COVID-19 in maternal, perinatal and neonatal mortality in four locations in Bogota. Descriptive study

BACKGROUND // The multiple effects of the COVID-19 pandemic are beginning to be seen from the alteration of vital statistics figures. This is summarized in changes in the usual causes of death and excess attributable mortality, which can finally be seen in structural changes in the populations of the countries. For this reason, this research was created with the objective of determining the impact of the COVID-19 pandemic on maternal, perinatal and neonatal mortality in four locations in Bogota D.C. (Colombia).METHODS // A retrospective longitudinal investigation was carried out in which 217,419 mortality data were analyzed in the towns of Kennedy, Fontibon, Bosa and Puente Aranda in the city of Bogota -Colombia that occurred between the years 2018 to 2021, of which maternal (54), perinatal (1,370) and neonatal (483) deaths in order to identify a history of SARS-CoV-2 infection that could be related to the excess mortality associated with COVID-19. The data were collected from the open records of vital statistics of the National Statistics Department (DANE), where they were analyzed from frequency measures or central tendency and dispersion according to the types of variables. The specific mortality indicators related to maternal, perinatal and neonatal death events were calculated.RESULTS // A decrease in perinatal and neonatal mortality was evidenced since 2020, which was associated with the progressive de-crease in pregnancies in those same years;Additionally, a considerable increase in maternal deaths was observed for 2021 compared to the other years analyzed. The proportion of maternal deaths in 2020 and 2021 by 10% and 17%, respectively, were attributed to COVID-19.CONCLUSIONS // It is observed that the trend of maternal mortality is related to the increase in mortality from COVID-19, maternal deaths associated with COVID-19 occurred specifically in the zonal planning units that registered more than 160 cases of COVID-19 for the year 2021.

Milk donation and pandemic: human milk as a global good

The human milk donation has been an undervalued and very biasedly examined subject until relatively recently, in comparison with other types of human donation (organs, tissues, fluids), not being recognized its dimension of bodily altruistic and philanthropic act in the same way as other (mildly) analogous realities, as well as in its approach from the perspective of feminist and gender studies. On the other hand, although the COVID-19 pandemic and the various lockdown processes have had an onerous impact on human breastfeeding in general, we find data on the global increase in breastfeeding donation as a specific altruistic gesture during the pandemic in Spain and, even, on the decisions in the most complicated moments of the state of alarm about donating one's own milk in the tragedy of perinatal death. These altruistic donations contribute to carrying out the fulfillment of what has already been declared a human right and one of the social investments with the most advantageous cost-benefit index. The recognized, intensified and amplified need for milk banks in a pandemic brings to the fore in a specific way the condition of human milk as capital physiological resource, and, ultimately, as a global good. This article is dedicated to delving into a critical hermeneutics of milk donation in light of the pandemic and as an opportunity to rethink the studies of recent decades in this regard.

COVID-19 and pregnancy. Review and update / COVID-19 and pregnancy. Review and update / COVID-19 y embarazo. Revisión y actualización

RESUMEN Objetivo . Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en estos primeros 4 meses de 2020y el embarazo. Metodología . Revisión sistemática en las bases de datos PubMed y Google Scholar, hasta el 25 de abril de 2020. Se buscó artículos publicados relacionados con mujeres embarazadas infectadas con SARS-CoV-2. No hubo restricción de idioma. La búsqueda se extendió a las referencias de los artículos encontrados. Resultados . La enfermedad COVID-19 en mujeres embarazadas se caracteriza porque más del 90% de las pacientes evoluciona en forma leve, 2% requiere ingresar a las unidades de cuidados intensivos. Una muerte materna ha sido reportada. La prematuridad es alrededor de 25%, con predominio de recién nacidos prematuros tardíos; aproximadamente el 9% se complica con rotura prematura de membranas; la mortalidad perinatal es baja o similar a la de la población general y no se ha demostrado la transmisión vertical. Conclusiones . Los ginecólogos obstetras deben prepararse para atender cada vez más casos con COVID-19 y, por lo tanto, es necesario tener su conocimiento. La enfermedad evoluciona de la misma manera que en las no embarazadas, genera mayor prematuridad, no se ha demostrado la transmisión vertical, pero hay altas posibilidades de transmisión horizontal durante el parto vaginal.

