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Covid-19 & pregnancy – registries

April 19, 2020

Registries & regional data

A list of “Covid-19 & pregnancy” registries, as well as of some regional groups who have reported data.

Both are likely to be more representative than hospital-based series (click here), or news reports (click here), although they will overlap. Updated 24 June.

National Registries

1 UKOSS – The United Kingdom Obstetric Surveillance System (UKOSS) Pandemic COVID-19 in pregnancy registry (click here, & registered here) is collecting cases via each NHS Trust’s local UKOSS reporter. It includes early pregnancy, including miscarriage & ectopic pregnancy.

2. COVI-PREG – (click here) Based in Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, Switzerland.

3. PRIORITY – (click here), the Pregnancy Coronavirus Outcomes Registry (PRIORITY), coordinated through the University of California is collecting both confirmed and suspected cases. Doctors may refer patients. Patients may refer themselves. By 16 April, 300 participants had been enrolled.

4. ROI COVID-19 – The Republic of Ireland Covid-19 registry (click here).

5. NethOSS – the Netherlands Covid-19 registry (click here). To register cases email info@nethoss-perined.nl. By 12 April 2020, 107 reports had been received, 91 with brief, and 50 with extensive additional information.

6. CHOPAN – The Australian Registry. CHOPAN (Coronavirus Health Outcomes in Pregnancy & Newborns)  – click here, or here to register.

7. National Health Commission of China – Not strictly a registry, but on 17th April a group using this source reported all cases of Covid-19 in pregnancy seen in any hospital in Wuhan between December 8, 2019 & March 20, 2020 (click here). These data supersede all previous reports from Wuhan hospitals for women admitted before March 20.

8. ItOSS -The Italian registry – Click here.

9. PregCOVID, The National Registry of Pregnant Women with COVID-19 in India (click here). Contact: Dr Rahul Gajbhiye. Dept Clinical Research ICMR-National Institute for Research in Reproductive Health, J M Street, Parel, Mumbai email: gajbhiyer@nirrh.res.in

10. Obs Covid Spain – A Spanish Covid-19 in pregnancy registry based around the 77 hospitals in the previously exisiting “Emergency Obstetrics Spain Group”. (click here for the protocol).

Other registries

1. PANCOVID – Pregnancy And Neonatal outcomes for women with COVID-19 (click here). Run by Imperial College London and University of Wales.

2. US CDC – United States, Centres for Disease Control (CDC) includes pregnancy in its Covid-19 report forms. This report here, up to March 28, included 143 pregnant women.

3. ICNARC – The UK Intensive Care National Audit & Research Centre (ICNARC) includes some pregnant women. For their 4 April 2020 report, which included eight pregnant or recently pregnant women, click here.   Data updated 17 April.

4. ObsCovid – A UK registry, supported by RCOG, RCM, OAA & RCoA, for maternity healthcare workers to record and follow-up encounters with mothers with suspected or confirmed COVID-19 (click here).

5. Santé Publique France – Reports Covid-19 admissions to intensive care in France (click here, report in French). By 16 April, 13 pregnant women had been admitted to intensive care. None had died.

6. The Traditional, Complementary & Integrative Health & Medicine COVID-19 Support Registry (click here) includes a data field on pregnancy.

7. COVID-19 ICU registry – Click here. A Multicenter International Data Repository of patients admitted to ICU. Hosted by Massachussets General Hospital.  It will include pregnant women.

8. INTERCOVID – Click here. A prospective case control study using the centres who participated in the INTERGROWTH-21st Project.

9. IRCEP – International Registry of Coronavirus Exposure in Pregnancy (IRCEP) (click here). Not yet opened. Based in the TH Chan School of Public health, Harvard University.

10. COV-PREG-COAG – run by the International Society of Thombosis & Haemostasis. The International Registry on Pregnancy and COVID-19 Associated Coagulopathy and Thrombosis (COV-PREG-COAG) can be accessed here.

11. PeriCovid – Understanding COVID-19 infection in pregnant women and their babies. Run by St George’s, London. Protocol here.

12. COVID-19 New Mum Study – (click here).

13. Mother to Baby Covid-19 in pregnancy study.  (click here). Open to women in US or Canada. Also recruiting breastfeeding women with  COVID-19 .

14. COVID Mothers Study – (click here). Mothers who had Covid-19 in prengnancy or whose babies had it under the age of one year are eligible to participate in this anonymous registry.

Regional Reports

1. The COVID-19 Obstetrics Task Force, Lombardy, reported 42 cases in pregnancy from six regional hubs (including Milan, Brescia, Bergamo, Monza, & Pavia) up to March 20th (click here).

Jim Thornton

Disambiguating Chinese hospitals reporting Covid-19 in pregnancy

April 13, 2020

Revised 16 April 2020. Details at foot of post*

The city of Wuhan has a population of 12M, about the same as London, and Hubei, the province in which it sits, 58M, about the same as the UK.  Sorting out the various hospitals and universities where reported cases of Covid-19 in pregnancy were treated is no easy matter, especially for non-Chinese speakers, and for papers where affiliation names have been translated in idiosyncratic ways.

But it needs to be done because some authors have submitted the same manuscripts to multiple journals, included previously reported cases in new case series without making this clear, or reported different aspects of the same cases in multiple papers (click here). The following list has been created from the primary sources listed here, using the disambiguator (click here) provided by the Global Research Identifier Database GRID (click here).  Hospitals in bold are those from which patients with Covid-19 in pregnancy have been reported. Study numbers refer to the primary sources listed here.

Zhongnan Hospital of Wuhan University (Study 1, 13). GRID ID grid.413247.7 No aliases.

Huazhong University of Science and Technology, Wuhan grid.33199.31 has three affiliated hospitals.

