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Covid-19 in pregnancy 1-100

March 22, 2020

The 1st 100 primary sources. To May 15th 2020

For the 2nd 100 (click here).

This is not a source for advice on COVID-19. Neither professional nor lay. For that, in the UK, visit the government website here, or the RCOG here. In the US, CDC advice is here and NIH research updates here.

Nor is this a place to report cases. UK cases should be reported to the UK Obstetric Surveillance System (UKOSS) (click here) via each NHS Trust’s local UKOSS reporter. Early pregnancy cases, including miscarriages & ectopic pregnancies, should also be reported there.  There are also a number of other registries here.

However, some primary sources are confusing, in that hospitals overlap and pre-prints appear before full publication; there must be a risk of double counting.  Many are also difficult to access. Below are links to, & brief notes on, the primary scientific reports in English on Covid-19 in pregnancy and the newborn. They are in, roughly, reverse order. We will update. Click here for running totals. I’ve excluded reports solely in news media; they are collected here. For Nottingham University Covid-19 research group (click here). For a more general database of reviews & comments (click here).

June 25 update – study 43 withdrawn

May 15 update – study 100 added

Study 100 – Case report at 26 weeks (& 5 other cases) from Belgium

A woman was diagnosed with Covid-19 six days after giving birth at 26 weeks by Caesarean because of pre-eclampsia & HELLP syndrome at Cliniques Universitaires Saint Luc, in Brussels, Belgium, (click here or Lancet Piersigilli PIIS2352464220301401). The baby tested positive for SARS-CoV-2 but but otherwise behaved as expected for her gestational age. Subsequently five further women with Covid-19 delivered in the same hopsital. All babies were negative. Only one required NICU for unrelated reasons.  Citation: Fiammetta Piersigilli, Katherine Carkeek, Catheline Hocq, Bénédicte van Grambezen, Corinne Hubinont, Olga Chatzis, Dimitri Van der Linden, Olivier Danhaive COVID-19 in a 26-week preterm neonate. Lancet Child Adolesc Health 2020 Published Online May 7, 2020 https://doi.org/10.1016/S2352-4642(20)30140-1

May 14th update – studies 97-99 added

Study 99 – Placental pathology of 20 cases from Weill Cornell Medical Center

Of 20 women with Covid-19, five delivered by Caesarean and 15 vaginally (click here or Baergen Ped Pathol 1093526620925569). Three gave birth preterm and there was one set of twins. No baby outcomes are reported. These may overlap with other New York cases. Citation: Baergen, R. N., & Heller, D. S. (2020). Placental Pathology in Covid-19 Positive Mothers: Preliminary Findings. Pediatric and Developmental Pathology, 23(3), 177–180. https://doi.org/10.1177/1093526620925569

Study 98 – Ulcerative Colitis & COVID-19 in pregancy

A 26-year-old woman with known ulcerative colitis developed Covid-19 very early in pregnancy (fetal heartbeat & yolk sac on scan). She did not require admission to ITU or ventilation, and recovered, but the pregnancy miscarried (click here or UC and COVID pregnancy IBD izaa109 (1). She was treated at NY Langone so may also be included in studies 85 & 86. Citation: Melissa H Rosen, MD, Jordan Axelrad, MD, MPH, David Hudesman, MD, David T Rubin, MD, Shannon Chang, MD, Management of Acute Severe Ulcerative Colitis in a Pregnant Woman With COVID-19 Infection: A Case Report and Review of the Literature, Inflammatory Bowel Diseases, , izaa109, https://doi.org/10.1093/ibd/izaa109

Study 97 – Case report from Strasbourg

A 21 year old with severe Covid-19 at 23 weeks gestation (click here or Case rep Strasbourg PIIS0301211520302736) was admitted to ICU, treated with noninvasive ventilation and positional therapy and recovered. The pregnancy is ongoing. Citation: Vibert F, Kretz M, Thuet V, Barthel F, De Marcillac F, Deruelle P, Lecointre L, Prone positioning and high-flow oxygen improved respiratory function in a 25-week pregnant woman with COVID-19. European Journal of Obstetrics & Gynecology and Reproductive Biology (2020). doi: https://doi.org/10.1016/j.ejogrb.2020.05.022

May 13th update – studies 95 & 96 added (HT Shakila Thangaratinam).

Study 96 – another report of 5 cases from NY Presbyterian, Cornell

The same 5 cases as study 95 (click here). Citation: J. Justin Mulveya, Cynthia M.Magro, Lucy X Ma, Gerard J Nuovo, Rebecca N Baergen. Analysis of complement deposition and viral RNA in placentas of COVID-19 patients. Annals of Diagnostic Pathology Volume 46, June 2020, https://doi.org/10.1016/j.anndiagpath.2020.151530

Study 95 – placental pathology of the first 5 cases from NY Presbyterian, Cornell

Five patients with Covid-19, one delivered by Caesarean, & four vaginally (click here). All resulted in healthy, term deliveries, but no further baby details reported. All mothers recovered. Discussion, “at the time of writing these patients represent 100% of the confirmed COVID-19 deliveries at New York Presbyterian Hospital, Cornell Campus“. A different hospital from NY Presbyterian Allen (studies 27 & 41). Citation: Justin Mulveya, Cynthia M.Magro, Lucy X Ma, Gerard J Nuovo, Rebecca N Baergen. A mechanistic analysis placental intravascular thrombus formation in COVID-19 patients. Annals of Diagnostic Pathology Volume 46, June 2020, https://doi.org/10.1016/j.anndiagpath.2020.151529

May 12 Update – studies 93 & 94 added

Study 94 – Case report from Portugal

A 31-year-old woman with Covid-19 at 38 weeks had a vaginal birth in a level 3 hospital in Porto (click here or PIIS030121152030258X). The baby was isolated and not infected. Not the same case as study 74 because delivered vaginally. Citation: Polonia-Valente R, Moucho M, Tavares M, Vilan A, Montenegro N, Rodrigues T. Vaginal delivery in a woman infected with SARS-CoV-2 – the first case reported in Portugal. European Journal of Obstetrics & Gynecology & Reproductive Biology (2020), doi: https://doi.org/10.1016/j.ejogrb.2020.05.007

Study 93 – 9 cases from North Middlesex Hospital, London

Out of 9 hospital cases, 1 was preterm, 1 had a vaginal birth, and 1 baby was infected (click here or Govind EJOG London PIIS0301211520302578). Presumably all 9 included in study 92. Citation: A. Govind, et al., Re: Novel Coronavirus COVID-19 in late pregnancy: Outcomes of first nine cases in an inner city London hospital, Eur J Obstet Gynecol (2020), https://doi.org/10.1016/j.ejogrb.2020.05.004

May 11th update. Keelin’s found study 91’s figures. And study 92, the first report from UKOSS, added.

Study 92 – UKOSS

The first report (May 11th 2020) from the UK Obstetric Surveillance System (UKOSS) Covid-19 registry of 427 pregnant women admitted to hospital with confirmed Sars-CoV-2 from all 194 UK obstetric units (click here). Twice the size of all previous studies combined. No overlaps. Too important to summarise. Read it. Citation: Marian Knight, Kathryn Bunch, Nicola Vousden, Eddie Morris, Nigel Simpson, Chris Gale, Patrick O’Brien, Maria Quigley, Peter Brocklehurst, Jennifer J Kurinczuk. Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS) in press.

9 June update. Published in BMJ online (click here or bmj.m2107.full for published version).

May 10th update – Studies 88 to 91 added.

Study 91 – Alleged visualisation of the SARS-Cov-2 virus invading the placenta

Case report of a woman, aged 40, with severe Covid-19 requiring ventilation, and later delivery at 28 weeks gestion by Caesarean section (click here or ALGARROBA). The mother recovered and was discharged on day 10. The baby tested negative. The paper is missing its figures, but there’s a video clip (click here). Update 11th May (click here for the figures). Author affiliations suggest she was cared for at NYU Langone Health, Winthrop Hospital. Citation: Gabriela N. ALGARROBA,, Patricia REKAWEK, Sevan A. VAHANIAN, Poonam KHULLAR, Thomas PALAIA, Morgan R. PELTIER, Martin R. CHAVEZ, Anthony M. VINTZILEOS. Visualization of SARS-CoV-2 virus invading the human placenta using electron microscopy. Am J Obstet Gynecol. in press. 

Study 90 – ICNARC 8th May update

The 8th May update (click here or ICNARC COVID-19 report 2020-05-08.pdf) contains 21 currently, and 30 recently, pregnant women critically ill with Covid-19. Of these 9 and 16 respectively had received advanced respiratory support. Excluded from running totals.

