(Abstract)
OBJECTIVE:
to conduct a systematic review of the outcomes reported for pregnant patients with COVID 19.
DATA SOURCES:
we searched electronically Pubmed, Cinahl, Scopus using combination of keywords "Coronavirus and/ or pregnancy"; "COVID and/or pregnancy"; "COVID disease and/or pregnancy"; "COVID pneumonia and/or pregnancy. There were no restriction of languages in order to collect as much cases as possible.
STUDY ELIGIBILITY CRITERIA:
all pregnant women, with a COVID19 diagnosed with acid nucleic test, with reported data about pregnancy and, in case of delivery, reported outcomes.
STUDY APPRAISAL AND SYNTHESIS METHODS:
all the studies included have been evaluated according the tool for evaluating the methodological quality of case reports and case series described by Murad et al. RESULTS: 6 studies including 51 women were eligible for the systematic review. Three pregnancies were ongoing at the time of the report; of the remaining 48, 46 were delivered with a cesarean section and 2 vaginally; there was 1 stillbirth and 1 neonatal death.
CONCLUSIONS:
although vertical transmission of SARS-Cov2 has been excluded thus far and the outcome for mothers and fetuses has been generally good, the high rate of preterm cesarean delivery is a reason for concern. These interventions were typically elective, and it is reasonable to question whether they were warranted or not. COVID-19 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.
AJOG at a Glance:
A. Why was this study conducted?
COVID-19 is pandemic and will affect a large number of pregnant patients in the near future. Preliminary experience suggests that the outcome is often favorable, but it is unclear how and when these patients have been delivered.
B. What are the key findings?
The median gestational age was 36, 5 weeks (IQR 35-38), with 15 cases of preterm birth (39%); cesarean delivery was reported in 96% of the cases but the indications were not clearly described
C. What does this study add to what is already known?
Most patients with COVID-19 illness thus far have been delivered preterm by cesarean, in some cases electively. Whether this is warranted or not remains to be established.
妊娠中のCOVID-19（新型コロナウイルス感染症）:報告症例の系統的レビュー。 (Am J Obstet Gynecol. 2020.04.17)
(要約）
目的:
COVID19（新型コロナウイルス感染症）妊娠症例の転帰に関し系統的レビューした。
データソース:
キーワード「コロナウイルス（COVID疾患，COVID肺炎）および/または、妊娠」を組み合わせ、Pubmed、Cinahl、Scopusを検索した．可能な限り多くの症例を収集するため言語の制限は行わなかった。
研究の組入れ基準:
核酸検査でCOVID19（新型コロナウイルス感染症）と診断された妊婦で、妊娠または分娩に関する転帰が報告された症例。
研究の評価および統合方法:
Muradらの症例報告・症例集積の質を評価する方法に従い、研究を評価した。
結果:
6研究51症例が抽出された。報告時3例は妊娠継続中であり、残りの48例中46例は帝王切開、2例は経膣分娩で出産した（死産1例、新生児死亡1例）。
結論:
これまでのところSARS-Cov2（新型コロナウィルス）の垂直感染は除外され、母児の転帰は一般的に良好である。しかし高い早産期の帝王切開率は懸念すべき点である。帝王切開の一部は待機的手術であるが、待機手術で良いか否かを検討するのが妥当である。妊娠後期の呼吸不全を伴ったCOVID-19は複雑な臨床経過をとるであろう。
本論文のポイント
・なぜ本研究は行われたか？
→COVID-19はパンデミックであり、近い未来に多くの妊婦に影響を与える。先行的な経験では，転帰は概ね良好である。しかし、分娩方法と分娩時期は不明である。
・本研究の重要なポイントは？
妊娠期間は中央値 36.5週 (IQR 35-38)．早産15例(39%)。帝王切開 96%（適応の詳細は不明）
・本研究の新しい知見は？
約40%のCOVID-19妊娠は早産期に帝王切開され，その一部は待機的に行われている。これが正しいかどうかは今後の課題である。