0.41, 95%CI 0.18, 0.93]. Relative risk of CS was 3-fold higher in patients with IAI[95% CI 1.6, 5.5], and 2.3-fold-higher in BMI > 39.9[95% CI 1.1, 5.0](Table2). Among sx patients, BMI > 39.9 was associated with 4-fold increase risk of CS;while in asx patients, IAI was associated with 4-fold increase risk of CS(Table 2). Maternal age and PEC were not associated with mode of delivery. Conclusion: Some known risk factors for severe and critical COVID, including higher BMI, were associated with CS in COVID positive pregnant patients. Symptomatic disease at time of delivery was more associated with SVD. [Formula presented] [Formula presented]