Study 89 – Case report from San Fancisco

A 34-year-old woman developed Covid-19 at at 28 weeks of gestation (click here or Acute_Respiratory_Distress_Syndrome_in_a_Preterm.97348). Her deteriorating condition necessitated delivery by Caesarean section. She required 10 days mechanical ventilation. Neonatal swabs for SARS-CoV-2 and COVID-19 immunoglobulin (Ig) G and IgM were negative. Citation: Blauvelt CA, Chiu C, Donovan AL, Prahl M, Shimotake TK, George RB, Schwartz BS, Farooqi NA, Ali SS, Cassidy A, Gonzalez JM, Gaw SL. Acute Respiratory Distress Syndrome in a Preterm Pregnant Patient With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. 2020 May 8. doi: 10.1097/AOG.0000000000003949. [Epub ahead of print]

Study 88 – 13 pregnant women with Covid-19 in intensive care in Sweden

Of 53 women aged 20-45 years with SARS-CoV-2 reported to the Swedish Intensive Care Registry, 13 were either pregnant or <1 week postpartum (click here or ). Citation: Collin J, Byström E, Carnahan A, Ahrne M. Pregnant and postpartum women with SARS-CoV-2 infection in intensive care in Sweden. Acta Obstet Gynecol Scand. 2020 May 9. doi: 10.1111/aogs.13901. [Epub ahead of print]

May 9th update – Study 87 added

Study 87 – Case report from Detroit

A 36-year-old developed severe Covid-19 at 23 weeks gestion, and required 7 days ventilation (click here or 1-s2.0-S2214911220300473-main DETROIT). She survived, and the pregnancy is ongoing. She was treated at the Henry Ford Hospital, Detroit. Citation: L. Hong, N. Smith, M. Keerthy, et al., Severe COVID-19 infection in pregnancy requiring intubation without preterm delivery: A case report. Case Reports in Women’s Health (2020), https://doi.org/10.1016/j.crwh.2020.e00217

May 8th update – studies 84-86 added

Study 86 – 64 pregnant women with severe Covid-19 in 12 US hospitals

Of 64 pregnant women with severe (n=44) or critical (n=20) Covid-19, one had a cardiac arrest, 19 were intubated, none had ECMO, and 13 remain hospitalized, but none have died (click here or COVID_CC_post_review_04302020). Of the 32 who have given birth 24 were delivered by Caesarean. One baby was infected, but no babies died. The women had been admitted to 12 unnamed hospitals between March 5 & April 20. From the author affiliations the hospitals probably include Pennsylvania, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia; Perelman School of Medicine, University of Pennsylvania; St. Luke’s University Health Network, Bethlehem; Crozer Chester Medical Center, Chester; Einstein Healthcare Network, Philadelphia. New York Montefiore Medical Center/Albert Einstein College of Medicine, Bronx; New York University Langone Medical Center; Icahn School of Medicine at Mount Sinai; New Jersey Rutgers Robert Wood Johnson Medical School, New Brunswick; Saint Barnabas Medical Center, Livingston; Ohio TriHealth-Good Samaritan Hospital, Cincinnati. Citation: Rebecca A.M. Pierce-Williams, Julia Burd, Laura Felder, Rasha Khoury, Peter S. Bernstein, Karina Avila, Christina A. Penfield, Ashley S. Roman, Chelsea A. DeBolt, Joanne L. Stone, Angela Bianco, Adina R. Kern-Goldberger, Adi Hirshberg, Sindhu K. Srinivas,, Jenani S. Jayakumaran, Justin S. Brandt, Hannah Anastasio, Meredith Birsner, Devon S. O’Brien, Harish M. Sedev, Cara D. Dolin, William T. Schnettler, Anju Suhag, Shabani Ahluwalia, Reshama S. Navathe, Adeeb Khalifeh, Kathryn Anderson, Vincenzo Berghella. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol. In press.

Study 85 – 32 women from New York University, Langone Health

Between March 1 & April 20, 32 women with Covid-19 gave birth at NYU Langone Health. Eleven had placental or membrane swabs tested of which 3 were positive. Of the 11 women 3 women with critical, and one with severe disease, were delivered by caesarean. All the rest, one severe disease, the remainder mild, gave birth vaginally. None of the infants tested positive or demonstrated symptoms of COVID-19 infection. Citation: Christina A. Penfield, Sara G. Brubaker, Meghana A. Limaye, Jennifer Lighter, Adam J. Ratner Kristen M. Thomas, Jessica Meyer, Ashley S. Roman. Detection of SARS-COV-2 in Placental and Fetal Membrane Samples. Am J Obstet Gynecol. In press.

Study 84 – Twins from St Thomas’s, London.

A woman with twins developed Covid-19 at 32 weeks (click here or Twins abruption STH london AJOGMFM-20-1053).  She was delivered by Caesarean section due to suspected abruption. Both babies tested negative for COVID-19. Citation: Katy Kuhrt, Jess McMicking, Surabhi Nanda, Catherine Nelson Piercy, Andrew Shennan. Placental abruption in a twin pregnancy at 32 weeks’ gestation complicated by COVID-19, without vertical transmission to the babies. Am J Obstet Gynecol in press.

May 7th update – studies 82 & 83 added. Study 81 comment revised; this is probably the same ECMO case as previously reported in studies 3 and 57.

Study 83 – 82 women in New York

Of 82 pregnant women with Covid-19, admitted to seven hospitals within an unnamed large hospital group in New York State, eight (9.8%) were admitted to intensive care (click here or L20-081), a similar proportion to non-pregnant women of reproductive age. No clinical outcomes are reported. Study 49 by the same group, reporting Covid-19 admissions in an unnamed 14 hospital group, is cited. Although not explicitly stated, it seems likely that the cases overlap. Citation: Matthew J. Blitz, Amos Grünebaum, Asma Tekbali, Eran Bornstein, Burton Rochelson, Michael Nimaroff, Frank A. Chervenak. Intensive Care Unit Admissions for Pregnant and Non-Pregnant Women with COVID-19. Am J Obstet Gynecol in press. 

Study 82 – 9 screen-positive women at The Portland, London.

Between March 27 & April 20th, The Portland, a private hospital in London, performed planned Caesareans for 129 NHS patients.  All were screened for SARS-CoV2, and 9 (7%) were positive, of whom only one was symptomatic (click here or SARS-CoV-2_and_pregnancy_letter_line_nbrs).  None of the positive asymptomatic women developed COVID-19 symptoms. The outcome of the symptomatic woman was not reported. All babies were well at birth and at discharge. Citation: Asma KHALIL, Robert HILL, Shamez LADHANI, Katherine PATTISSON, Pat O’BRIEN. SARS-CoV-2 in pregnancy: symptomatic pregnant women are only the tip of the iceberg. Am J Obstet Gynecol. in press.

May 6th update – study 79 (HT Shakila Thangaratinam) & studies 80 & 81 added.

Study 81 – Case report from Xiaolan People’s Hospital of Zhongshan

A 31 year old woman developed Covid-19 at 35 weeks gestation (click here, or ijgo.13189). The mother’s condition deteriorated rapidly, requiring ventilation, and later ECMO. The baby was delivered by emergency caesarean but died within two hours. The mother survived. This is the second pregnant woman requiring ECMO reported from China. Zhongshan People’s Hospital disambiguates as grid.476868.3 and no patients from Zhongshan have previously been reported, not in Study 3, nor in studies 55 or 57. This case is therefore likely original. Citation: Li J, Wang Y, Zeng Y, Song T, Pan X, Jia M, He F, Hou L, Li B, He S, Chen D. Critically ill pregnant patient with COVID-19 and neonatal death within two hours of birth. Int J Gynaecol Obstet. 2020 May 5. doi: 10.1002/ijgo.13189.

Revised comment 7 May. The city of Zhongshan is in the province of Guangdong. Study 3, which initially mentioned “patient 6”, a 31 year old woman at 34 weeks on ECMO, whose baby had died, included one patient from Guangdong. Study 57 described a 32-year-old woman at 35 weeks from Zhongshan, Guangdong whose baby had died soon after birth. At the time of the report that woman had been weaned off ECMO but remained an inpatient. Despite the minor inconsistencies in maternal and gestational ages, it is likely that all three reports refer to the same woman. If so there has only been one pregnant woman with Covid-19, treated with ECMO, and reported from China. She survived.

Study 80 – 13 women from Renmin Hospital, Wuhan,

These 13 women were cared for in Renmin Hospital of Wuhan University, Wuhan (click here for abstract. Full text not yet available). Citation: Wu Y, Liu C, Dong L, Zhang C, Chen Y, Liu J, Zhang C, Duan C, Zhang H, Mol BW, Dennis CL, Yin T, Yang J, Huang H. Coronavirus disease 2019 among pregnant Chinese women: Case series data on the safety of vaginal birth and breastfeeding. BJOG. 2020 May 5. doi: 10.1111/1471-0528.16276. [Epub ahead of print]

Study 79 – Case report from Turin

A 28-year-old woman with Covid-19 gave birth vaginally at 37 weeks (click here or PIIS0301211520302025). The baby tested positive but was otherwise well. The baby was born at Sant’Anna Hospital, Turin, Italy. Turin is outside Lombardy; this case was not included in studies 32 and 64. Citation: A. Carosso, et al., Pre-labor anorectal swab for SARS-CoV-2 in COVID-19 pregnant patients: is it time to think about it? Eur J Obstet Gynecol (2020), https://doi.org/10.1016/j.ejogrb.2020.04.023

May 5th update – study 78 added

Study 78 – Case report from Fondazione Policlinico Universitario Agostino Gemelli

A 23 weeks pregnant woman with Covid-19 admitted on 10th March to Fondazione Policlinico Universitario Agostino Gemelli (click here or PIIS0002937820304683). Obstetric ultrasound revealed a normally grown fetus with normal amniotic fluid and Doppler parameters. No further pregnancy details. Likely to be one of the women with ongoing pregnancy in study 76Citation: Inchingolo R, Smargiassi A, Moro F, Buonsenso D, Salvi S, Del Giacomo P, Scoppettuolo G, Demi L, Soldati G, Testa AC, The Diagnosis of Pneumonia in a Pregnant Woman with COVID-19 Using Maternal Lung Ultrasound. American Journal of Obstetrics and Gynecology (2020), doi: https://doi.org/10.1016/j.ajog.2020.04.020.

May 4th update – Studies 76 & 77added

Study 77 – ICNARC 1st May update

The 1st May update (click here or ICNARC COVID-19 report 2020-05-01) contains 20 currently, and 27 recently, pregnant women critically ill with Covid-19. Of these 7 and 14 respectively had received advanced respiratory support. Excluded from running totals.

Study 76 – 7 cases from Fondazione Policlinico Universitario Agostino Gemelli  Rome, Italy

Of seven pregnant women with Covid-19, one miscarried at 7 weeks, 4 pregnancies are ongoing, and 2 were delivered, both by Caessarean (click here or  buonsenso Rome AJP s-0040-1710541). Both babies had many swabs tested but were well. Citation: Danilo Buonsenso, Simonetta Costa, Maurizio Sanguinetti, Paola Cattani, Brunella Posteraro, Simona Marchetti, Brigida Carducci, Antonio Lanzone, Enrica Tamburrini, Giovanni Vento, Piero Valentini. Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Am J Perinatol https://doi.org/10.1055/s-0040-1710541.