Huazhong University of Science and Technology Hospital grid.488485.d It seems likely that this includes the Maternal & Child Hospital of Hubei Province (Studies 8, 17, 30 & 38) (see below).

Tongji Hospital (studies  11, 15) grid.412793.a

Wuhan Union Hospital (studies 2a, 2b, 2c, 5*, 6, ) grid.412839.5

First Affiliated Hospital of Sun Yat-sen University (study 3*) grid.412615.5 is in Guangzhou, a port city 1,000km south of Wuhan, near Hong Kong. See 16 April revision.*

First Affiliated Hospital Zhejiang University (studies 4 & 9)  grid.452661.2 Aliases Zheda Hospital, Zhejiang Provincial First Hospital. This is in the City of Hangzhou near Shanghai, about 700 km east of Wuhan

Renmin Hospital of Wuhan University (Studies 6a, 10, 12, 36, 37, 40) grid.412632.0 Aliases, People’s Hospital of Wuhan University, Hubei Provincial People’s Hospital, First Affiliated Hospital of Wuhan University, Wuhan University Renmin Hospital, Hubei General Hospital.

Eastern Hospital of Wuhan University People’s Hospital (Study 6a) is not listed on the GRID database. It is likely that this is an alias of Renmin Hospital of Wuhan University above.

Qingdao Women and Children’s Hospital, Qingdao (Study 7) is not listed on the GRID database. However, Quingdao is a port city 1,100 km north east of Wuhan.

Wuhan Children’s Hospital, in Wuhan, (study 8) is not listed on the GRID database but disambiguates to Huazhong University of Science and Technology, Wuhan grid.33199.31 above. It seems likely to be an alias of the Maternal & Child Hospital of Hubei Province itself part of Huazhong University of Science and Technology Hospital.

Shenzhen 2nd People’s Hospital (study 16) is not listed on the GRID database. Shenzen is a city in the south of China near Hong Kong

Maternal & Child Hospital of Hubei Province, Tongji Medical College (Studies 17, 30 & 38) is not listed on the GRID database. However, according to Wikipedia it is the 10th clinical college/hospital associated with Tongji Medical College, which itself disambiguates to Huazhong University of Science and Technology Wuhan grid.33199.31 (above). The Wikipedia link also goes to the same point on the map as Huazhong University of Science and Technology Hospital, in the City of Wuhan, but geographically distinct both from Tongji Hospital and from Wuhan Union Hospital. It seems likely that the Maternal & Child Hospital is part of Huazhong University of Science and Technology Hospital grid.488485.d.

Affiliated Infectious Hospital of Soochow University, Suzhou grid.429222.d (Study 19). Suzhou is a city near Shanghai about 700 km east of Wuhan

Beijing YouAn Hospital (study 34) grid.414379.c

Central Hospital of Wuhan (Study 39) grid.440160.7

*Revision 16 April 2020

Patients included in studies 1 and 13 both came from Zhongnan Hospital of Wuhan University. This has been corrected.

The sources of the patients in Study 3 “patients admitted to hospitals outside of Wuhan […] 3 patients from Zhejiang, 3 from other cities of Hubei and 1 each from Fujian, Shanxi, Beijing, Guangdong, Jiangxi, Heilongjiang and Anhui”, and in Study 5 “mothers […] in 5 hospitals in Hubei from January 20 to February 5, 2020”, were misclassified as coming from a single hospital in the first version of this post.

Jim Thornton

Covid-19 in Pregnancy – News Reports

April 5, 2020

Cases reported by traditional media – 1-100

There’s plenty of fake news on Facebook, Twitter & Reddit, but traditional journalism still counts for something. Reported fact in established newspapers, or by traditional broadcasters, requires not only that someone told it to a journalist, but also that the journalist did at least some verification. All cases below have been reported by a traditional newspaper or broadcaster, and my summaries are limited to the facts as reported. Although some cases, notably 3 and 9, have appeared in hundreds of media outlets, I’ve avoided duplicates. Cases may overlap with scientific reports, and are probably biased to reports in English. See also primary scientific reports here. Reports are in reverse order, most recent first. I will update. For reports 101 onward (click here).

Warning. The partners of Prime Ministers and professional footballers are over-represented in this small series! It is almost certain that deaths are too.

100. Rachel Bailey from Shelby County, Alabama, was 5-months pregnant when she developed Covid-19 (click here). She is now 30 weeks and recovering. The pregnancy is ongoing. Report 6 May

99. Patient 765, a 20-year-old woman from Padrayanpura, in the late stage of pregnancy, tested positive on 8 May at Vani Villas Women and Children Hospital in Bangalore, Karnataka, India (click here). No further details. Report 9 May.

98. Florette Johnson from Florida, had Covid-19 around term. She had a vaginal birth but later required ventilation (click here). The baby was isolated. Both mother and baby are recovering. Report 9 May.

97. Monique Cook from Atlanta, Georgia, developed Covid-19 at 8 months gestation with twins. She was delivered by Caesarean section at Piedmont Henry hospital on 22 March, and transferred to Piedmont Atlanta hospital for ECMO treatment (click here). She was extubated after 5 days and is now recovering at home.  The twins have also been discharged. Report 8 May

9 May update

96. Gabriela Maia, the wife of Max Johnson, the half brother of British prime minister Boris Johnson, is pregnant, and has Covid-19 (click here). She is recovering. Report 28 March.

95. A baby born at 30 weeks gestation on April 3, in Natal, Brazil, tested positive for SARS- Cov2, and died age 4 days. The mother had respiratory symptoms but her test result was not yet available (click here). The authorities cannot confirm if the infection caused the death. Report 10 April.

