Timing of delivery
According to the Expert Advice on Novel Coronavirus Infection in
Pregnancy and Puerperium [1, 3], issued by Chinese Medical
Association (CMA), the current consensus is that 2019-nCoV infection is
not an absolute indication for ending pregnancy, but that expedition of
delivery should be evaluated on a case-by-case basis. Maternal disease
progression, gestational age and fetal intrauterine status are primary
concerns. If maternal safety is assured, the timing of delivery should
primarily be determined by the gestational age.
After consulting with several obstetric experts in Wuhan city, who have
each dealt with COVID-19 infected pregnancies, we suggest that the
timing of delivery for COVID-19 infection complicated pregnancies should
be based on the following four principles:
1. If the infected pregnant women demonstrate obstetric indications for
early delivery, such as placenta previa, preeclampsia, malpresentation
etc., the timing of delivery should be based on the specific obstetric
circumstances.
2. If the infection of COVID-19 is not improved by treatment, early
delivery should be considered, even in the absence of obstetric
indications.
3. If the maternal COVID-19 infection is assessed as severe or critical,
according to the diagnostic criteria in the National Health and Medical
Commission’s New Coronavirus Infection Pneumonia Diagnosis and Treatment
Program (the fifth edition), early delivery needs to be considered to
ensure maternal safety, regardless of gestational age [4].
(a) Severe: Respiratory distress (RR≥30 beats / min), or mean oxygen
saturation ≤93% at rest, or arterial blood oxygen partial pressure
(PaO2) / oxygen concentration (FiO2) ≤300mmHg;
(b) Critical: Respiratory failure and mechanical ventilation required,
or shock, or combined with other organ failure and requires ICU
monitoring and treatment.
4. Whether mild or common COVID-19 infection is an indication for
delivery in the third trimester remains to be determined. During severe
epidemics, delivery after 32-34 gestational weeks may be beneficial to
the subsequent treatment and safety of these patients [5].
In summary, the current opinion of obstetric experts is that timing of
delivery should be determined by the maternal disease status. Maternal
safety is the priority; multidisciplinary consultation and the opinions
of critical care medical experts should be considered carefully.