May 2nd update – Studies 73 to 75 added

Study 75 – 10 vaginal births in Zhongnan Hospital

Among 88 pregnant women with confirmed or suspected COVID-19 admitted to the obstetric isolation ward of Zhongnan Hospital of Wuhan University between January 20 and March 2, ten delivered vaginally (click here or LIAO ijgo.13188). All 7 tested neonates were negative. Three babies were not tested. These ten cases don’t overlap with those in studies 1, 13 & 56, who had all delivered by Caesarean, but probably overlap with studies 55 and 57. Not added to running totals. Citation: Jing Liao, Xiaoyan He, Qing Gong, Lingyun Yang, Chunhua Zhou, Jiafu Li. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID‐19 pandemic. First published: 29 April 2020 https://doi.org/10.1002/ijgo.13188

Study 74 – Case report from Portugal

A healthy woman with “occasional dry cough” tested positive at term and was delivered by Caesarean (click here or Lyra Portugal case13883-54440-1-PB. The baby was uninfected and both did well. Citation: Joana LYRA, Rita VALENTE, Marta ROSÁRIO, Mariana GUIMARÃES. Acta Med Port 2020 xxx;33(AOP):xxx-xxx ▪ https://doi.org/10.20344/amp.13883

Study 73 – 28 women from The Central Hospital of Wuhan

Among pregnant women cared for in the Central Hospital of Wuhan between 15 January to 15 March 2020. (click here or Quancheng IJID 1-s2.0-S1201971220302800-main) there were 17 Caesareans, 5 vaginal births, 4 medical abortions and 2 ongoing pregnancies. Total 30 [sic]. They include one set of twins. No babies were infected, and no mothers or babies died. The authors admit that these data are included in Study 55. They are probably also included in study 57, & overlap with Study 39.  Not added to running totals. Citation: Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, Gang Y, Shirong L, Zhen W, GuoPing X, Lei Z, The sixth batch of Anhui medical team aiding Wuhan for COVID-19, Coronavirus disease 2019 in pregnancy, International Journal of Infectious Diseases (2020), doi: https://doi.org/10.1016/j.ijid.2020.04.065

May 1st update – Study 72 added

Study 72- Miscarriage in Switzerland

A 28-year-old with Covid-19 miscarried at 19 weeks gestation at Lausanne University Hospital (click here or second trimester miss jama_baud_2020_ld_200040 ). Placental swabs were positive for SARS-CoV-2. The mother’s outcome was not reported. Citation: David Baud, Gilbert Greub, Guillaume Favre, Carole Gengler, Katia Jaton, Estelle Dubruc, Léo Pomar. Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection. JAMA. Published online April 30, 2020. doi:10.1001/jama.2020.7233

30th April update – Studies 68 to 71 added

Study 71 – Follow-up of 4 women from Study 6

Patients 12-15 in Study 6 from Tongji were still in hospital at the time of the report. This (click here or YANG L_Tongji_AJR) describes follow-up till March 30th. All four had been discharged and were still pregnant. Citation: Lin LiDehan Liu, Lian Yang. Follow-Up Information About the Four Pregnant Patients With Coronavirus Disease (COVID-19) Pneumonia Who Were Still in the Hospital at the End of Our Study American Journal of Roentgenology: W1-W2. 10.2214/AJR.20.23247

Study 70 – Maternal death from Iran

A 22-year-old developed Covid-19 at 32 (or possibly 30) weeks gestation, and was treated at Imam Khomeini Hospital of Mazandaran University, Sari, Iran (click here or ZAMANIYAN M_Iran_Prenatal diagnosis). She was delivered by Caesarean section, but on day 10 required ventilation, and died on day 15. The first baby swabs were negative, but amniotic fluid and later baby swabs were positive. Apart from developing a fever the baby did well. The clinical details suggest that she was not included in Study 67. Citation: Marzieh Zamaniyan, Aghdas Ebadi, Samaneh Aghajanpoor Mir, Zahra Rahmani, Mohammadreza Haghshenas, Setareh Azizi. Preterm delivery in pregnant woman with critical COVID‐19 pneumonia and vertical transmission. Prenatal diagnosis. First published:17 April 2020 https://doi.org/10.1002/pd.5713

Study 69 – Case report from Missouri

A patient with Covid-19 at 33 weeks gestation required intubation and ventilation for 11 days (click here or Kelly false negative SARSCOV2 AJOGMFM). The baby was delivered by Caesarean. The mother has been extubated, and is recovering. The baby tested negative and is well. From author affiliations the patient was probably cared for in Barnes Jewish Hospital in St Louis. Citation: Jeannie C Kelly, Michael Dombrowksi, Micaela O’neil-Callahan, Annessa S Kernberg, Antonina I Frolova, Molly J Stout.  False-Negative COVID-19 Testing: Considerations in Obstetrical Care. American Journal of Obstetrics & Gynecology MFM Available online 28 April 2020, https://doi.org/10.1016/j.ajogmf.2020.100130

Study 68 – 55 pregnant women in the UK ISARIC report

This preprint from the  International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) (click here or ISARIC UK 2020.04.23.20076042v1.full) includes 16,749 hospitalised UK patients with COVID-19. This represents 14.7% of people who have tested positive for COVID-19 in the UK, most of whom have not required hospital admission, and 28% of admissions with COVID-19. 55/963 (6%) of the women of reproductive age were pregnant. This is similar to the estimated proportion of pregnant women in the community. Pregnancy was not associated with mortality. Citation: Annemarie B Docherty, Ewen M Harrison, Christopher A Green, Hayley E Hardwick, Riinu Pius, Lisa Norman, Karl A Holden, Jonathan M Read, Frank Dondelinger, Gail Carson, Laura Merson, James Lee, Daniel Plotkin, Louise Sigfrid, Sophie Halpin, Clare Jackson, Carrol Gamble, Peter W Horby, Jonathan S Nguyen-Van-Tam, Jake Dunning, Peter JM Openshaw, J Kenneth Baillie, Malcolm Gracie Semple. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. medRxiv 2020.04.23.20076042; doi: https://doi.org/10.1101/2020.04.23.20076042

29th April update.

Study 67 – 7/9 maternal deaths with severe disease in Iran

This preprint from Am J Obstet Gynecol (click here or Aagaard_W20-2021) reports 9 pregnant women with severe Covid-19 treated between mid-February & mid-March 2020 in Iran. The hospitals, exact ages and exact dates of admission and death were concealed to protect anonymity. Seven mothers died, one recovered and one remains seriously ill.  Of the babies 6 died (incl one set of twins) and 5 survived (incl one set of twins). These cases may overlap with those in studies 23 & 43. Citation: Sedigheh Hantoushzadeh, Alireza A. Shamshirsaz, Ashraf Aleyasin, Maxim D Seferovic, Soudabeh Kazemi Aski, Sara E. Arian, Parichehr Pooransari, Fahimeh Ghotbizadeh, Soroush Aalipour, ,Zahra Soleimani, Mahsa Naemi, Behnaz Molaei, Roghaye Ahangari, Mohammadreza Salehi, Atousa Dabiri Oskoei, Parisa Pirozan, Roya Faraji Darkhaneh, Mahboobeh Gharib Laki, Ali Karimi Farani, Shahla Atrak, Mir Mohammad Miri, Mehran Kouchek,  Seyedpouzhia Shojaei, Fahimeh Hadavand, Fatemeh Keikha, Maryam Sadat Hosseini, Sedigheh Borna, Shideh Ariana, Mamak Shariat, Alireza Fatemi, Behnaz Nouri, Seyed Mojtaba Nekooghadam, Kjersti Aagaard. Maternal Death Due to COVID-19 Disease. Am J Obstet Gynecol. In press. https://doi.org/10.1016/j.ajog.2020.04.030

28 April update – Studies 64-66 added

Study 66 – A review from Brazil of 9 maternal deaths due to Covid-19

This preprint from AJOG refers to nine maternal deaths (click here or Maternal deaths AJOG L20-082. Two from Iran had been reported in Study 23 below. Of the five from Brazil, two post-partum deaths in women delivered by Caesarean section, are referenced to the Brazilian Ministry of Health. No further details are given. The other three are sourced to Brazilian newspapers. The first link provided (click here) goes to the newspaper Folha de Londrina, but not to the report of the maternal death. The 2nd link (click here) describes the death of Viviane Albuquerque, age 33 from Pernambuco, at 32 weeks gestation (added here). The third link (click here) is broken. The final two deaths occurred in Mexico. The first is attributed to the Mexican Ministry of Health. The second to a newspaper report. The link provided (click here) goes to a report of two maternal deaths from Covid-19. Added to the news reports here.  Not added to the running totals. Citation:  Amorim MMR, Takemoto MLS, Fonseca EB. Maternal Deaths with Covid19: a different outcome from mid to low resource countries? Am J Obstet Gynnecol. In press. 

Study 65 – 5 patients with severe disease from Philadelphia

This preprint from AJOG (click here or Hirshberg AJOG L20-083) describes five women in Phaladelphia, who required ventilation. Three were delivered by Caesarean, and two remain undelivered. No mothers or babies died, but one woman remains severely ill. Citation: Adi HIRSHBERG,, Adina R. KERN-GOLDBERGER, Lisa D. LEVINE,, Rebecca PIERCE-WILLIAMS, William R. SHORT, Samuel PARRY, Vincenzo BERGHELLA, Jourdan E. TRIEBWASSER, Sindhu K. SRINIVAS. Care of critically ill pregnant patients with COVID-19: a case series. Am J Obstet Gynecol. In press. 