8 May update – Cases 86-94 added.

94. Terra Eubanks, a pregnant nurse at Baton Rouge General Hospital in Louisiana, got Covid-19. She recovered (click here). The pregnancy is ongoing. Report 7 May.

93. Johana Rocio Mendoza Chancay, age 40, from Union City, New Jersey, was 26 weeks gestation when she developed Covid-19. She was transferred from Hoboken University Medical Center to Robert Wood Johnson University Hospital in New Brunswick where she gave birth by Caesarean section on March 30th (click here). Her daughter Zion weighed 1lb 13oz. The mother was ventilated and in a coma until April 13. Both recovered. Report 22 April.

92. An unnamed pregnant woman (referred to as P652) had an inconclusive Covid-19 test result at Dr Lal Path Labs in Delhi on 2nd May. The result was interpreted at positive and the woman was nursed on a Covid-19 ward. On May 6, a test at Bangalore Medical College and Research Institute’s Virus Research and Diagnostic Laboratory was declared negative. A third test at the National Institute of Virology’s Bengaluru Field Unit was also negative (click here). Report 8 May.

91. An unnamed pregnant woman is among five Lincolnshire police staff who have tested positive for coronavirus (click here). Report 5 May.

90. Katherine Dawson, aged 36, developed Covid-19 at 32 weeks gestation. She was delivered by Caesarean section at Blackpool Victoria Hospital on 1 April. Her condition deteriorated and she required artificial ventilation (click here). The baby, Ruby, was reported to be infected at birth. Mother and baby recovered, and were discharged on 6 May. Report 6 May.

89. An unnamed  28-year-old women, recovered from Covid-19 and was discharged from Symbiosis Hospital in her 37th week of pregnancy (click here). Report 24 April.

88. An unnamed five-month pregnant woman tested positive for coronavirus at the Pune Municipal Corporation’s Sonawane hospital (click here). She was transferred to Bharati Hospital. Report 14 April.

86. & 87. An unnamed 25-year-old pregnant woman with Covid-19 gave birth by Caesarean section on April 20 at the Sassoon General Hospital in Pune, India, to a healthy boy. Another unnamed woman with Covid-19 delivered by Caesarean section the same day in Aurangabad district civil hospital (click here). Neither baby was infected. Report April 20.

7 May update – cases 80 to 85 added.

85. An unnamed woman with Covid-19 gave birth in Nagaur in Rajustan, India, on April 23 to a baby who also tested positive (click here). Eight other pregnant women from the Ramganj area also tested positive. Report 24 April.

84. An unnamed pregnant woman who had recovered from Covid19 gave birth at her home in Kalnad, Kerala, India after being refused hospital admission (click here). She was later treated at Kannur Medical College Hospital in Pariyaram, before transfer to the General Hospital in Kasaragod for observation. The outcome was not reported. Report 4 May

82 & 83. An unnamed 35-year-old woman from Shangus in south Kashmir’s Anantnag district had Covid-19 at the time of her birth at the SKIMS Medical College Hospital Bemina, Jammu & Kashmir, India (click here). No further details are given. The same report notes that two other pregnant women “have died and nearly 10 have got infected with coronavirus in past two weeks” at the same hospital. It is not clear whether the two women who died had Covid 19. Elsewhere in the same report another woman, Firdousa Javaid is reported to have tested positive in a different maternity hospital, Lalla Ded. Report 6 May.

81. Melissa Brewer from Mountain Green, Utah, whose baby is due in May 2020, had minimal symptoms but tested positive for SARS-CoV2 (click here). The pregnancy is ongoing. Report 5 May.

80. Molly Baldwin, age 28, from Fitchburg, Massachusetts, developed Covid-19 at 33 weeks gestation (click here). She is self-quarantining at home. The pregnancy is ongoing. Report 5 May

5 May update – cases 78 & 79 added

79. An unnamed baby developed Covid-19 at age three months and was treated at Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh between April 12 and 26th (click here). His mother was SARS-COV-2 negative and continued to breast feed him. The baby recovered and the mother remained negative. Report 5 May.

78. An unnamed woman with Covid-19 gave birth at Aurangabad Civil Hospital in Maharashtra, India (click here). The baby was not infected. Report 5 May.

4 May update – cases 74 to 77 added.

77. Sarita [a pseudonym] from Los Angeles was asymptomatic, but tested positive for SARS-COV-2 during her pregnancy (click here). Her baby, born mid April, was isolated from her and tested negative. At four days of age the baby suffered some sort of respiratory arrest, but recovered. Report 1st May

76. Silvia Leroy, age 35, developed Covid-19 and was transferred from Brookdale, her local hospital, to Mount Sinai hospital in Manhattan (click here). She was on a ventilator for a week, but appeared to be recovering, when she had a cardiac arrest. Her baby, Esther, was delivered by Caesarean section. Sylvia is alive but reported to have brain damage. Report 29 April.

75. Kim Stidworthy, age 25, from New Mexico was 20 weeks gestation when she developed Covid-19 (click here). She spent four days in hospital. The pregnancy is ongoing. Report 1st May.

74. Tamekia Melong, age 37, from Baldwin, Long Island, New York is pregnant and developed Covid-19 in March (click here). The pregnancy is ongoing. Report 3rd May

30 April update – Cases 71 to 73 added. Also up to 10 pregnant women had tested positive for corona virus in the Rotunda Hospital in Dublin (click here) by 1 April. Report 1 April.

73. Alysha Ramos, age 29, pregnant with Covid-19, is in prison in Valparaiso, Indiana (click here & here). Reports 5 & 23 April.

72. Veronica Markley, age 37, from Colorado had Covid-19 at 30 weeks gestation (click here). She was intubated and put on a ventilator at Presbyterian/St. Luke’s Medical Center in Denver, but is recovering. The pregnancy is ongoing. Report 27 April

71. Ashley Duque, age 33, from San Diego developed Covid-19 at 17 weeks gestation (click here). She required 4 days ventilation but is recovering. The pregnancy is ongoing. Report 10 April.

