• M Prabhu, K Cagino, K C Matthews, R L Friedlander, S M Glynn, J M Kubiak, Y J Yang, Z Zhao, R N Baergen, J I DiPace, A S Razavi, D W Skupski, J R Snyder, H K Singh, R B Kalish, C M Oxford, and L E Riley.
• Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA.
• BJOG. 2020 Nov 1; 127 (12): 1548-1556.

ObjectiveTo describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19).DesignProspective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing.SettingThree New York City hospitals.PopulationPregnant women >20 weeks of gestation admitted for delivery.MethodsData were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests.Main Outcome MeasuresPrevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology.ResultsOf 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001).ConclusionAmong pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery.Tweetable AbstractCOVID-19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.© 2020 Royal College of Obstetricians and Gynaecologists.

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