Study 64 – 42 cases from Lombardy

This pre-print in BJOG (click here or 1471-0528.16278) describes the 42 cases in study 32 in much more detail. They were cared for in 6 hub hospitals: Milan-Mangiagalli and Sacco, Bergamo Pope Giovanni XXIII; Brescia-Civil Hospital; Monza-S. Gerardo Hospital/MBBM Foundation; Pavia-San Matteo, and 6 spoke hospital Milan-Melloni and S. Giuseppe; Seriate-Bolognini; Treviglio-Civil
Hospital, The Maternity Hospital of Padua and the Maternity Hospital of Modena. Citation: Enrico Ferrazzi, Luigi Frigerio, Valeria Savasi, Patrizia Vergani, Federico Prefumo, Santa Barresi, Stefano Bianchi, Elena Ciriello, Fabio Facchinetti, Maria Teresa Gervasi, Enrico Iurlaro, Alessandra Kustermann, Giovanna Mangili, Fabio Mosca, Luisa Patanè, Donata Spazzini, Arsenio Spinillo, Giuseppe Trojano, Michele Vignali, Antonella Villa, GianVincenzo Zuccott,i Fabio Parazzini, Irene Cetin. Vaginal delivery in SARS‐CoV‐2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG 27 April 2020 https://doi.org/10.1111/1471-0528.16278

27 April update – Studies 58-63 added

Study 63. ICNARC 24 April update

The 24 April update (click here or ICNARC COVID-19 report 2020-04-24) contains 20 currently, and 25 recently, pregnant women critically ill with Covid-19. Of these 5 and 7 respectively had received advanced respiratory support. Excluded from running totals.

Study 62. Case report from Hefei city

A 22 year old woman with asymptomatic COVID-19 was delivered by Caesarean on Feb 11, 2020 at the No 2 People’s Hospital of Hefei City (click here). The baby tested negative and both did well. Although this hospital does not appear on www.grid.ac this is the first report from Hefei City, which is 373 km from Wuhan. Citation: Lu D, Sang L, Du S, Li T, Chang Y, Yang XA. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol. 2020 Apr 24. doi: 10.1002/jmv.25927. [Epub ahead of print]

Study 61. 32 Covid-19 screen positive women from New York Winthrop Hospital

Out of 161 pregnant women admitted in labour to New York University Winthrop Hospital between March 30 & April 12, and screened for Covid-19, 32 were positive, of whom 11 were symptomatic (click here or AJOG_Screening_all_pregnant_women vintzileos). Of 29 neonates tested all were negative with three results pending. No clinical outcomes reported. Citation: William S VINTZILEOS, Jolene MUSCAT, Eva HOFFMANN, Duc VO, Nicole S JOHN, Rosanne VERTICHIO, Anthony M VINTZILEOS, Screening all pregnant women admitted to Labor and Delivery for the virus responsible for 2 COVID-19 American Journal of Obstetrics & Gynecology. in press. 

Study 60. Preterm labour in a patient with Covid-19

A woman from South Carolina developed Covid-19 at 23 weeks, was treated for suspected preterm labour at 24 weeks, and recovered. The pregnancy is ongoing at 27 weeks (click here or Browne Aj Peri preterm labour). Citation: Paul C. Browne, Jennifer B. Linfert, Emilio Perez-Jorge. Successful Treatment of Preterm Labor in Association with Acute COVID-19 Infection. Am J Perinatol. Published Online 24 April 2020. DOI: 10.1055/s-0040-1709993

Study 59. Two patients with Covid-19 & negative amniocentesis

Two women from Tongji Hospital, Wuhan developed Covid-19 in the first trimester and underwent amniocentesis in the second (click here or Yu SARS COV2 in AF Lancet Infect Dis 20). Both specimens were negative. Both cases may overlap with those in Studies 55 and 57. Not added to running totals. Citation: Nan Yu, Wei Li, Qingling Kang, Wanjiang Zeng, Ling Feng, Jianli Wu. No SARS-CoV-2 detected in amniotic fluid in mid-pregnancy. Lancet Infect Dis 2020 Published Online April 22, 2020 https://doi.org/10.1016/S1473-3099(20)30320-0

Study 58. First case report from India

An asymptomatic woman at 38+6 weeks gestation tested positive for COVID-19 (click here or Sharma India ijgo.13179). She delivered by Caesarean section, and her breast-fed baby tested negative on day 7. Both recovered. Citation: K. Aparna Sharma, Rajesh Kumari, Garima Kachhawa, Anjolie Chhabra, Ramesh Agarwal, Akash Sharma, Neerja Bhatla. Management of the first patient with confirmed COVID‐19 in pregnancy in India: From guidelines to frontlines. Int J Gynecol Obstet. In press. doi:10.1002/ijgo.13179 

25 April update – Studies 56 & 57 added.

Study 57. 116 cases from 25 hospitals in China

This preprint from Am J Obstet Gynecol (click here) includes 116 mothers with Covid-19 (65 lab confirmed, 51 clinically diagnosed), of whom 8 had severe disease. None died. 99 mothers had delivered 100 babies (one set of twins) of whom one died. This paper claims to be an “an expanded series that have included 33 published cases.16,18-20”. Their reference 16 is our Study 1, ref 18 is our Study 38 and ref 19 is our Study 6a.  Their reference 20 is as follows:  “Lei D, Wang C, Li C, et al. Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases. Chin J Perinat Med 2020,23:doi: 10.3760/cma.j.cn113903-20200216-00117.” Although cited in a number of reviews we have so far been unable to find the original source.

The patients were collected from 25 hospitals within and outside Hubei province, between January 20 and March 24, 2020. Three recruiting hospitals, all from Wuhan, listed in the supplementary material, overlap with those in study 55 (appendix table s1). These are Zhongnan Hospital of Wuhan univerisity, the Central Hospital of Wuhan, and Tongi Hospital, all multiple reporters of Covid-19 in pregnancy. Thus it is likely that, in addition to the studies cited, this series overlaps considerably with Study 55. Not added to running totals. The patient requiring ECMO came from Zhongshan, Guangdong. She is probably the same woman reported as treated with ECMO from the city in Study 3. She survived. Citation: Yan J, Guo J, Fan C, Juan J, Yu X, Li J, Feng L, Li C, Chen H, Qiao Y, Lei D, Wang C, Xiong G, Xiao F, He W, Pang Q, Hu X, Wang S, Chen D, Zhang Y, Poon LC, Yang H, Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases, American Journal of Obstetrics and Gynecology (2020), doi: https://doi.org/10.1016/j.ajog.2020.04.014.

Study 56. Seven mothers and babies from Zhongnan Hospital

All mothers had Covid-19 and were delivered by Caesarean. No mothers or babies died (click here). 6/7 babies had a range of swabs taken, all of which were negative. Due to probability of duplication with Studies 1 and 55, not included in running totals. Citation. Pu Yang, Xia Wang, Pin Liu, Cong Wei, Bingyan He, Junwen Zheng, Dongchi Zhao. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19 Journal of Clinical Virology Volume 127, June 2020, 104356.  https://doi.org/10.1016/j.jcv.2020.104356 

22 April update – studies 53-55 added.

Study 55. 118 cases with Covid-19 from Wuhan collected by the National Health Commission of China

This regional series, published in New Engl J Med, of women treated between December 8, 2019, & March 20, 2020, was extracted by the National Health Commission of China, which stores the medical records of all 50 designated hospitals in Wuhan city (click here). Nineteen of the 50 hospitals had reported cases (Appendix table S1, click here). No mothers died, and apart from 3 spontaneous abortions, 2 ectopic pregnancies, & 4 induced abortions, no babies died. At the next running total update we will replace all other cases from hospitals in Wuhan with these data. Citation: Lian Chen, Qin Li, Danni Zheng, Hai Jiang, Yuan Wei, Li Zou, Ling Feng, Guoping Xiong, Guoqiang Sun, Haibo Wang, Yangyu Zhao, Jie Qiao, Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. New Engl J Med. April 17, 2020 DOI: 10.1056/NEJMc2009226

Study 54. Six confirmed, & two suspected cases from the Maternal & Child Health Hospital, Wuhan

The eight patients from the Maternal and Child Health Hospital of Hubei Province, Wuhan, between January 23 and February 10, 2020 (click here) probably overlap with other reports from the same hospital. They are not included in the running totals. Citation: Wu, C., Yang, W., Wu, X. et al. Clinical Manifestation and Laboratory Characteristics of SARS-CoV-2 Infection in Pregnant Women. Virol. Sin. (2020). https://doi.org/10.1007/s12250-020-00227-0

Study 53. Case report from Las Palmas de Gran Canaria, Spain

A 44-year-old woman developed Covid-19 at 29+2 weeks gestation (click here or 1-s2.0-S0014256520301120-main (002)). She was treated at Hospitalario Universitario Insular Materno Infantil, and required mechanical ventilation and delivery by caesarean. Both mother and baby recovered. [Spanish. Google translate] Citation: González Romero D, Ocampo Pérez J, González Bautista L, Santana-Cabrera L. Pronóstico perinatal y de la paciente embarazada con infección por COVID-19. Revista Clínica Española Available online 17 April 2020, https://doi.org/10.1016/j.rce.2020.04.006

20 April update Studies 48 – 52 added

Study 52. ICNARC update 17 April

This update of the UK Intensive Care National Audit & Research Centre (ICNARC) database (click here or ICNARC COVID-19 report 2020-04-17.pdf (1) mentions 16 currently, and 21 recently, pregnant women with Covid-19 who are or had been critically ill. Three & six respectively had received advanced respiratory support. Excluded from running totals.