29 April update – Cases 63 to 70 added.  Case 9 – Carrie Symonds, the partner of British Prime Minister Boris Johnson, who gave birth to a healthy baby boy on April 29th, updated. Case 61, an accidental duplicate, deleted. Maternal and baby deaths highlighted in bold.

70. Jennifer Laubach from Clarkston, Michigan, gave birth to twins at 32 weeks at Troy Beaumont Hospital. The babies were isolated because she had symptoms and her partner had Covid-19. She later tested positive (click here). She and the twins recovered. Report 29 April.

69. Abigail Jacobs, age 29, from Kahnawake near Montreal, Canada, developed Covid-19 symptoms in mid March at 24 weeks gestation (click here). Her first test was negative, but a repeat on March 29 was positive. She self-isolated and has recovered. The pregnancy is ongoing. Report 18 April.

68. An unnamed woman from Charlotte, North Carolina, who is three and a half months pregnant tested positive for COVID-19 (click here). Report 14 April.

67. Kim Anderson, age 36 from Idaho Falls developed Covid-19 on March 22nd at about 8 months gestation. She required oxygen therepy in hospital but not ventilation. The pregnancy is ongoing. Report 15 April.

66. A unnamed woman who is four months pregnant is the first pregnant COVID-19 patient admitted to Victoria Hospital in Karnataka, India (click here). Report 31 March.

65. An unnamed pregnant woman age 35 from the Kharpora Kokernag area of Anantnag in Indian administered South Kashmir was admitted to the Maternity and Child Care Hospital in Anantnag (click here). She gave birth to stillborn twins and died soon after. Her test results later confirmed that she was Covid-19 positive. It is reported that Syed Yasir, the commissioner of the region, believes the cause of death was negligence rather than Covid-129. An enquiry is ongoing. Report 27 April.

64. Amanda Joyce, age 33, who works at Newton Wellesley Hospital on the outskirts of Boston, Massachusetts, developed Covid-19 while pregnant (click here). She self-isolated at home, and the pregnancy is ongoing. Report  17 April.

63. Andrea Circle Bear, age 30, from Eagle Butte, South Dakota was pregnant and an inmate in a US Federal prison when she developed Covid-19 (click here). She was transferred to Carswell, a federal prison medical facility in Fort Worth, Texas, and thence to a local hospital where she was delivered by Caesarean section on 2 April. She died on 28 April. The baby’s status was not reported. Report 29 April.

28 April update – cases 58 to 62 added

62. Morgan Brink, age 30, from Roodeport in South Africa, tested positive for coronavirus on 25 March (click here). She had a cough and is self-isolating at home. Report 9 April.

61. Marie Youri, age 19, who had Covid-19, gave birth on 11 April in Yaoundé, the capital of Cameroon (click here). She is on oxygen therapy, & baby Foraya, birth weight 2.1kg, is in isolation. Report 12 April. Accidental duplicate

59 & 60. The deaths of two unidentified women in Mexico (click here). (Report cited in Study 66 here). Report 9th April.

58. Viviane Albuquerque, age 33 from Pernambuco, Brazil, died from Covid-19 at 32 weeks gestation (click here). The baby, delivered by Caesarean, survived. (Report cited in Study 66 (here) which also cites two other newspaper reports of maternal deaths in Brazil, but the links provided miss the reports.) Report 6th April.

26 April update – cases 55 to 57 added

57. Danielle Martin, age 32, from Belfast, Northern Ireland, developed Covid-19 while pregnant with twins at nine weeks (click here). She required artificial ventilation but recovered, and the pregnancy is ongoing. Report 23 April. Update 9 October (click here), she gave birth to healthy twins early in October.

56. Molly Burdick, from Portland in Oregon had Covid-19. 18 days later she was treated for a ruptured (tubal) ectopic pregnancy (click here). She recovered. Report 21 April

55. Sally Nuza, from Ascot, Berkshire developed Covid-19 at 8 months gestation (click here). She recovered, the pregnancy is ongoing, and her unborn baby son is ‘perfectly healthy’. Report 24 April.

24 April update – Cases 53 & 54 added.

54. Wogene Debele from Maryland died of Covid-19 three weeks after giving birth (click here).  Report 23 April

53. Fozia Hanif age 29 developed Covid-19 and gave birth by Caesarean section on 2nd April. She died in Birmingham Heartlands Hospital on April 8th (click here). Report 23rd April

21 April update – Cases 50 to 52 added.

52. Jasmine Jones age 26 from Indianapolis, Indiana, and pregnant with twins, tested positive on March 22nd, at 33 weeks (click here). She was symptomatic, self-isolated at home and the pregnancy is ongoing. Report 20 April.

51.  Silvana Vergara from New York caught the virus at 22 weeks gestation (click here). She was “reassured”, so presumably has recovered and the pregnancy is ongoing, although this is not specifically stated. Report 18 April.

50. Sarah Manning tested positive for SARS-COV-2 a few days before giving birth in Jersey’s midwifery unit (click here). Presumably a normal vaginal birth. Mother and baby are pictured, unmasked, bottle feeding and not separated. Report 20 April.

19 April update Cases 47 to 49 added.

49. An unnamed woman developed symptoms of Covid-19 soon after giving birth in Strong Memorial Hospital, Rochester, New York. Whether she, her partner, or the baby, tested positive has not been disclosed. Report 31 March.

48. Jennifer Kruman, age 33, of Crown Heights, Brooklyn, tested positive 12 hours after giving birth to baby Isaac Hai Kruman, om March 31, at Mount Sinai West Hospital, Manhattan (click here). Isaac tested negative and both went home after 24 hours. Report 17 April.

