AUTHOR=Cai Jianghui , Tang Mi , Gao Yu , Zhang Hongxi , Yang Yanfeng , Zhang Dan , Wang Han , Liang Hua , Zhang Rui , Wu Bo 

TITLE=Cesarean Section or Vaginal Delivery to Prevent Possible Vertical Transmission From a Pregnant Mother Confirmed With COVID-19 to a Neonate: A Systematic Review

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.634949

DOI=10.3389/fmed.2021.634949

ISSN=2296-858X

ABSTRACT=Background: The impact of mode of delivery on the infection rates of Coronavirus disease 2019 (COVID-19) in the newborn remains unknown. We aimed to summarize the existing literature on COVID-19 infection during pregnancy to evaluate which mode of delivery is better for preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate.
Methods: We performed a comprehensive literature search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, and the Chinese Biomedical Literature database (CBM) from December 31, 2019, to June 18, 2020. No language restrictions were applied. We screened abstracts for relevance, extracted data, and assessed risk of bias in duplicate. We rated the certainty of evidence using the GRADE approach. Primary outcome was severe acute respiratory syndrome coronavirus (SARS-CoV-2) test positivity in neonates born to mothers with confirmed COVID-19 following different modes of delivery. Secondary outcomes were neonatal deaths and maternal deaths. This study is registered with PROSPERO, CRD42020194049.
Results: Sixty-eight observational studies meeting inclusion criteria were included in the current study, with no randomized controlled trials. In total, information on mode of delivery, detailed neonatal outcomes, and SARS-CoV-2 status were available for 1019 pregnant women and 1035 neonates. Six hundred and eighteen (59.71%) neonates were born through cesarean section and 417(40.29%) through vaginal delivery. Probable congenital SARS-CoV-2 infections were reported in 34/1035 (3.29%) neonates. Of babies born vaginally, 9/417 (2.16%) tested positive compared with 25/618 (4.05%) born by cesarean. Of babies born vaginally, 0/417 (0.00%) neonatal deaths reported compared with 6/618 (0.97%) born by cesarean. Of women who delivered vaginally, 1/416 (0.24%) maternal deaths reported compared with 11/603 (1.82%) delivered by cesarean, two women died before delivery. Sensitivity analyses showed similar findings.
Conclusions: The rate of neonatal COVID-19 infection, neonatal deaths, and maternal deaths is no greater when the mother gave birth through vaginal delivery. The mode of birth should be individualized and based on a woman’s preferences alongside obstetric indications. Additional good-quality studies with comprehensive serial tests from multiple specimens and long-term follow-up of infants are urgently needed.