Study 51. Case report from the British American Hospital, Lima, Peru

A 41 year old women with severe Covid-19 requiring ventilation was delivered by caesarean section at 33 weeks gestation (click here or Alzamora Am J Perintal Apr 18 . The baby was isolated but a nasopharyngeal swab taken at 16 hours was positive for SARS-COV-2. The baby was ventilated for 12 hours, and later, at age 6 days, developed mild respiratory symptoms. The mother’s serology is reported on day 4, but otherwise the maternal outcome is not reported. It is presumed that she recovered. Citation: Maria Claudia Alzamora, Tania Paredes, David Caceres, Camille M. Webb, Luis M. Valdez, Mauricio La Rosa. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. Am J Perinatal. Online April 18. DOI https://doi.org/10.1055/s-0040-1710050. 

Study 50. A severe case of Covid-19 from the Good Samaritan Hospital. Cincinnati, Ohio

A 39 year old woman presented at 31 weeks gestation with severe Covid-19. She required ventilation. After 8 days on ITU she was delivered by Caesarean section for fetal bradycardia. The baby was intubated on NICU for three days, and isolated for 14. Amniotic fluid and nasopharyngeal swabs were negative. The mother remains on synchronized intermittent mandatory ventilation. The clinical details and patient age indicate that this is not patient no. 42 (click here) reported in the Ohio newspapers. Citation: Schnettler WT, Al Ahwel Y, Suhag A, Severe ARDS in COVID-19-infected pregnancy: obstetric and intensive care considerations American Journal of Obstetrics & Gynecology MFM (2020), doi: https://doi.org/10.1016/j.ajogmf.2020.100120.

Study 49. 62 pregnant women from a 14 hospital group in New York State

Over four weeks to March 29th, 62 out of 3064 pregnant women attending an unnamed 14 hospital group in New York State tested positive for SARS-COV2 (click here).  No further details given, & since they may overlap with other New York Cases, not included in running totals. Citiation: Tekbali A, Grünebaum A, Saraya A, McCullough L, Bornstein E, Chervenak FA. Pregnant versus non-pregnant SARS-CoV-2 and COVID-19 Hospital Admissions: The first 4 weeks in New York, American Journal of Obstetrics and Gynecology (2020), doi: https://doi.org/10.1016/j.ajog.2020.04.012.

Study 48. One case from Toronto & one from Clamart, France.

Two cases (click here or COVID coagulopathy Canada jth.14856)  One delivered in Mount Sinai Hospital, Toronto, Canada, and one in Antoine Béclère hospital in Clamart, France. Citation: Evangelia Vlachodimitropoulou Koumoutsea, Alexandre J. Vivanti, Nadine Shehata, Alexandra Benachi, Agnes Le Gouez, Celine Desconclois, Wendy Whittle, John Snelgrove, Kinga Ann Malinowski. COVID19 and acute coagulopathy in pregnancy. J Thrombosis Haemostasis. 17 April 2020. https://doi.org/10.1111/jth.14856

19 April update Study 47 added.

Study 47. Report of 13 pregnant women in ITU from Santé Publique France 

Thirteen pregnant women have been admitted to intensive care in France (click here or COVID19_PE_20200418 Report in French). None have died. Not included in running totals. Citation: COVID-19: epidemiological update of April 16, 2020 Santé Publique France.

18 April update. Study 46 (16 April update of NethOSS) added, & study 42 (prev NethOSS data) removed from running totals

Study 46. 107 women from the Netherlands Covid-19 registry

This 16 April update of NethOSS (click here), accessed 18 April 2020, contains the following. 5/91 women with brief additional details were admitted to intensive care. 25 have given birth, eight by Caesarean. No mother or baby has died. Citation: See Study 42. Available here. Accessed 18 April. 

16 April update. Studies 44 & 45 added. HT @Belinda_J_Lowe for study 45. We’ve also done some housekeeping today. Study 13 probably overlaps with study 1, so S13 has been removed from running totals. Study 3 includes 13 patients from multiple centres, both in and outside Hubei province, who may overlap with other studies. 12 mothers (3 undelivered) and 9 babies therefore removed from the running total. Only S3, case 6, woman on ECMO & baby stillborn & preterm, does not appear to have been reported elsewhere, so remains in the running totals.

Study 45. Case report from Bond University, Australia

Mother age 31, with mild Covid-19 confirmed by testing at 40w+0d (click here or full text preprint here). Spontaneous labour at 40w+3d. Ventouse birth. Baby breast fed. Covid-91 neg swab at 24 hours. Mother and baby well. This case report from Bond University Hospital, Southport, Queensland, is the first from Australia. Citation: Lowe B, Bopp B. COVID‐19 vaginal delivery – a case report. ANZOG 15 April 2020. https://doi.org/10.1111/ajo.13173

Study 44.  42 suspected & 13 confirmed cases from Tongji Hospital

Thirteen pregnant women all seen at Tongji Hospital grid.412793.a between Jan 20 & Mar 5, 2020 (click here). Four delivered vaginally and nine by Caesarean. All mothers had mild disease and none died. The baby details for the Covid and non-Covid mothers are reported together. These cases probably overlap with previous reports from Tongji hospital so not included in running totals. Citation: Hui yang, Guoqiang Sun, Fei Tang, Min Peng, Ying Gao, Jing Peng, Hui Xie, Yun Zhao, Zhichun Jin, Clinical Features and Outcomes of Pregnant Women Suspected of Coronavirus Disease 2019, Journal of Infection (2020), doi: https://doi.org/10.1016/j.jinf.2020.04.003 

14 April update Studies 41 – 43 added.

Study 43. A maternal death from Covid-19 in Iran

25 June update. This paper has been withdrawn because the case, as we had suspected, had also been included in Study 67. Study 67 had been submitted first, albeit to another journal, so the authors judged that it had priority. Details on Retraction Watch (click here)

A 27 year old woman was transferred to Vali-e-asr Hospital at 30 weeks gestation (click here or Karami Travel med Apr 11 2020) with severe respiratory failure. She required intubation and ventilation. A few hours later she delivered a stillborn baby vaginally, and a few hours after that she died. Post-mortem on the mother confirmed SARS-Cov-2 in the lungs. No further details are given about the baby.  Vali-e-asr Hospital does not appear on Grid.ac but is part of Zanjan University of Medical Sciences. grid.469309.1. This is the first academic report (as opposed to unconfirmed news reports) of a maternal death due to Covid-19.  Citation: Parisa Karami, Maliheh Naghavib, Abdolamir Feyzib, Mehdi Aghamohammadic, Mohammad Sadegh Novinc, Ahmadreza Mobaiend, Mohamad Qorbanisania, Aida Karamia, Amir Hossein Norooznezhad. Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Medicine and Infectious Disease, in press. https://doi.org/10.1016/j.tmaid.2020.101665

Study 42. 89 women from the Netherlands Covid-19 registry

This is the first Covid-19 in pregnancy registry report of which we are aware. It has not been formally published, but is available here and regularly updated.  Using Google translate, the 9 April version, accessed 14 April 2020 contains the following. 5/89 pregnant women with Covid-19 have been admitted to intensive care. 19 women have given birth, four by Caesarean. No mother or baby has died. Updated by study 46 & removed from running totals. Citation: The Nederlandse Vereniging voor Obstetrie en Gynaecologie (Dutch Association for Obstetrics and Gynecology) (NVOG). Registratie COVID-19 positieve zwangeren in NethOSS (Update registration COVID-19 positive pregnant women in NethOSS). Available https://www.nvog.nl/actueel/registratie-van-covid-19-positieve-zwangeren-in-nethoss/ Accessed 14 April. 

Study 41. 33 women from NY Presbyterian & Columbia

These 33 women with Covid-19 delivered infants at the New York–Presbyterian Allen Hospital and Columbia University Irving Medical Center between March 22 & April 4, 2020 (click here). They presumably include the 18 women with Covid-19 previously reported as having delivered in the same two hospitals (Studies 14 & 27), as well as some of the women who were at the time undelivered in those two series. Since no birth details are given, these cases have not been included in running totals. Citation: Sutton, D, Fuchs, K, D’Alton M, Goffman D. Universal Screening for SARS-CoV-2 in Women Admitted for Delivery. New Engl J Med April 13, 2020. DOI: 10.1056/NEJMc2009316

13 April update Studies 39 and 40 added.

Study 40. 17 pregnant women from Renmin

These 17 women with Covid-19, all delivered by Caesarean section in Remnin hospital (click here or Khan Clin Micro Infect 27 Mar), almost certainly are the same women as in studies 6a & 12. They have not been added to the running totals. Citation: Khan S, Jun L, Nawsherwan Siddique R, Li Y, Han G, Xue M, Nabi G, Liu J, Association of COVID-19 infection with pregnancy outcomes in healthcare workers and general women, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2020.03.034 

Study 39. 23 pregnant women from the Central Hospital Wuhan

23 pregnant women with COVID-19 from the Central Hospital of Wuhan. Wu ijgo.13165 Three patients terminated the pregnancy in the first trimester. Of the other 20, 18 delivered by Caesarean and two vaginally. There was one set of twins. No neonates were infected. This is the first report from this hospital which has a unique GRID reference. We have therefore added these to the running totals. Citation: Xiaoqing Wu, Ruihong Sun, Jianpu Chen, Yuanliang Xie, Shutong Zhang, Xiang Wang. Radiological findings and clinical characteristics of pregnant women with
COVID-19 pneumonia In J Gynecol Obstet. In press doi: 10.1002/ijgo.13165 

11 April update Studies 34 – 38 added.

Study 38. 41 women from the Maternal & Child Health Hospital of Hubei Province

Out of 41 pregnant women from the Maternal and Child Health Hospital of Hubei Province, with typical Covid-19 infection on lung CT, 16 were SARS-CoV-2 positive, 17 negative and 8 not tested. Nineteen were inpatients for delivery, and the rest outpatients from 22 weeks onwards. No birth details were given and in view of the probability of overlap with other cases in the same hospital none have been added to the running totals. Citation: H. Liu, F. Liu and J. Li et al., Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children, Journal of Infection, https://doi.org/10.1016/j.jinf.2020.03.007