ABSTRACT Objective : To search for all the information and available evidence on infection with SARS-CoV-2, a virus that appeared during the first 4 months of 2020, and pregnancy. Methods : Systematic review in PubMed and Google Scholar databases until April 25, 2020. We searched for published articles related to pregnant women infected with SARS-CoV-2. There was no language restriction. The search was extended to the references of the articles found. Results : In pregnant women with COVID-19, more than 90% of patients evolve mildly, 2% require intensive care. One maternal death has been reported. Prematurity occurs in approximately 25% of the cases, with predominance of late preterm infants; premature rupture of membranes presents in about 9%. Perinatal mortality is lower or similar to that of the general population, and vertical transmission has not been shown. Conclusions : Obstetrician-gynecologists must prepare to attend more cases with COVID-19 and therefore they need to know this disease. COVID-19 progresses similarly in pregnant and non-pregnant women, although it is associated to prematurity. While vertical transmission has not been demonstrated, horizontal transmission during vaginal birth is very likely.

Diabetes and pregnancy-2022 update.

With a share of 80%, gestational diabetes mellitus (GDM) is the most common form of hyperglycemia in pregnancy. Breastfeeding reduces the risk of type 2 diabetes;the longer the duration of breastfeeding, the greater the effect. Women who have had a premature birth or a stillbirth are at increased risk of dying prematurely themselves. The potential of pre-eclampsia prevention with low-dose acetylsalicylic acid in women with diabetes mellitus is far from being adequately used. Pregnant women reduce their risk of a severe course of the disease by being vaccinated against coronavirus disease 2019 (COVID-19). The still high rate of perinatal mortality in pregnancies with type 1 and type 2 diabetes may primarily be reduced by improving basic factors in periconceptional care. Two-stage screening for GDM reduces GDM prevalence and medicalization compared to one-stage screening without harm to mothers and their newborns. The approval of metformin for pregnant women since February 2022 does not mean that metformin is recommended as the primary pharmacotherapy for pregnant women.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Increase in maternal mortality and prematurity during the COVID-19 pandemic in Chile

Introduction: At the third year of the pandemic in Chile, the reported cases of COVID-19 reached 4,769,638 and 61,725 deaths (1.4%), with 93% of the population with a complete vaccination schedule (17,686,528). Aim: The purpose of this study is a brief communication on the impact of the SARS-CoV-2 pandemic on maternal, perinatal and prematurity mortality in Chile. Method: The national database of the Informatics Department of the Ministry of Health of Chile (DEIS), and the information reported from the official WHO website were used. All births, general and fetal deaths from January 1990 to September 2022 were included. A comparison is made between the basic maternal and perinatal indicators of the last 30 years and those of the years of the pandemic. Results: From March 2020 to September 2022, approximately 61,000 people died in Chile with a diagnosis associated with COVID-19, 17% of the general mortality for the period (approx. 364.000 deaths). An acceleration in the historical trend towards a decrease in the overall birth/death ratio was observed from 1.9 pre-pandemic to 1.4 during the third year of the pandemic. Maternal Mortality Ratio in 2020 (28.1 × 100,000) increased compared to 2019 pre-pandemic (19.1) or the simple historical trend line projected for 2020 (18.0) by 56%. Prematurity under 37 weeks of gestation increased from 8.5% (2019) to 9.5% for the years 2021 and 2022. Neonatal mortality in the first 28 days remained stable at 9 per thousand births during the 3 years of the pandemic and fetal mortality (>21 weeks) had a slight increase to 4.7 per thousand (year 2020) in relation to 3.4 in 2019. Conclusions: In Chile, an increase of approximately 56% in maternal mortality occurred in the first year of the SARS-CoV-2 pandemic. In the second year, a significant increase in late prematurity and a slight increase in fetal mortality were observed. These findings have been reported in the reviews and latest updates of the year 2022. © 2023

Spontaneous mid-trimester uterine rupture associated with fetal death in a young patient during COVID-19 pandemic: A case report.

Uterine rupture mostly occurs in the third trimester. However, it may occur at an earlier time with the same catastrophic consequences. The authors present a case report of uterine rupture occurring in the second trimester at 18 weeks gestation.

Maternal death due to serious group A streptococcal toxic shock syndrome reduced after the coronavirus disease pandemic in Japan.

