SARS-CoV-2 Infection and C-Section: A Prospective Observational Study.

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic posed significant risks to pregnant women, leading to increased obstetric interventions.
• Understanding the factors influencing cesarean section (C-section) rates in SARS-CoV-2-infected pregnancies is crucial for optimizing maternal and perinatal care.

Purpose of the Study:

• To investigate the reasons and risk factors for C-sections in pregnant women with SARS-CoV-2 infection.
• To analyze the perinatal outcomes associated with C-sections in this population using Robson's classification.

Main Methods:

• A prospective observational study involving 1704 pregnant women with SARS-CoV-2 PCR-positive results across 79 hospitals.
• Comparison of delivery outcomes between 1248 women with vaginal delivery and 456 women who underwent C-sections.
• Application of Robson's classification to categorize C-section indications, particularly in cases of pneumonia.

Main Results:

• C-section patients were older, had more comorbidities, and higher rates of in vitro fertilization and multiple pregnancies.
• Pneumonia was a significant risk factor for C-section (p < 0.001), with 41.1% of these being preterm deliveries (Robson's 10th category).
• Hemorrhagic events, hypertensive disorders, thrombotic events, and ICU admissions were higher in the C-section group (p < 0.001).

Conclusions:

• Maternal clinical conditions, particularly pneumonia, were associated with C-sections requiring early pregnancy termination in SARS-CoV-2-infected women.
• Uterine scarring and labor induction were predisposing factors for C-sections in asymptomatic or mildly symptomatic patients.
• The study highlights the complex interplay between SARS-CoV-2 infection, maternal health, and delivery mode, emphasizing the need for tailored obstetric management.