Study 37. Three vaginal births in Renmin

Three babies were born vaginally to women with Covid-19, one preterm, two term. None were infected. Khan 3 vaginal births renmin. All previous reports from Renmin (Studies 6a, 10, 12 & 36) were of Caesarean births, so these have been included as non-duplicates in the summary totals. Citation: Suliman Khan, Liangyu Peng, Rabeea Siddique, Ghulam Nabi, Nawsherwan, Mengzhou Xue, Jianbo Liu, Guang Han. Infection Control & Hospital Epidemiology as part of the Cambridge Coronavirus Collection. March 2020. DOI: 10.1017/ice.2020.84

Study 36. Caesarean birth in 17 women in Remnin

This case series includes details of the Caesarean births of 17 women with Covid-18 in Renmin Hospital of Wuhan University Chen 17 renmin cs. All mothers and babies survived. However the series probably includes the 16 cases also reported from Remnin in Chinese (study 6a), which included the same number, three, preterm patients, all also delivered by Caesarean. They may also overlap with study 10; both studies mention two doctors delivered by Caesarean in Renmin. The obstetrican on study 36, Bi-heng Cheng, is shared with study 6a. We have therefore not included these cases in the running total. Citation: Rong Chen, Yuan Zhang, Lei Huang, Bi-heng Cheng, Zhong-yuan Xia, Qing-tao Meng, Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anesth https://doi.org/10.1007/s12630-020-01630-7

Study 35. Four neonates with Covid-19 from China

Four infected neonates (age less than 1 month) all born by Caesarean section (click here). They were identified by searching China’s national database of 81,026 laboratory-confirmed cases up to March 13 using the same methods as in a study of infants age 1 month to one year reported in JAMA (click here but not listed in this blog post). It seems likely that they overlap with the three infected neonates reported earlier in JAMA (study 12), the case report in Clinical Infectious Diseases (study 11) or the infected neonate reported in Lancet Inf Dis (study 15). We have therefore not included them in the running totals. Citation: Zhi-Jiang Zhang, Xue-Jie Yu, Tao Fu, Yu Liu, Yan Jiang, Bing Xiang Yang, Yongyi Bi. Novel Coronavirus Infection in Newborn Babies Under 28 Days in China. European Respiratory Journal 2020; DOI: 10.1183/13993003.00697-2020

Study 34. Case report of uninfected baby from Beijing

Abstract (click here). Full text (here). A 25 year old woman with Covid-19 at 35 weeks recovered and had a normal vaginal birth of a 3070g boy at 38w + 4d. The baby had no signs of past or present infection with SARS-COV-2. The birth occurred at YouAn Hospital, Capital Medical University, Beijing, which has not previously reported cases in pregnancy, but the mother had been transferred from an unnamed hospital in Wuhan. Nevertheless we have included this as a non-duplicated case in summary totals. Citation: Xiali Xiong, Hong Wei, Zhihong Zhang, Jing Chang, Xiaopeng Ma, Xiang Gao, Qiang Chen, Qiumei Pang. Vaginal Delivery Report of a Healthy Neonate Born to a Convalescent Mother with COVID-19 J Med Virol. 2020 Apr 10. doi: 10.1002/jmv.25857. 

10th April update Study 33 added

Study 33. US Centres for Disease Control reports 143 pregnant women

Preliminary data on lab-confirmed COVID-19 reported to CDC Feb 12–March 28, 2020. Of 7,162 cases, 143 were pregnant. Of these 72 stayed home, 31 hospitalised (non ICU), 4 entered ICU, and  36 had unknown hospitalisation status. “[…] for […] pregnancy, few severe outcomes were reported […].” Many probably reported elsewhere, so not added to running totals. Citation: Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382–386. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e2external icon.

9 April update. Study 31 & 32 added. Keelin O’Donoghue & Kate Walker have joined the team. Thank you also to Nicola Vousden for alerting us to 31.

Study 32. 42 women from Lombardy

This pre-print Ferrazzi Lombardy ijgo.13162 cites a paper in press describing 42 pregnant women from Lombardy, Italy who had Covid-19 and delivered, 18 by Caesarean, and 24 vaginally. Two were spontaneously preterm. Seven women required CPAP or were admitted to ICU, but all “eventually did well”. No baby details are given. This is the first scientific report from Italy. Citation: Ferrazzi EM, Frigerio L, Cetin I, Vergani P, Spinillo A, Prefumo F, Pellegrini E, Gargantini G.COVID-19 Obstetrics Task Force, Lombardy, Italy: executive management summary and short report of outcome. Int J Gynecol Obstet in press. 

Study 31. Case report from Ankara, Turkey

Report from Dept OBGYN, Ankara University, Faculty of Medicine. Woman age 32, with Covid-19 at 35 weeks gestation, delivered by Caesarean section prior to admission to intensive care (click here). Birthweight 2790g. Three days after birth mother required intubation and ventilation, and she remains in intensive care. Baby not infected.  Citation: E. Kalafat E. Yaprak G. Cinar B. Varli S. Ozisik C. Uzun A. Azap A. Koc Lung ultrasound and computed tomographic findings in pregnant woman with COVID‐19 Ultrasound Obstet Gynecol. First published: 06 April 2020 https://doi.org/10.1002/uog.22034

8 April update. Study 30 added. Thank you to Nicola Vousden (click here) for alerting me to this one. From tomorrow, www.ripe-tomato.org will raise its Covid-19 in pregnancy game. Two colleagues, Keelin O’Donoghue from Cork and Kate Walker from Nottingham, will join in searching and classifying, we will improve and publish our search strategy, and register this project on PROSPERO. Stand by for details.

Study 30. 16 women with Covid-19 pneumonia from Hubei province

Sixteen pregnant women with confirmed COVID-19 pneumonia, and 18 with pneumonia on chest imaging who tested negative, were compared with two groups of control pregnancies (click here or ciaa352). The comparative design is similar to study 6a which, apart from an English abstract, has only been published in Chinese. However the hospital and authors differ, so I’m confident there is no overlap. Citation: Li N, Han L, Peng M, Lv Y, Ouyang Y, Liu K, Yue L, Li Q, Sun G, Chen L, Yang L. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis. 2020 Mar 30. pii: ciaa352. doi: 10.1093/cid/ciaa352. [Epub ahead of print]

7 April update Studies 27-29 added. HT Keelin O’Donogue @Keelinodonoghue & Penny Wilson @nomadicgp

Study 29. ICNARC report 4 April 2020

This report ICNARC COVID-19 report 2020-04-04.pdf  or click here, from the UK Intensive Care National Audit & Research Centre (ICNARC) mentions two currently, and six recently (<6 weeks) pregnant women with Covid-19 who were also critically ill. One of the currently pregnant, and two of the recently pregnant women, were receiving advanced respiratory support. Excluded from running totals.

Study 28. Seven cases from Newark Beth Israel Medical Center. Newark, NJ

Pre-print from Am J Obstet Gynecol MFM 1-s2.0-S2589933320300434-main, or click here, of two pregnant women with Covid-19 who developed cardiomyopathy. Report also mentions five other pregnant women with Covid-19 in Newark Beth Israel Medical Center.  Details are only given for the two women with cardiomyopathy, and no baby details are given. For consistency of numbers I’ve assumed the other five pregnancies are ongoing in running totals. Citation: Alexander Juusela, Munir Nazir Martin Gimovsky. Two Cases of COVID-19 Related Cardiomyopathy in Pregnancy. AJOG MFM Available online 3 April 2020, doi.org/10.1016/j.ajogmf.2020.100113

Study 27. Expanded series from New York Presbyterian

This pre-print reports 43 pregnant women with COVID-19. It includes 36 new cases, identified during a period of universal testing, and 7 previously reported (Study 14) 43_COVID_040320. Click here. Citation: Breslin N, Baptiste C, Gyamfi-Bannerman C, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2(2):100118. doi:10.1016/j.ajogmf.2020.100118

6 April update. No new scientific reports today. But obstetricians & midwives will enjoy reading the first newspaper report of a Covid-19 pregnancy and birth in France. Case 10 here. Better written and more detailed than many scientific reports.

5 April update. Study 26 added. The first report of puerperal Covid-19. Not added to running totals.

Study 26. The first case report of puerperal COVID-19

This baby developed COVID-19 symptoms at age 10 days and was admitted to Wuhan Children’s Hospital age 17 days on February 5, 2020.  Click here for the article in Chinese. What follows is based on Google translate. Both parents are reported to have had Covid-19 symptoms from three days before admission, i. e. day 14 after birth. This is therefore not a case of COVID infection in pregnancy or at birth, and therefore excluded from the running totals. However, the mother had puerperal Covid-19 and is, I believe, the first such case reported. The baby recovered and by implication, albeit not stated explicitly, so did the parents. The first author Zeng Lingkong shares a name with the first author of the series of 33 neonatal cases reported in JAMA Paediatrics, Study 8., but this is clearly not one of the three infected babies reported in that paper. Citation: Zeng Lingkong, Tao Xuwei, Yuan Wenhao, et al. The first neonatal coronavirus pneumonia in China [J]. Chinese Journal of Pediatrics, 2020,58 (04): 279-280. DOI: 10.3760 / cma.j.cn112140 -20200212-00081

4 April update Study 25 added belatedly.

Study 25. Report of the WHO-China Joint Mission on Coronavirus Disease 2019, 16-24 February 2020

Click here or who-china-joint-mission-on-covid-19-final-report for full text including annexes. (For Chinese version click here or who-china-joint-mission-on-covid-19-final-report chinese version. Annexe 6, page 32 of English version: “As opposed to Influenza A(H1N1)pdm09, pregnant women do not appear to be at higher risk of severe disease. In an investigation of 147 pregnant women (64 confirmed, 82 suspected and 1 asymptomatic), 8% had severe disease and 1% were critical.” Neither raw numbers, a citation, nor any further details are given. Assuming the percentages are of all 147, this would imply 12 women with severe disease, and one or two who were critical. In view of the high possibility of double counting – cases notified to the WHO team are likely to have also got reported elsewhere – I’ve left these out of the running total. Citation: Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020. Report submitted 28 February 2020

3 April update Studies 23 & 24 added. Study 23 is judged unreliable for reasons given below, and study 24 included no pregnancies. Neither have been included in the running totals.