47. Octobeya Scott, age 30, developed COVID-19 pneumonia at 33 weeks gestation (click here). She was delivered by Caesarean section under general anaesthesia, on March 22 at Jack D. Weiler Hospital of the Albert Einstein College of Medicine, The Bronx, and ventilated for a further five hours. The baby, Alicia Anderson, was separated for five days. Both have now returned home. Report 18 April.

18 April update Cases 42 to 46 added.

46. Salina Shaw, age 37, from Southend in Essex, who had tested positive for Covid-19, gave birth on 4 April and died on 12 April (click here). Report 17 April.

45. Kilee Coye, age 25, from Canastota, New York State, has tested positive for the virus, and has some symptoms. She is 35 weeks pregnant (click here). Her partner also has Covid-19 and is on a ventilator. Report 15 April.

44. Lidia Puerta, age 26, from Spain tested positive at eight months gestation (click here, para 10). She was in quarantine in a hospital in Singapore, and the pregnancy ongoing at the time of the report. Report 22 March.

43. Yanira Soriano, age 36, developed Covid-19 at 34 weeks gestation. She required ventilation and the baby was delivered by caesarean at Southside Hospital in Bay Shore, New York. The baby tested negative. Mother and baby have been discharged. Report 16 April.

42. Megan Sites age 27 from Celina, Ohio, contracted Covid-19 at 29 weeks gestation (click here). She required ventilation, and later ECMO, and the baby was delivered by Caesarean section at 29 weeks. The baby, tested negative twice, is currently on NICU. The mother has improved slightly. Now off ECMO, but still ventilated.  Report 16 April.

16 April update Case 40 & 41 added.

41. Actress Patti Murin, age 39, probably has Covid-19, but has not been tested, and is self-isolating at home in California (click here). She is pregnant and due in July, so about 27 weeks gestation. Report 9 April.

40. Mary Agyeiwaa Boateng, née Agyapong, age 28, died on 12 April, in Luton & Dunstable Hospital UK from Covid-19 (click here). Her baby was reported to be “doing very well”. Report 15 April.

14 April update Cases 35-39 added

39. An unnamed woman with Covid-19 is delivered by Caesarean section at 32 weeks gestation at a public hospital in Nairobi (click here). The obstetrician used a pseudonym because she was not authorised to speak to the media.  No further details were given. Report 13 April.

38. Angela Primachenko age 27 from Vancouver was diagnosed with Covid-19 at 33 weeks and became seriously ill. She gave birth at 34 weeks after induced labour, while being ventilated at Legacy Salmon Creek Medical Center (click here). Her daughter was isolated in intensive care and has tested negative. Mrs. Primachneko has been discharged home. Report 13 April.

35-37. This report in The New York Times (click here) describes Precious Anderson, pregnant & critically ill with Covid-19, and two other unnamed women. The piece also mentions 29 pregnant or delivering women with suspected or confirmed Covid-19 in the Brooklyn Hospital Center. No mother or baby had died, and there had been no confirmed cases among newborns. The Brooklyn Hospital Centre is separate from the Presbyterian Allen Hospital & Columbia Irving Medical Center, so presumably these cases have not been reported in an academic paper yet. Report 12 April.

13 April update Cases 32-34 added. HT @danieladrandic.

34. An unnamed woman, delivered by Caesarean section at the MedLife Grivita private maternity hospital in Bucharest on March 13th, developed pneumonia after birth (click here). A test taken on March 20th was positive and she was transferred to Matei Bals Hospital, the Covid-19 treatment center in Bucharest. At the time of transfer mother and baby were reported to be in good condition (click here). Report 24 March.

33. These ten asymptomatic babies, in a maternity unit in the Romanian city of Timisoara, were apparently not infected in pregnancy or by their mothers (click here). “The mothers tested negative, but the babies tested positive so we have to consider their contacts with medical staff.” Report 7 April.

32. An unnamed mother died in the University Clinic of Gynaecology & Obstetrics in Skopje, North Macedonia. Her baby had died before birth. Neither death was directly due to Covid-19, but according to the report the mother, who had been transferred from Ohrid General Hospital, had her treatment delayed while Covid-19 test results (eventually negative) were awaited. This delay may have contributed to her death (click here). An investigation is ongoing. Report 6 April.

12 April update

31. An unnamed woman with Covid-19 was delivered by Caesarean section in the King Abdullah University Hospital in Irbid, northern Jordan (click here). The baby was isolated from the mother and has reportedly tested negative. Mother and baby doing well. Report 29 March.

30. Sophie Biddle, age 37, was diagnosed with Covid-19 on March 7th, but has recovered (click here). Her 20 week scan on March 23 was reportedly normal and the pregnancy is ongoing. Report 30 March.

10 April update cases 26 – 29 added.

29. An unnamed woman in Ritsona refugee camp 40 miles north of Athens tested positive for Covid-19 a day or two after giving birth (click here). Report 2 April.

28. 19-year old Marie Youri with Covid-19 gave birth prematurely in Yaounde, Cameroon (click here and here). She is said to be doing well with oxygen treatment. The baby Foraya weighed 2,100 grams and has not displayed any coronavirus symptoms. Report 8 April.

27. An unnamed 22-year-old woman with Covid-19 from Kyengera, Wakiso District, Uganda gave birth by Caesarean Section at Entebbe Grade B Hospital on April 5th (click here). Mother and baby were said to be in good health. Report 6 April.

26. An unnamed pregnant woman from Nallasopara died at Nair Hospital in Mumbai on April 4 (click here). Her baby was reported to have died in-utero before admission. She had been referred from a local hospital in Nallasopara after her condition deteriorated. It is reported that doctors suspect she died of Covid-19. A committee is investigating. Report 7 April.

