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Almeida JD, Tyrrell DAJ. The morphology of three previously uncharacterized human respiratory viruses that grow in organ culture.. Journal of General Virology. 1967:(1)175-178

Akhtar H, Patel C, Abuelgasimb E, Harky A. COVID-19 (SARS-CoV-2) Infection in pregnancy: a systematic review.. Gynecologic and Obstetric Investigation. 2020; 85:295-306 https://doi.org/10.1159/000509290

Chen H, Guo J, Wang C Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.. Lancet. 2020; 395:809-15 https://doi.org/10.1016/S0140-6736(20)30360-3

Chua MSQ, Lee JCS, Sulaiman S, Tan HK. From the frontline of COVID-19 – how prepared are we as obstetricians? A commentary.. British Journal of Obstetrics and Gynaecology. 2020; 127:786-788 https://doi.org/10.1111/1471-0528.16192

Cuerva MJ, Carbonell M, Palumbo GM Personal Protective Equipment during the COVID-19 pandemic and operative time in cesarean section: retrospective cohort study.. Journal of Maternal-Fetal and Neonatal Medicine. 2020; 14:1-4 https://doi.org/10.1080/14767058.2020.1793324

Dickson MJ, Willett M. Midwives would prefer a vaginal delivery.. British Medical Journal. 1999; 319 https://doi.org/10.1136/bmj.319.7215.1008a

Ferrazzi E, Frigerio L, Savasi V Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis.. British Journal of Obstetrics and Gynaecology. 2020; 127:1116-1121 https://doi.org/10.1111/1471-0528.16278

Romanis EC, Nelson AJ. Maternal request caesareans and COVID-19: the virus does not diminish the importance of choice in childbirth.. Journal of Medical Ethics. 2020; 0:1-6 https://doi.org/10.1136/medethics-2020-106526

COVID-19 and caesareans

02 December 2020
3 min read
 The possibility of vaginal transmission of SARS-CoV-2 from mother to newborn is understood to be low
Volume 28 · Issue 12

Abstract

George F Winter offers insight into the risk associated with carrying out caesarean sections on women who test positive for SARS-CoV-2 compared with those who do not

In their recent systematic review of SARS-CoV-2 in pregnancy, Akhtar et al (2020) considered 22 studies, which identified 156 pregnant women with SARS-CoV-2 and 108 neonatal outcomes. The most common maternal/fetal complications included intrauterine/fetal distress (14%) and premature rupture of membranes (8%). Neonatal clinical manifestations of SARS-CoV-2 included shortness of breath (6%), gastrointestinal symptoms (4%), and fever (3%). There was no evidence to support vertical transmission of SARS-CoV-2 infection to the unborn child (Akhtar et al, 2020). Similarly, when Chen et al (2020) investigated nine women who developed SARS-CoV-2 pneumonia in late pregnancy, they failed to find evidence for intrauterine infection caused by vertical transmission.

Significantly, all nine women investigated by Chen et al (2020) had undergone caesareans, so the possibility of vaginal transmission could not be evaluated. Further, Chua et al (2020) cite previous studies of long-established human coronaviruses – first visualised in the 1960s (Almeida and Tyrrell, 1967) while studying common cold agents – demonstrating the possibility of materno-fetal transmission, with human coronavirus detected in both maternal respiratory and vaginal swabs: ‘As such, we should aim to reduce the exposure of newborns to all maternal bodily fluids’ (Chua et al, 2020). And in their retrospective analysis of 42 pregnant women from Northern Italy with confirmed SARS-CoV-2 infection, Ferrazzi et al (2020) suggest that vaginal delivery may be associated with a low risk of intrapartum SARS-CoV-2 transmission to the newborn.

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