The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.

BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.

Obstetric Outcomes of SARS-CoV-2 Infection in Asymptomatic Pregnant Women.

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13-3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.

Síndrome obstructivo congénito de las vías aéreas altas (síndrome de CHAOS). Causa infrecuente de hídrops fetal / Congenital high airway obstruction syndrome (CHAOS syndrome). An infrequent cause of fetal hydrops

La obstrucción congénita de las vías respiratorias altas corresponde a una malformación rara e infrecuente, cuyo diagnóstico prenatal ya ha sido descrito con anterioridad. Reconocerlo prenatalmente nos va a permitir ofrecer a la paciente las posibles opciones que haya que seguir, como conducta prenatal, opciones que van a poder mejorar sustancialmente los resultados finales, respecto a los casos no diagnosticados anteparto, en los que tendremos que aplicar maniobras de urgencia obligada, que presentarán un resultado imprevisible. Actualmente, la mayoría de los casos descritos en la literatura científica corresponden a embarazos con diagnóstico prenatal, lo que ha permitido la práctica de una cesárea programada llevada a cabo mediante el sistema EXIT (tratamiento intraparto ex útero), obteniendo resultados óptimos en alguno de ellos

Congenital high airway obstruction syndrome (CHAOS) is an uncommon malformation. Prenatal diagnosis of this malformation by ultrasound has previously been described. Prenatal identification will allow us to offer patients the possibility of prenatal counseling and to substantially improve perinatal outcomes in comparison with those in fetuses without a prenatal diagnosis, in which emergency maneuvers must be performed with unpredictable results. Currently, most of the cases described in the literature correspond to pregnancies with a prenatal diagnosis, which has allowed cesarean section to be successfully performed with the EXIT procedure (ex utero intrapartum treatment). Excellent results have sometimes been obtained