Determinants for Mode of Delivery in COVID-19 Pregnancy: A Single-center Retrospective Observational Study

ABSTRACT

Introduction: With the rise in COVID-19 cases round the world, we have the problem of COVID-19 positive pregnancies at hand. Various case series and reports around the world have shown a high incidence of cesarian deliveries in these patients. We have attempted to study the factors predicting an increase in cesarean section (CS) rates in COVID-19 positive pregnancies admitted to our institution. Methods: Retrospective analysis of all deliveries of COVID-19 affected pregnancies in a tertiary care center in north Kerala from 15 April 2020 to 31 October 2020. There were 253 deliveries during this period with 183 cases of cesarean and 70 vaginal deliveries. The data were entered in Microsoft Excel and analyzed with appropriate statistical software. Results: There was 71.42% cesarean section rate in women below 35 years of age compared to 100% in those above 35 years. The rate was higher among nullipara (77.77%) compared to 67.32% among multipara. There was also a positive correlation between cesarean with obesity [prepregnancy body mass index (BMI) more than 30]. There were 70.22% term cesareans compared to 89.28% in preterm. Induction of labor also seemed to increase rate of cesarean. Fetal growth restriction (88.88%) contributed more to cesarean rates unlike those without (71.06%) preterm rupture of membranes (PROM) and meconium staining of amniotic fluid (MSAF) was also seen to increase the possibility of cesarean. Cardiotocogram abnormalities (13.83%) were another important contributing factor. A total of 100% of patients with abnormal cardiotocogram (CTG) underwent cesarean section when compared to only 67.88% in those with normal CTG. In patients delivered while still positive, the incidence of cesarean section was 77.63%, while this reduced to 63.04% in those whom delivery was delayed till seronegativity achieved. A total of 75.95% cases were done in the morning. There were 19.67% cases of fetal distress which added to the cesarean numbers. Conclusions: We found increased maternal age, obesity, nulliparity, fetal growth restriction, PROM, MSAF as factors which contributed to increased cesarean section rates in COVID-19 positive pregnancies. Hence these pregnancies need careful monitoring. © The Author(s).