Purpose: Serious group A streptococcal (GAS) infections and toxic shock syndrome (TSS) are rare conditions, but their rapid progression often results in death. The purpose of the present study was to clarify recent trend after the coronavirus disease (COVID-19) pandemic of GAS infection in Japan.Materials and Methods: Maternal death statistics were analyzed by the Japan Maternal Death Exploratory Committee.Results: Maternal deaths due to GAS-TSS accounted for 4.2% (n = 22) of all maternal deaths in Japan (n = 525) in the last 12 years. GAS-TSS remains one of the leading causes of maternal death after obstetric hemorrhage and hypertensive disorder. However, no maternal deaths due to GAS-TSS have been reported since the COVID-19 pandemic in Japan after the last death occurred in February 2020.Conclusions: The major change during this period was that most Japanese people wore facemasks at all times and did frequent disinfection. It is considered that the reduction in the incidence of GAS infections itself reduced the number of serious GAS-related maternal deaths. Wearing facemasks and frequent disinfection during pregnancy might to be recommended to prevent various infectious diseases including serious GAS infection, even after the COVID-19 pandemic era.

Placental pathological findings in coronavirus disease 2019: Perinatal outcomes.

INTRODUCTION: Placental alterations caused by severe acute respiratory coronavirus-2 (SARS-CoV-2) infection have already been described, but most studies used small sample groups and the difference according to the severity of the disease has not been verified. Our objective was to describe placental alterations in patients with coronavirus disease 2019 (COVID-19) and analyze the association of pathological placental findings with the clinical parameters of COVID-19 and perinatal results. METHODS: This was a nested study within a prospective cohort study involving 109 symptomatic pregnant women with COVID-19. The prevalence of observed placental alterations was described, and the associations of pathological findings with the clinical parameters of COVID-19 severity and with perinatal outcomes were assessed. RESULTS: The frequency of types of placental features was poor maternal vascular perfusion in 45% of cases, poor fetal vascular perfusion in 33.9%, hematogenous origin infection in 32.1%, and morphological changes corresponding to ascending infection in 21.1%. Hematogenous infection differed significantly according to COVID-19 severity (p = 0.008), with a prevalence ratio (PR) of 1.74 (95% confidence interval, 1.02-2.98) in the moderate COVID-19 group compared to the mild COVID-19 group. Among the perinatal outcomes, there was an unexpected inverse association between prematurity and placental infection of hematogenous origin, with lower rates of prematurity among cases with inflammation of hematogenous origin (p = 0.029). DISCUSSION: Moderate SARS-Cov-2 infection presented a higher prevalence of placental pathological findings. There was no association of placental findings with adverse perinatal outcomes.

COVID-19 INFECTION IN PREGNANCY: PLACENTAL HISTOPATHOLOGY AND PERINATAL OUTCOMES. CASE SERIES ANALYSIS

Background: SARS-CoV-2 enters the cell, by interacting with angiotensin-converting enzyme 2 (ACE-2) receptors, and affects a wide range of tissues and organs. Thus, ACE-2 receptors are found in placental tissues, as confirmed by the growing number of publications on the detection of virions in cotyledons. To date, the infectious involvement and localization of SARS-CoV-2 in placental tissue are described in a small series of cases and occur with a low frequency of 21%. The current data show that pregnant women infected with SARS-CoV-2 have a high risk of miscarriage, preeclampsia, preterm birth, and perinatal mortality. In view of the fact that constant efforts are being undertaken to study the placentas of patients who have experienced COVID-19 in order to further predict the effect of SARS-CoV-2 on pregnant women and newborns. Case report: This investigation analyzes data on three clinical cases of the course and outcomes pregnancy in patients after having experienced the novel coronavirus infection in early gestation. It presents in detail the nature of histopathological changes in placental tissue after SARS-CoV-2 infection. Conclusion: Based on the presented clinical cases, by comparing the findings and changes in the fetoplacental complex, there is an idea of its possible damage in pregnant women who have experienced SARS-CoV-2 infection in the early stages of gestation, regardless of the severity of the disease, as demonstrated by these clinical cases.