A separate report (click here) of a 30 year old, nine month pregnant woman dying of Covid-19 in Mumbai may refer to the same woman. Report 6 April.

9 April update case 25 added.

25. Mallory Pease gave birth at Oaklawn Hospital in Marshall, Michigan to daughter Alivia on March 23 at term. She was symptomatic and tested positive for Covid-19. Alivia was not infected. Route of delivery not reported. Mother and baby both now discharged. Report 8 April.

8 April update cases 19 – 24 added.

24. Raquel Iacurto, age 32, a teacher from New York, was admitted to Long Island Jewish Medical Center with respiratory symptoms at 25 weeks gestation on March 11 and tested positive (click here).  She was discharged after three days. The pregnancy is ongoing. Report 28 March.

23. Simone Shoffman, a beauty blogger from Bothwell, near Glasgow in Scotland is pregnant and has tested positive. She is undelivered at home (click here). Report 6 April.

21. & 22. Two unnamed pregnant women with COVID-19 gave birth in Rebagliati Hospital in Lima, Peru, the first on March 22, the second on March 31st, both by Caesarean (click here). Both mothers were reported to be in good health, and neither baby was infected. Report April 8th.

20. Karen Mannering, from Herne Bay, UK, was admitted to the Queen Elizabeth the Queen Mother Hospital in Margate on 21 March with respiratory infection. She tested positive on 25th March, when she was seven months gestation. She has since been discharged home and the pregnancy is ongoing (click here). Report 31 March, updated 1 April.

19. Michelle Wright, aged 37, who is 29-weeks pregnant, has tested positive for coronavirus. The pregnancy is ongoing. She is an inpatient at Russells Hall Hospital in Dudley, UK (click here). Report 7 April.

7 April update cases 16 – 18 added.

18. A newborn baby has reportedly tested positive for coronavirus at James Paget Hospital in Norfolk (click here). No details of the mother have been given. Report 18 March.

17. An unnamed woman with Covid-19 from Baton Rouge, Louisiana, is reported to have gone into preterm labour at 21 weeks (click here). The baby did not survive. The death was reported to the coroner so presumably the baby was born alive. The mother is reported to be on a ventilator. Report 6th April.  The coroner has reportedly decided that the death was due to coronavirus. The mother remains on a ventilator, update 7 April (click here).

16. An unnamed woman with Covid-19 has died during labour at The Whittingdon Hospital, London (click here). The baby survived. Covid-19 has not been ruled out as the cause, and the death has been referred to the Coroner. Report 6 April.

6 April update. Case 10, the first report, scientific or otherwise, of a COVID-19 birth from France, case 11 from Detroit, case 12, the first report from Greece, and two cases 13 & 14 from Egypt added. I’ve also belatedly added a case from Portugal from 17 March.

15. An unnamed woman with Covid-19 (click here) gave birth in Porto’s São João hospital on 17th March. She was described as “doing well”. No further details were given. Report 17 March.

14. An unnamed woman who had recently recovered from COVID-19 gave birth on 4 April by Caesarean section in Hurghada Hospital, (click here). Report 5th April.

13. A 30-year-old eight months pregnant woman infected with COVID-19, treated at Esna Specialized Hospital in Egypt is recovering (click here). The pregnancy is ongoing. Report 3rd April.

12. An unnamed 24 year old woman infected with Covid-19 has given birth at 40 weeks (term) at Attikon General Hospital in Athens, as reported by the state-run news agency ANA-MPA on 27th March (click here). She had tested positive on March 15 and was kept in the hospital for 2 weeks. The baby boy tested negative. No further details are given but both mother and baby are healthy and ready to go home.

11. First reported in the Detroit Free Press, (link broken). For “Click on Detroit” (click here). Jennifer Thompson from Warren, a Detroit suburb, developed symptoms on March 7th at 8 months. She tested positive on March 13th, and her son, Hollis, was born in Beaumont Hospital in Royal Oak, on March 28th. Birth details not reported, but mother and baby back home and doing well. Report 4 April.

10. The artist Ariane Chang @Arianechang describes her baby’s birth by elective Caesarean section under regional block at term on March 19th in “a private birthing clinic in the 15th arrondissement” in Paris, [Presumably Maternité Catholique Sainte Félicité] in the New York Review of Books (click here). She had had symptoms of COVID-19 for two days, and tested positive prior to a second operation under general anaesthesia to control intra-abdominal bleeding, the following day. Baby Clare, reportedly the first baby born to a COVID-19 mother in that clinic, was breast fed but not tested. Mother and baby recovering at home. Ariane Chang illustrates the article with her own paintings and drawings. Report 2nd April.

9. Carrie Symonds, the partner of British Prime Minister Boris Johnson is reported to have had symptoms of Covid-19 for a week (click here and many other sources). According to reports she has not been tested. Since the PM with whom she is living has had confimed COVID-19, it seems likely that she does too. Her due date has been reported as early July. Working back from a hypothetical EDD of 4th July would make her 27 weeks today.  Report 4 April. Update 29 April. She gave birth to a healthy baby boy.

8. Vanesa Muro “a carrier of Covid-19” gave birth to Oscar, birth weight 3.6 kg, by Caesarean on March 13 at the “Madrid hospital in La Paz” [more likely either La Paz university hospital or La Paz maternity hospital in Madrid] (click here).  (El Mundo report click here.) The date of her scheduled Caesarean had been brought forward by three days. Mother and baby were separated for 10 days. Oscar tested negative. Both well. Report 3rd April.

