Coronavirus disease 2019 (COVID-19) and human pregnancy: a scoping review

Abstract

The coronavirus disease 2019 (COVID-19) is caused by the infection with a coronavirus (SARS-CoV-2). Pregnants present mild or moderate symptoms, with 5% presenting as a severe pneumonia. Prevalence and evolution of COVID-19 in pregnancy is similar to that of the general population, including the risk of maternal death. Radiography, computed tomography or ultrasound imaging are pivotal for the diagnosis and given the clinical suspicion of COVID-19 pneumonia. Lab findings include lymphocytopenia, thrombocytopenia, leukopenia, and the elevation of D-dimer and ferritin. To date, there is no specific treatment or vaccination for COVID-19; yet clinical management in pregnants is also similar to that of the general population, with prophylactic antibiotic treatment for bacterial pneumonia and oxygen support. Thromboprophylaxis should be indicated in severe cases, given that pregnancy is a hypercoagulable state that may be exacerbated by COVID-19. Hospital management should focus on treating the mother and protecting the newborn and the health personnel. Regarding COVID-19 and perinatal outcomes, premature deliveries are mainly associated to iatrogenic pregnancy termination through cesarean section aimed conserving maternal well-being. To date, vertical transmission to the fetus has not been demonstrated, neither intrauterine, nor through the birth canal. The virus has not been detected in vaginal fluids, or in breast milk. Breastfeeding may be allowed depending on maternal and neonatal health status. There are still many unknown issues, although there is a continuous update of scientific information related to pregnancy and COVID-19

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