Impact of COVID-19 infection during pregnancy

Objective: to analyse the impact of the infection by SARSCoV- 2 in pregnant women, in terms of obstetric and perinatal consequences. Method: a descriptive, longitudinal, observational and retrospective study conducted in the Hospital Infanta Cristina (Parla, Madrid) with pregnant women infected with COVID-19 during the second half of their pregnancy and/or labour, since the start of the pandemic in Spain in March until December 2020. The association between the need for hospital admission and sociodemographic, anthropometric and pregnancy variables was analysed with the Student's T test, Mann Whitney U test, Pearson's Chi Squared and Fisher's Exact Test, with a p< 0.05 significance. Results: the study included 46 women;37% of them were Spanish, and their mean age was 31.3 years. The mean Body Mass Index (BMI) of the pregnant women was of 25.9 kg/m2, the majority were multiparous, and there was a predominance of asymptomatic pregnancies (54.23%) followed by symptoms such as cough and dyspnea (13%) and fever (13%). Four women required hospital admission, and one of them required Intensive Care. No significant differences were found according to hospital admission, although the gestational age at the time of delivery was lower among hospitalized women (38 vs. 39.5 weeks;p= 0.095) and their BMI was higher (29.7 vs. 25 kg/m2;p= 0.559). There were no perinatal deaths. Conclusions: infection by COVID19 does not seem to have any impact on pregnancy evolution or perinatal survival, although further research is required. © 2021 DAE Editorial, Grupo Paradigma. All rights reserved.

COVID-19 IN PREGNANT WOMEN OF SIBERIA AND THE RUSSIAN FAR EAST: 2-YEAR RESULTS OF THE PANDEMIC

Objective: To assess the morbidity, clinical course, maternal and perinatal outcomes of the new coronavirus infection COVID-19 in pregnant women in the Far Eastern and Siberian Federal Districts based on the results of 2020–2021. Materials and methods: The latest information on COVID-19 in pregnant women, women in labor and women who recently gave birth was analyzed. The findings were presented by the chief obstetricians-gynecologists of the regions in the period from March 11, 2020 to December 25, 2021. Results: A total of 27,210 cases of COVID-19 in pregnant, parturient and puerperal women were registered during the 2-year pandemic. The morbidity rate in these women was 2.4 times higher compared to the general population: 18988.0 vs 8019.5 per 100,000 people. SARS-CoV-2 infection was asymptomatic in 24.2% of mothers;it was mild in 50.0%, moderate in 21.3%, severe in 3.7%, and extremely severe in 0.8%. Pregnant women were more often hospitalized and stayed in intensive care and anesthesiology units compared to patients in the general population (5.5% vs 1.9%, p<0.001), and invasive mechanical ventilation (IMV) was used less often (0.7% vs 1.4%, p<0.05). There were 6,416 (23.6%) patients who gave birth to 6,512 children. Preterm delivery was in 18.5% (6.1% in Russia);cesarean sections – 38.8% (30.1% in Russia);operative vaginal delivery – 0.3% (0.13% in Russia). There were 81 (0.3%) deaths among mothers with COVID-19 (2.5% of cases among the population, p<0.001). Perinatal losses were registered in 156 cases (2.4%): stillbirths – 141 (2.17%), early neonatal mortality – 15 (0.23%). COVID-19(+) was revealed in 165 (2.5%) newborns. Conclusion: The incidence of COVID-19 in pregnant women was significantly higher than in general population during the 2-year pandemic, but the disease is characterized by more frequent hospitalization to intensive care and anesthesiology units, by lower demand for IMV and lower mortality rate. The second year of the pandemic was characterized by a more unfavorable course of COVID-19 in mothers and by an increase in the severe forms of the disease and indicators of maternal and perinatal mortality. The rates of preterm delivery and cesarean section in patients with COVID-19 were higher than in the general population. The incidence of SARS-CoV-2 virus isolation in newborns decreased significantly (from 6.2 to 2.5%). Further studies in this area are necessary. The morbidity rate of COVID-19 in pregnant women in Siberia and the Far East is higher than in the general population, but the disease is characterized by a lower need for IMV and a lower mortality rate. The rates of preterm birth and cesarean section are higher in patients with COVID-19 than in the general population. Finding of the SARS-CoV-2 RNA in newborns suggests vertical transmission of the infection. © A group of authors, 2022.