7. Urszula Osborne, age 41, a nurse in Boston Mass, contracted Covid-19 while eight months pregnant (click here). She is recovering and the pregnancy is ongoing. But her husband had severe disease requiring ventilation.  Report 3rd April

6. A 37 year old pregnant woman reportedly infected with Covid-19 died on 29 March after a Caesarean section at the Teresa Herrera Hospital in Coruña. The fetus had reportedly already died (click here). Details conflict, and the family are reported as disputing whether the death was due to Covid-19. An investigation is ongoing (click here). Report 30 March.

5. An unnamed woman age 27 is reported to have died from Covid-19 after giving birth in Łańcut in the south of Poland (click here and here). Report 20th March

4. Allegedly the first birth in Galicia to a mother with Covid-19 (click here). Baby Fabio, born at Álvaro Cunqueiro Hospital in Vigo by Caesarean section at 35 weeks. Birth weight 2.6 kg. Not infected. Mother and baby both doing well. Report 19 March.

3. Model, Michela Persico, partner of Juventus footballer, Daniele Rugani, (click here) is reported to be infected with SARS-COV-2 and is pregnant. The pregnancy is ongoing.  Report 19 March.

2. North Middlesex Hospital UK. Mother with Covid-19 pneumonia gives birth to an infected baby (click here). No further details. Report 14 March.

1 Valentina, is the partner of Matteo, who has been claimed to be Italy’s “patient one”. Matteo was seriously ill with Covid-19, but is reported to be recovering. Valentina is also reported to have developed less severe Covid-19, and is recovering at home. She is reported by La Republica (click here) to be eight months pregnant. At the time of the report, Valentina was undelivered. Report 9 March.

Jim Thornton

 

Covid-19 in pregnancy. Running totals

March 31, 2020

At least four registries are collecting cases but, so far as we’re aware, none have yet published results. Update 14 April, the Netherlands registry is publishing data. Below are totals from scientific reports in English, avoiding duplicates as far as possible. Update 12 May the UKOSS registry is now published, dwarfs all other studies, and is likely the most representative. These running totals are now obsolete.  We will therefore stop adding to them from today, 12 May.  We will continue to correct errors. Click here for links to, and descriptions of, the original reports. Cases only reported in newspapers & social media are not included.

Update 12 May – UKOSS (Study 92) and studies 79 & 85 added.  Studies 86 to 91 (tba), US studies which may include duplicates, will be added when disambiguated.

Update 3 May – various studies added.  More detailed Lombardy report S64 replaces S32. Inclusion of S66, S67 & S70, non-duplicated maternal death reports, probably make the maternal death totals misleading. Discussed here.

Update 25 April – 33 duplicate mothers and babies removed from Study 8 due to overlap with Study 55. Three infected babies from Study 8 remain in the “infected” column because Study 55 did not report baby infection.

Update 23 April – Studies 48, 50, 51 & 53 (5 mothers & 5 babies) added. Study 55 (9 early pregnancy losses, 68 delivered mothers, 70 babies & 41 ongoing pregnancies from Wuhan hospitals) also added. But 71 previously included & presumed non-duplicate delivered mothers and 73 babies from Wuhan, reported in studies 1, 2, 5, 6, 6a, 10, 11, 12, 13, 15, 17, 30, & 37 removed. The woman whose baby died, reported in study 5, has been left in the count since neither she nor her baby appears in study 55.

Update 18 April. Studies 45 & 46 added, & study 42 (updated NethOSS) removed from running totals

Update 16 April. Study 13; all six cases removed from running totals. Study 3; 12/13 mothers & 9/10 babies removed. Both due to suspected duplication.

Update 14 April Studies 42 & 43 added. Study 42 is the Netherlands “Covid-19 in pregnancy” registry, the first to report. Study 43 is the first academic report of a maternal death from Covid-19

Update 13 April Study 39 added.

Update 11 April Study 34 and 37 added

Update 9 April 2020 Studies 31 and 32 added

Update 8 April Study 30 added.

Update 7 April 2020 Studies 27 & 28 included. Study 14 all duplicates. Reasons for excluding studies 23-26 and 29 here.

Update 2 April 2020 Studies 18 – 22 added.

Update 1 April 2020 Study 6A included. (See also note re corrections below)

Mothers

Study no n Non duplic Term 36 + Preterm Vag CS Ongoing Severe Alive & del Dead
92 427 427 180 63 101 144 180 40 242 5
91 tba                  
89 tba                  
                     
87 tba                  
86 tba                  
85 11 11     7 4   5 11 0
79 1 1 1   1       1 0
76 6 6 2     2 4   2 0
74 1 1 1     1     1 0
70 1 1       1   1 0 1
69 1 1       1   1 1 0
67 9 9           9 2 7g
66 7 7               7g
65 5 5       3 2 5 3 0
64 42 42 40 2 24 18   7 42 0
62 1 1       1     1 0
60 1 1         1      
58 1 1 1     1     1 0
55 118e 109 54 14 5 63 41 9 68 0
53 1 1   1   1   1 1 0
51 1 1   1   1   1 1 0
50 1 1   1   1   1 1 0
48 2 2   2   2   0 2 0
46 107 107d 24 1 17 8 66 5 25 o
45 1 1 1   1       1 0
43 1 1   1 1     1 0 1g
42 89 0                
39 23 23b 20   2 18     23 0
37 3 0                
34 1 1 1   1       1 0
32 42 0                
31 1 1   1   1   1 1 0
30 16 0                
28 7 7   1   2 5a 2 2 0
27 43 43 17 1 10 8 25 6 18 0
22 1 1 1     1     1 0
21 1 1 1   1       1 0
20 1 1 1     1     1 0
19 1 1   1   1     1 0
18 1 1   1 1       1 0
17 5 0                
15 7 0                
14 7 0                
13 6 0                
12 1 0                
11 1 0                
10 2 0                
9 1 1 1     1     1 0
8 33 0                
7 1 1   1     1     0
6a 16 0                
4 1 1   1   1   0 1 0
3 13 1   1       1* 0 0
5 24 1f             1f 0
1 9 0                
total   806           80 457 21g

*ECMO, a assumed to be ongoing, not explicitly stated. b two 1st trimester terminations. c brief additional information from only 74 cases. d brief additional details from 91. e includes 9 early pregnancy losses. f this woman from study 5 presumed non duplicate since her baby died, and no babies reported to have died in study 55.  g see discussion on maternal deaths here.

