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Cesarean Section or Vaginal Delivery to Prevent Possible Vertical Transmission From a Pregnant Mother Confirmed With COVID-19 to a Neonate: A Systematic Review.

ABSTRACT: Background: The impact of delivery mode on the infection rates of Coronavirus disease 2019 (COVID-19) in the newborn remains unknown. We aimed to summarize the existing literature on COVID-19 infection during pregnancy to evaluate which mode of delivery is better for preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. Methods: We performed a comprehensive literature search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, and the Chinese Biomedical Literature database (CBM) from 31 December 2019 to 18 June 2020. We applied no language restrictions. We screened abstracts for relevance, extracted data, and assessed the risk of bias in duplicate. We rated the certainty of evidence using the GRADE approach. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity in neonates born to mothers with confirmed COVID-19 following different delivery modes. Secondary outcomes were neonatal deaths and maternal deaths. This study is registered with PROSPERO, CRD42020194049. Results: Sixty-eight observational studies meeting inclusion criteria were included in the current study, with no randomized controlled trials. In total, information on the mode of delivery, detailed neonatal outcomes, and SARS-CoV-2 status were available for 1,019 pregnant women and 1,035 neonates. Six hundred and eighteen (59.71%) neonates were born through cesarean section and 417(40.29%) through vaginal delivery. Probable congenital SARS-CoV-2 infections were reported in 34/1,035 (3.29%) neonates. Of babies born vaginally, 9/417 (2.16%) were tested positive compared with 25/618 (4.05%) born by cesarean. Of babies born vaginally, 0/417 (0.00%) neonatal deaths were reported compared with 6/618 (0.97%) born by cesarean. Of women who delivered vaginally, 1/416 (0.24%) maternal deaths were reported compared with 11/603 (1.82%) delivered by cesarean. Two women died before delivery. Sensitivity analyses and subgroup analyses showed similar findings. Conclusions: The rate of neonatal COVID-19 infection, neonatal deaths, and maternal deaths are no greater when the mother gave birth through vaginal delivery. Based on the evidence available, there is no sufficient evidence supporting that the cesarean section is better than vaginal delivery in preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. The mode of birth should be individualized and based on disease severity and obstetric indications. Additional good-quality studies with comprehensive serial tests from multiple specimens are urgently needed. Study registration: PROSPERO CRD42020194049.

SUBMITTER: Cai J

PROVIDER: S-EPMC7926203 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundWith the development of China's two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC.Material and methodsThis observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.ResultsThe durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.ConclusionsLabor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.

Project description:Background: It has not been fully elucidated whether the change of the uterus flora is correlated to impaired fecundity. This case-control study aimed to analyze the differences in uterus microbial flora between women with post-cesarean section (CS) scar diverticulum (PCSD) (CS group) and women after vaginal delivery (control group), exploring the correlation between differentially expressed microbial flora and inflammation. Methods: Infertile women who underwent hysteroscopy were enrolled in this case-control study. The swab samples were classified into four subgroups: CS cervix group, CS endometrium group, control cervix group, and control endometrium group. The total DNA obtained from 16 women (a total of 31 samples, the cervix or endometrium) was extracted for 16S recombinant DNA (rDNA) analysis. The Luminex platform was used to detect the abundance of 34 kinds of local inflammatory cytokines in 32 endometrium samples, and the correlation between microbial flora and inflammatory cytokines was analyzed. Results: The alpha and beta diversity analysis indicated that the microbial diversity was higher in the CS group compared to the control group, especially in endometrium tissues. The heatmaps revealed that the microbial flora structure differs at each level of the phylum-class-order-family-genus among the groups. The analysis of four of the most prominently changed microbial flora revealed that Lactobacillus in the cervix was significantly higher in the control group when compared with the cesarean section group (P < 0.05). Furthermore, Proteobacteria and Neisseriaceae had a higher abundance in the CS groups, especially in the cervical tissue (P < 0.05), while Staphylococcaceae increased only in the CS endometrium tissue (P < 0.05). Next, these women were re-divided into the high- and low-Staphylococcaceae, and the abundance of 34 kinds of local inflammation cytokines was compared between groups. It was found that there was a positive correlation between Staphylococcaceae and IL-2, and a negative correlation between Staphylococcaceae and IL-8 (P < 0.05). Conclusion: The present results suggest that the disrupted uterus microbiota composition in women with CS may be closely associated with local inflammation. The interplay between the microbiota and the immune system may be linked to clinical disorders. The potential mechanisms require further exploration.

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Cesarean Section or Vaginal Delivery to Prevent Possible Vertical Transmission From a Pregnant Mother Confirmed With COVID-19 to a Neonate: A Systematic Review.

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