Obstetric and perinatal outcomes of pregnancies with COVID 19: a systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aimed at comparing obstetric and perinatal outcomes in laboratory-tested pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before delivering. METHOD: We performed a comprehensive systematic review of electronic databases for studies reporting pregnant women with and without SARS-CoV-2 infection, as determined by polymerase chain reaction (PCR) before delivery, during the pandemic period published up to June 25, 2021. Results are reported as mean difference (MD) or odds ratio (OR) and their 95% confidence interval (CI). RESULTS: Seventeen observational studies with low to moderate risk of bias, reported on 2,769 pregnant women with a positive SARS-CoV-2 PCR test and 13,807 with a negative test. Pregnant women with a positive PCR test delivered at an earlier gestational age (MD -0.19; 95% CI -0.36 to -0.02 weeks), smoked less (OR 0.75; 95% CI 0.61-0.94) and were associated with higher odds for preeclampsia (OR 1.30; 95% CI 1.09-1.54), NICU admissions (OR 2.37; 95% CI 1.18-4.76), stillbirths (OR 2.70; 95% CI, 1.38-5.29), and perinatal mortality (OR 3.23; 95% CI 1.23-8.52). There were no significant differences between positive and negative tested women in terms of nulliparity, multiple pregnancies, gestational diabetes, route of delivery, labor induction, preterm birth, infant birth weight, 5 min Apgar scores < 7, small-for-gestational-age infants and fetal malformations. Eleven studies included neonatal PCR SARS-CoV-2 testing which was performed on 129 infants, of which 20 were positive. CONCLUSION: Positive SARS-CoV-2 tested pregnant women had higher odds for preeclampsia/hypertensive disorders of pregnancy, NICU admissions, stillbirths and perinatal mortality.

Effects of Covid-19 Pandemic on First and Second Trimester Pregnancies

Objective: Main purpose of this study is to determine the effects of pandemic disease COVID-19 on first and second trimester pregnancies. Study Design: Cross-sectional/Descriptive study Place and Duration: Study was conducted at Gynae and Obs department of Jinnah International Hospital, Abbottabad for duration of 10 months from January to October, 2021. Methods: Total ninety pregnant women of ages 18- 35 years were presented in this study. All the presented women had pandemic disease COVID-19. Women had first and second trimester pregnancies. Patients' age, body mass index, parity, education status, socio-economic status and residency were calculated after taking informed written consent. Chi square and t-test was performed to differentiate between symptomatic and asymptomatic cases. Outcomes were assessed in terms of stress, depression among mothers and low birth weight of infants, perinatal death, preterm delivery, and C-section. Data was analyzed by SPSS 23.0 version. Results: Among 90 pregnant women 40 (44.4%) patients had first trimester pregnancies and 50 (55.6%) females had second trimester pregnancies. Mean age of the patients was 29.16±6.34 years and had mean BMI 22.13±5.16 kg/m2. Majority of the patients 52 (57.8%) had parity primipara. 44 (48.9%) patients were educated and majority of the patients were financially weak 62 (68.9%). 55 (61.1%) females were from urban areas. 54 (60%) females were symptomatic and 36 (40%) were asymptomatic. Frequency of depression among females was 68 (75.6%) and depression was found in 61 (67.8%) cases. Low birth weight was found in 22 (24.4%) cases, prevalence of preterm delivery was among 38 (42.2%) cases, number of C-section among cases was 47 (52.2%). Perinatal death was found in 7 (7.8%) cases. Majority of the patients with infants were instantly discharged after delivery 75 (83.3%) and 8 patients were admitted because of severity of pandemic disease. Conclusion: We determined in this study that Covid-19 among females with trimester first and second pregnancies were highly affected and had severity of psychotic disorders at start of disease but had lower adverse outcomes with low perinatal mortality. Majority of the females were recovered and discharged safely after delivery.