Study 24. No SARS-COV-2 in vaginas of non-pregnant women with severe Covid-19

Although not a study of pregnancy, this report of ten women with confirmed severe COVID-19 pneumonia in Tongji Zhongfa Hospital, Wuhan, China (click here or ciaa375) is reassuring for vaginal birth. None were positive for SARS-CoV-2 by RT-PCR assay in vaginal fluid. Citation: Lin Qiu, Xia Liu, Meng Xiao, Jing Xie, Wei Cao, Zhengyin Liu, Abraham Morse, Yuhua Xie, Taisheng Li, Lan Zhu. SARS-CoV-2 is not detectable in the vaginal fluid of women with severe COVID-19 infection. Clinical Infectious Diseases, ciaa375,  https://doi.org/10.1093/cid/ciaa375

Study 23. Three cases from Iran

This review (click here, full text here) from researchers in both Tehran and Shiraz, includes a report of the births of three infants from infected mothers, apparently not previously reported. The authors’ source was this Iranian ministry website (click here). All three babies were uninfected and survived, but two of the three mothers developed acute respiratory distress syndrome (ARDS) after delivery and died; presumably related to their Covid-19 infection. Citation: Mojgan Karimi-Zarchia, Hossein Neamatzadeh, Seyed Alireza Dastgheib, Hajar Abbasi, Seyed Reza Mirjalili, Thena Behforouz, Farzad Ferdosian, Reza Bahrami. Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review. Fetal & Paed Pathol. https://doi.org/10.1080/15513815.2020.1747120 

Comment by Jim. Although these cases are reported in a scientific journal, the source is a website. The authors do not claim to have treated either the women nor the babies. The women are said to have delivered in Mazandaran and Zanjan provinces. None of the authors give these provinces as their address.  A google translation of the link provided reveals a report of a single case of a woman with COVID-19 who delivered at 36 weeks in Babol. Mother and baby doing well. Again none of the article authors came from Babol. It seems likely that the source of these three cases is the website alone. We have therefore excluded them from our running totals.

2 April update Thank you to Keelin O’Donoghue, Cork, for pointing me to Studies 18 & 19, which I had missed, and to Ganesh Acharya, Editor-in-Chief AOGS, for permission to upload a pre-publication version of Study 20.

Study 22. Case report from Korea

Delivered by Caesarean section at 37 weeks at Daegu Fatimal Hospital, Korea (click here). The baby was not infected. Mother and baby did well. Citation: Dong Hwan Lee, Jihyang Lee, Eunju Kim, Kyeongyoon Woo, Hak Youle Park, Jihyun An.  Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean J Anesthesiol. https://doi.org/10.4097/kja.20116    [Epub ahead of print]

Study 21. Case report from Washington DC

The patient had a normal vaginal delivery at 39 weeks at MedStar Washington Hospital Center (click here). Baby not infected. Both fine. Citation: Iqbal SN Rachael Overcash R, Neggin Mokhtari N,.
Haleema Saeed H, Gold S, Auguste T, Mirza M-U, Ruiz M-E, Chahine JJ, Waga M, Wortmann G. An Uncomplicated Delivery in a Patient with Covid-19 in the United States New Engl J Med April 1, 2020 DOI: 10.1056/NEJMc2007605

Study 20. Case report of twins from Stockholm

Twins born by Caesarean at 36 weeks in Southern General Hospital, Stockholm. Twins, breast milk & maternal vaginal secretions all Covid-19 negative. Pre-publication version here AOGS-20-0296_Proof_hi with permission of the editor, Ganesh Acharya. Published online 6 April (click here). Citation: Gidlof S, Savchenko J, Brune, T, Josefsson H. COVID-19 in pregnancy with comorbidities: More liberal testing strategy is needed.  Acta Obstetricia et Gynecologica Scandinavica 

Study 19. Case report from Souzhou, China

Woman delivered by Caesarean at 30 weeks in the Affiliated Infectious Hospital of Soochow University, Souzhou, China. Although “no improvement was made on maximal ventilator support for four hours”, later “informed consent was obtained, an emergency cesarean section under combined spinal-epidural anesthesia was performed” and “uneventful perinatal course”.  Baby isolated and not infected. Both survived. Citation: Xiaotong Wang, Zhiqiang Zhou, Jianping Zhang, Fengfeng Zhu, Yongyan Tang, Xinghua Shen. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clinical Infectious Diseases, ciaa200, https://doi.org/10.1093/cid/ciaa200

Study 18. Case report from Honduras, Central America

The woman went into preterm labour and delivered vaginally at 32 weeks at Hospital Escuela of Tegucigalpa, Honduras. Baby not infected. Both doing well at time of report. Citation. Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA, Bustillo C, Gonzales G, Vallecillo-Chinchilla G, Sanchez-Martínez FE,  Valle-Reconco JA, Sierra M, Bonilla-Aldana DK, Cardona-Ospina JA, Rodríguez-Morales AJ. A pregnant woman with COVID-19 in Central America. Travel Medicine and Infectious Disease. Online 25 March 2020. https://doi.org/10.1016/j.tmaid.2020.101639 

1 April update

Study 6a added (details below).

30th March update

Study 17. Five from Maternal & Child Hospital of Hubei Province, Tongji Medical College

Two Caesarean and three vaginal births delivered in the Maternal and Child Hospital of Hubei Province, Tongji Medical College (click here). Or siyu chen.  All mothers recovered. All babies well. According to Wikipaedia the MCH of HP is the 10th clinical college/hospital associated with Tongji Medical College. It is distinct from both Union hospital and Tongji hospital. These five births are therefore additional to those in the various Union Hospital reports, and to those in study 15. Citation: Chen S, Liao E, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol. 2020 Mar 28. doi: 10.1002/jmv.25789. [Epub ahead of print] 

Study 16. Three non-cases from Shenzhen 2nd People’s Hospital.

Shenzen, a city of 13 million had had 420 confirmed cases of Covid-19, the second highest number outside Hubei, up to March 11th. Despite an annual birth rate in the city of 188,000, the 2nd People’s Hospital saw no COVID-19 infected pregnant women. Instead they report three suspected cases who, after barrier nursing, and in one case surgery for an ectopic pregnancy, were later confirmed negative. Citation: Yu Chen, Zhe Li, Yuan-Yuan Zhang, Wei-Hua Zhao, Zhi-Ying Yu. Maternal health care management during the outbreak of coronavirus disease 2019 (COVID-19) J Med Virol. 2020 Mar 26. doi: 10.1002/jmv.25787. [Epub ahead of print]

29th March – 3rd update

Study 15. Seven cases from Tongji in Lancet Infect Dis

These seven cases (click here) delivered at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (Wuhan, China) between Jan 1 and Feb 8, 2020. All mothers had mild Covid-19 disease and all were delivered around term by Caesarean section. One baby (Patient 1) tested positive for Covid-19 by throat PCR at 36 hours and was transferred to Wuhan Children’s hospital. His mother’s age, gravidity, parity, lack of direct contact with Hunan seafood market and history of hypothyroidism all suggest this is the same mother/infant dyad as in report 11. Note however the reported birthweights differ 3250g v 3205g. No babies had any clinical symptoms and all (including the transferred one) were discharged home well. Wikipedia lists ten different hospitals/clinical colleges affiliated with Tongji Medical College in Wuhan. The 1st clinical college is called Wuhan Union Hospital. The 2nd clinical college is called Wuhan Tongji Hospital. This series is therefore unlikely to overlap with the various case series from Union Hospital Tongji. Citation: Nan Yu, Wei Li, Qingling Kang, Zhi Xiong, Shaoshuai Wang, Xingguang Lin, Yanyan Liu, Juan Xiao, Haiyi Liu, Dongrui Deng, Suhua Chen, Wanjiang Zeng, Ling Feng, Jianli Wu. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis 2020 Published Online March 24, 2020 https://doi.org/10.1016/S1473-3099(20)30176-6

29th March – 2nd update.

Study 14. Seven pregnant women from New York Presbyterian

AJOG MFM Preprint (click here) or COVID_Early_Lessons_032620 NY presbyterian. via @neel_shah. The first reported cases outside China. Citation; Breslin N, Baptiste C, Miller R, Fuchs K, Goffman D, Gyamfi-Bannerman C, D’Alton M. COVID-19 in pregnancy: early lessons. Am J Obstet Gynecol. Available online 27 March 2020. https://doi.org/10.1016/j.ajogmf.2020.100111

29th March update. Four more primary reports including ten more cases. All previously unreported.

