Abstract
Our hospital is the only medical institution in Ibaraki Prefecture designated as a Type I infectious disease center and a regional perinatal maternal and child health care center, and we have been actively accepting COVID-19-positive pregnant women. In this report, we describe the perinatal outcomes of 58 pregnant women who were polymerase chain reaction/antigen positive for COVID-19 and were managed at our hospital between July 2020 and September 2022. The severity of illness was mild in 49 patients (84.5%), moderate I in 5 (8.6%), moderate II in 2 (3.4%), and false positive in 2 (3.4%). Obstetric complications included 5 cases of impending preterm delivery, 3 cases of gestational diabetes mellitus, and 1 case of impending miscarriage. Among 22 of the women who gave birth while positive for COVID-19, the mode of delivery was vaginal delivery in 18 cases, cesarean section in 3 cases, and emergency cesarean section in 1 case after transfer to another hospital. Four cases were delivered on day 4 of illness, 3 on day 5, and 1 each on days 1, 3, 7, 8, 14, 16, 21, 25, and 29; 4 cases were asymptomatic at delivery but had tested positive on admission or screening at the time of family positive identification. The mean gestational age was 38 weeks 4 days (range, 34 weeks 2 days to 40 weeks 6 days; standard deviation [SD], 10.164 days), mean birth weight was 3042 g (range, 2000-3680 g; SD, 401.268 g), mean Apgar scores at 1 and 5 min were respectively 7.90 (range, 6-9; SD, 0.514) and 8.86 (8-9, SD, 0.343), and umbilical arterial pressure (UVC) was 7.90 mmHg (range, XX-XX; SD, X.343), and umbilical artery blood gas pH was 7.304 (range, 7.120-7.360; SD, 0.058). In the 44 COVID-19-positive pregnant women managed from the sixth wave onward, 43 (97.7%) had mild disease and 1 (2.3%) was a false positive. Since COVID-19-positive pregnant women are considered to be at high risk during the perinatal period and require careful management, many medical institutions initially performed elective Cesarean sections. However, the perinatal outcomes were good in the 18 patients who delivered vaginally at our hospital, and it is not essential to choose cesarean section because of COVID-19 positivity alone, unless the patient is severely ill. The reason for the significant decrease in the disease severity from the sixth wave onward may be the influence of widespread vaccination or changes in the disease caused by mutant strains. While continuing to recommend vaccination of pregnant women, it is necessary to flexibly change the response according to the disease status of COVID-19 in the future.