Early indirect impact of COVID-19 pandemic on utilisation and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya: A cross-sectional study

Y The paper determined the initial impact of COVID-19 pandemic on reproductive, maternal, newborn, child and adolescent health (RMNCAH) services in Kenya. Hospital data for the first four months (March-June 2020) of the pandemic and the equivalent period in 2019 were compared using two-sample test of proportions. Despite the global projections for worse indicators, there were no differences in monthly mean (+/- SD) attendance between March-June 2019 vs 2020 for antenatal care (400,191.2 +/- 12,700.0 vs 384,697.3 +/- 20,838.6), hospital births (98,713.0 +/- 4,117.0 vs 99,634.5 +/- 3,215.5), family planning attendance (431,930.5 +/- 19,059.9 vs 448,168.3 +/- 31,559.8), post-abortion care (3,206.5 +/- 111.7 vs 448,168.3 +/- 31,559.8) and pentavalent 1 immunisation (114,701.0 +/- 3,701.1 vs 110,915.8 +/- 7,209.4), p>0.05. However, there were significant increases in FP utilisation among young people (25.7% to 27.0%), injectable (short-term) FP method uptake (58.2% to 62.3%), caesarean section rate (14.6% to 15.8%), adolescent maternal deaths (6.2% to 10.9%) and fresh stillbirths (0.9% to 1.0%) with a reduction in implants (long-term) uptake (16.5% to 13.0%) (p<0.05). With uncertainty around the duration of the pandemic, strategies to mitigate against catastrophic indirect maternal health outcomes are urgently needed.

Antepartum stillbirth rates during the COVID-19 pandemic in Austria: A population-based study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has had dramatic effects on the pregnant population worldwide, increasing the risk of adverse perinatal outcomes. OBJECTIVE: To assess the incidence of antepartum stillbirth (aSB) during the COVID-19 pandemic in Austria. METHODS: We collected epidemiological data from the Austrian Birth Registry and compared the rate of aSB (i.e., fetal death at or after 24+0 gestational weeks) during the pandemic period (March-December 2020) and in the respective pre-pandemic months (2015-2019). RESULTS: In total, 65 660 pregnancies were included, of which 171 resulted in aSB at 33.7 ± 4.8 gestational weeks. During the pandemic, the aSB rate increased from 2.49‰ to 2.60‰ (P = 0.601), in contrast to the significant decline in preterm deliveries at or before 37 gestational weeks from 0.61‰ to 0.56‰ (relative risk [RR] 0.93; 95% confidence interval [CI] 0.91-0.96; P < 0.001). During the first lockdown, the aSB rate significantly increased from 2.38‰ to 3.52‰ (P = 0.021), yielding an adjusted odds ratio of 1.57 (95% CI 1.08-2.27; P = 0.018). The event of aSB during the COVID-19 pandemic was strongly related with increased fetal weight and maternal obesity. CONCLUSION: In Austria, there has been an overall increase in the incidence of aSB during the pandemic with a significant peak during the first lockdown.

Pregnancy Outcomes During the COVID-19 Pandemic in Canada, March to August 2020.

OBJECTIVE: Several studies have documented changes in the rates preterm birth and stillbirth during the COVID-19 pandemic. We carried out a study to examine obstetric intervention, preterm birth, and stillbirth rates in Canada from March to August 2020. METHODS: The study included all singleton hospital deliveries in Canada (excluding Québec) from March to August 2020 (and March to August for the years 2015-2019) with information obtained from the Canadian Institute for Health Information. Data for Ontario were examined separately because this province had the highest rates of COVID-19 in the study population. Rates and odds ratios with 95% confidence intervals (CIs) were used to quantify pregnancy-related outcomes. RESULTS: There were 136,445 and 717,905 singleton hospital deliveries in Canada (excluding Quebéc) in from March to August 2020 and between March and August 2015-2019, respectively. Rates of obstetric intervention declined in early gestation in 2020. Odds ratios for labour induction and cesarean delivery at <32 weeks gestation for March-August 2020 versus March-August in 2015 to 2019 were 0.84 (95% CI 0.74-0.95) and 0.92 (95% CI 0.85-1.00), respectively. Preterm birth rates increased in Canada (excluding Québec) from 6.42% in March-August 2015 to 6.74% in March-August 2019 but were unchanged in March-August 2020 (6.74%). Stillbirth rates were stable between March-August 2015 and March-August 2020. However, stillbirth rates peaked in Ontario in April 2020 due to higher rates of stillbirths at 20-27 and 37-41 weeks gestation. CONCLUSION: Changes in labour induction and cesarean delivery at early gestation and other perinatal outcomes during the period of March to August 2020 highlight the need to reconsider the use and impact of obstetric services in pandemics as well as the need for timely perinatal surveillance.

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.