Study 13. Cord blood serology from six babies in Zhongnan Hospital, Wuhan

Six cases reported in JAMA (click here). All births by Caesarean. All mothers mild disease. All babies asymptomatic. Since they were born in a different hospital these are probably additional to the other 33 Wuhan neonates reported in JAMA. Revision 16 April: These are from the same hospital as study 1 and may overlap. Therefore removed from running totals.  Citation: Hui Zeng, Chen Xu, Junli Fan, Yueting Tang, Qiaoling Deng, Wei Zhang, Xinghua Long. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4861

Study 12. Case report from Renmin Hospital Wuhan

Case report in JAMA of baby, born at Renmin Hospital, Wuhan, by Caesarean, 23 days after mother developed Covid-19, had IgM antibodies detected in cord blood (click here). This is additional to the two Remnin cases below, because the clinical details differ substantially. Citation: Lan Dong, Jinhua Tian, Songming He, Chuchao Zhu, Jian Wang, Chen Liu, Jing Yang. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4621

Study 11. Caesarean birth & neonatal infection, Wuhan

Case report (click here) of a baby born by Caesarean to an infected mother at Wuhan Tongji Hospital.  The baby was separated from the mother at birth but became infected (pharyngeal PCR at 36 hours). Both mother and baby recovered. I believe this case report is additional to the 33 Wuhan neonatal cases reported in JAMA, because the details (e.g. birth weight) do not align. This is therefore the fourth infected baby born by Caesarean. Citation: Shaoshuai Wang, Lili Guo, Ling Chen, Weiyong Liu, Yong Cao, Jingyi Zhang, Ling Feng A Case Report of Neonatal 2019 Coronavirus Disease in China. Clinical Infectious Diseases, ciaa225, https://doi.org/10.1093/cid/ciaa225

Study 10. Two cases from Renmin Hospital, Wuhan

Two pregnant doctors with Covid-19 both delivered by Caesarean at term (click here). Also remnin two cases.  Babies separated and not infected. Probably additional to the 33 JAMA Wuhan neonates because neither neonate was transferred to Wuhan Children’s Hospital. Citation: Cuifang Fan, Di Lei, Congcong Fang, Chunyan Li, Ming Wang, Yuling Liu, Yan Bao, Yanmei Sun, Jinfa Huang, Yuping Guo, Ying Yu, Suqing Wang Perinatal Transmission of COVID-19 Associated SARS-CoV-2: Should We Worry?  Clinical Infectious Diseases, ciaa226, https://doi.org/10.1093/cid/ciaa226

28 March 2020 update. Three more more primary scientific reports.

Study 9. A Caesarean birth from Zhejiang

This case report is in Chinese but has an English abstract. Click here. It’s from the First Affiliated Hospital, College of Medicine, Zhejiang University School of Medicine, Hangzhou. There appears to be no overlap of the authors with the Zhejiang Caesarean below, so this may be a new case. The Caesarean is reported as being “successful” which presumably means both mother and baby survived. Citation: Kang X, Zhang R, He H, Yao Y, Zheng Y, Wen X, Zhu S. Anesthesia management in cesarean section for a patient with coronavirus disease 2019. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 May 25;49(1):0. Chinese. PMID: 32207592   

12 June reconsideration. The hospitals in S9 & S4 are both First Affiliated Hospital Zhejiang University grid.452661.2.  The full Chinese text of S9 seems to be no longer available so not possible to compare clinical details. Assume this is same case as that in S4.

Study 8. The 33 neonatal cases from Wuhan

A series of 33 neonates born to mothers who had Covid-19. All from Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Reported in JAMA here. It seems possible that some or all of these infants are also included in the other Union Hospital Tongji series below.  Of the 26 neonates delivered by Caesarean three became infected. One born at 30 weeks and 2 days developed RDS, pneumonia and suspected sepsis, and required non-invasive ventilation. The authors speculate that some of his problems were related to prematurity rather than COVID-19. The other two neonates were healthy. All three survived. By inference, although this is not specifically stated in the paper, none of the seven infant born vaginally became infected.  Citation: Lingkong Zeng, Shiwen Xia, Wenhao Yuan, Kai Yan, Feifan Xiao, Jianbo Shao, Wenhao Zhou, Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr. Published online March 26, 2020. doi:10.1001/jamapediatrics.2020.0878

Study 7. The Quingdao case

This appears to be the first pregnancy case from  that city. Click here. The mother developed Covid-19 at 30 weeks but recovered and was discharged. At the time the report was written the pregnancy was ongoing. Citation: Rong Wen, Yue Sun, Quan-Sheng Xing A patient with SARS-CoV-2 infection during pregnancy in Qingdao, China Journal of Microbiology, Immunology and Infection Available online 10 March 2020 https://doi.org/10.1016/j.jmii.2020.03.004

22 March 2020 estimate. Assuming all the Union Hospital Tongji cases overlap, i.e. that Tongji has reported only 15 in total, there have been 38 published cases (39 babies) of Covid-19 infection in pregnancy. There have been no reports in the scientific literature of any maternal deaths, and all neonates have survived and not been infected. Four neonates remain undelivered.

Note 22 March 2020.  David A Schwarz (click here) in a review in Arch Pathol (preprint available March 21st) also makes the total 38 published cases.  However he includes a series published only in Chinese (his reference 17) Zhang I, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. 湖北地区新型冠状病毒肺炎流行期间孕妇的 384 妊娠结局分析 [Analysis of the Pregnancy Outcomes in Pregnant Women With COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi . 2020;55(0), E009. Available from: http://rs.yiigle.com/yufabiao/1184338.htm (accessed and translated 12 March 2020).  He reports this as including 16 cases.  For the moment I’ve not included this Hubei series, (but see Study 6a added 1 April).

Study 6a. 16 cases from Remnin

The cases included by David Schwarz on March 21 (see note above). English abstract (click here). Full text in Chinese here. Google translate used. The authors come from Remnin Hospital, but the paper reports that all 16 women were delivered by Caesarean at the Eastern Hospital of Wuhan University People’s Hospital.  Therefore assume no duplicates. Citation: Zhang Lu, Jiang Yan, Wei Min, et al. Analysis of pregnancy outcomes of pregnant women during the epidemic of new coronavirus pneumonia in Hubei [J / OL]. Chinese Journal of Obstetrics and Gynecology, 2020,55 (2020-03-08). http://rs.yiigle.com/yufabiao/1184338.htm. DOI: 10.3760 / cma.j.cn112141-20200218-00111. 

Study 6. The 15 Union hospital Tongji cases

A series of 15 pregnant women, of whom 11 had delivered and four remained undelivered from Union Hospital, Tongji Medical College, click here. These may include the four from the same hospital below and also possibly the 9 cases from the same hospital in Translational Paediatrics. Citation: Dehan Liu, Lin Li, Xin Wu, Dandan Zheng, Jiazheng Wang, Lian Yang and Chuansheng Zheng. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis American Journal of Roentgenology: 1-6. 10.2214/AJR.20.23072

Study 5. The 9 Union Hospital Tongji cases

Published in Translational Paediatrics (click here). Nine mothers, ten neonates. Citation: Huaping Zhu, Lin Wang, Chengzhi Fang, Sicong Peng, Lianhong Zhang, Guiping Chang, Shiwen Xia, Wenhao Zhou. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Translational Pediatrics Vol 9, No 1 (February 2020)  

Study 4. The Zeijang case

From the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China (click here) Caesarean for unclear indication. Baby not infected. Citation: Yang Li, Ruihong Zhao, Shufa Zheng, Xu Chen, Jinxi Wang, Xiaoli Sheng, Jianying Zhou, Hongliu Cai, Qiang Fang, Fei Yu, Jian Fan, Kaijin Xu, Yu Chen and Jifang Sheng Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerging Infectious Diseases. 2020 Apr [date cited]. https://doi.org/10.3201/eid2606.200287 DOI: 10.3201/eid2606.200287

Study 3. The Sun Yat Sen series

These 13 cases were reported from the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Province. Guangdong, P.R. China. (click here). Also pre-publication text 10.1016@j.jinf.2020.02.028). They included 3 patients from Zhejiang, 3 from other cities of Hubei and 1 each from Fujian, Shanxi, Beijing, Guangdong, Jiangxi, Heilongjiang and Anhui.   No infected neonates but one mother seriously ill on ECMO.  16 April update. Since patients in this series came from multiple centres, both in and outside Hubei province, they are likely to overlap with other studies. 12 mothers (3 undelivered) and 9 babies have therefore been removed from the running total. However case 6, where the woman was reported to be on ECMO and the baby stillborn, does not appear to have been reported elsewhere, so remains in the running totals. Citation: Yangli Liu, Haihong Chen, Kejing Tang, Yubiao Guo. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy J Infect. https://doi.org/10.1016/j.jinf.2020.02.028

Study 2. The first Union Hospital Tongji series

From Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan. The original abstract here, described three cases and linked to an original paper in Chinese. These may overlap with four cases later published in Frontiers click here. There is also a pre-print of three cases from Tongji, (Click here or preprints202002.0373.v1) which includes some authors from the Liverpool School of Tropical Medicine & Hygiene. Again these may overlap, or even be the same cases.

Study 2a. Citations: Chen S, Huang B, Luo DJ, Li X, Yang F, Zhao Y, Nie X, Huang BX. Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases. Zhonghua Bing Li Xue Za Zhi. 2020 Mar 1;49(0):E005. doi: 10.3760/cma.j.cn112151-20200225-00138.

Study 2b. Liu, W.; Wang, Q.; Zhang, Q.; Chen, L.; Chen, J.; Zhang, B.; Lu, Y.; Wang, S.; Xia, L.; Huang, L.; Wang, K.; Liang, L.; Zhang, Y.; Turtle, L.; Lissauer, D.; Lan, K.; Feng, L.; Yu, H.; Liu, Y.; Sun, Z. Coronavirus Disease 2019 (COVID-19) During Pregnancy: A Case Series. Preprints 2020, 2020020373

Study 2c. Yan Chen, Hua Peng, Lin Wang, Yin Zhao, Lingkong Zeng, Hui Gao and Yalan Liu.      Infants Born to Mothers With a New Coronavirus (COVID-19)  Front. Pediatr., 16 March 2020 | https://doi.org/10.3389/fped.2020.00104

Study 1. The original Lancet nine

All from Zhongnan Hospital of Wuhan University, Wuhan, click hereCitation: Huijun Chen, Juanjuan Guo, Chen Wang, Fan Luo, Xuechen Yu, Wei Zhang, Jiafu Li, Dongchi Zhao, Dan Xu, Qing Gong, Jing Liao, Huixia Yang, Wei Hou, Yuanzhen Zhang. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. Volume 395, Issue 10226, 7–13 March 2020, Pages 809-815.

Jim Thornton, Keelin O’Donoghue, and Kate Walker

 

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