Babies

Ref n Non duplic Term 36+ Preterm Vaginal CS Ongoing infected Alive  Del Dead
92 427 427k 180 63 101 144 180 12 238 5
91 tba                  
89 tba                  
87 tba                  
86 tba                  
85 11 11     7 4   0 11 0
79 1 1     1     1 1 0
76 6 6       2 4   2 0
74 1 1       1     1 0
70 1 1       1     1 0
69 1 1       1     1 0
67 11 11             5 6
66 9 7                
65 5 5       3 2   3 0
64 42 42 40 2 24 18   3 24 0
62 1 1       1     1 0
60 1 1         1      
58 1 1 1     1     1 1
55 70 70i 54 14 5 63     70 0
53 1 1   1   1     1 0
51 1 1   1   1   1 1 0
50 1 1   1   1     1 0
48 2 2   2   2     2 0
46 25 25 24 1 17 8     25 0
45 1 1 1   1       1 0
43 1 1   1 1       0 1h
42 19 0                
39 21 0                
37 3 0                
34 1 1 1   1       1 0
32 42 0                
31 1 1   1   1     1 0
30 17 0                
28 7 7 1 1   2 5d   2d 0
27 43 43 17 1 10 8 25 0 18 0
22 1 1 1     1   0 1 0
21 1 1 1   1     0 1 0
20 2 2c 2c     2c   0 2c 0
19 1 1   1   1   0 1 0
18 1 1   1 1     0 1 0
17 5 0                
15 7 0                
14 7 0                
13 6 0                
12 1 0                
11 1 0                
10 2 0                
9 1 1 1     1     1 0
8 33 0           3**    
7 1 1   1     1      
6a 16 0                
4 1 1   1   1   0 1 0
3 13 1   1           1*
5 24 1j               1b j
1 9 0                
Total   674           17 428 15

 

*stillbirth, **All 3 CS all PCR +ve & pneumonia (these three baby details included although cases probably overlap with study 55 not included in mother or baby totals), +IgM but probably are included in study 1, $PCR 36hours, a one set of twins, bCS at 34w BW 2,200g, refractory shock & DIC day 8, died day 9, COVID-19 throat swab day 9 negative. c twins. d Baby status assumed, not explicitly stated. e one set of twins. f no baby details. g one set of twins, but excluding three terminations. h Stillborn after spontaneous labour while mother was ventilated. i incl. two sets of twins.  j this baby from study 5 presumed non duplicate since it died, & no babies reported to have died in study 55. k includes 4 early pregnancy losses

Jim Thornton, Keelin O’Donoghue, & Kate Walker.

Adjustment 7 April. Earlier versions of this table had reported the babies and mothers of some ongoing pregnancies in the “alive” column. This column has been relabelled “Alive & delivered” with appropriate adjustments made.

Correction 1 April. The first version of this table on 30 March missed the neonatal death, and failed to note a set of twins born vaginally, in study 9. Both corrected. I’ve also reconsidered excluding the 33 neonatal cases reported in JAMA (Study 8) from the maternal totals, having learned that Wuhan Children’s Hospital has it’s own birth unit separate from Union Hospital.  The mother & baby numbers should now align, after taking multiples into account.

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

 

The Tay Moses

March 18, 2020

A small group of Twitter poetry fans appeared to think that Elliot, Auden, Larkin and Hughes encompassed the modern canon. We were pointed to this powerful poem about maternal ambivalence, framed as a retelling of the biblical Moses story. It’s by the Scottish poet Kathleeen Jamie. To my shame I’d not even heard of her. I have now.

The Tay Moses

By Kathleen Jamie

What can I fashion for you
but a woven creel of river-
rashes, a golden
oriole’s nest my gift
wrought from the Firth –

And choose my tide: either
the flow, when, watertight
you’ll drift to the uplands
my favourite hills, held safe
in eddies where salmon, wisdom
and guts withered in spawn,
rest between moves – that
slither of body as you were born –

or the ebb, when the water
will birl you to snag
on reeds, the river
pilot leaning over the side
‘Name o’ God!‘ and you’ll change hands:
tractor-man, grieve, farm-wife
who takes you into her
competent arms

even as I drive slamming
the car’s gears,
spitting gravel on tracks
down between berry-fields,
engine still racing, the door wide
as I run toward her, crying
LEAVE HIM! Please,
it’s okay, he’s mine.

I’m sorry

March 15, 2020

Apologising is tricky. The non-apology “I’m sorry you were upset” is obviously no good, but sincere ones can also be tricky. Too fulsome sounds insincere, but not enough is, well, not enough. Here’s the answer; do your best, but follow-up by sending this to the person you’ve upset. From 101 Poems That Could Save Your Life, edited by Daisy Goodwin. Harper Collins, 1999.

Deep Sorriness Atonement Song

By Glyn Maxwell

The man who sold Manhattan for a halfway decent bangle,
He had talks with Adolf Hitler and could see it from his angle,
And he could have signed the Quarrymen but didn’t think they’d make it
So he bought a cake on Pudding Lane and thought “Oh well I’ll bake it”

But his chances they were slim
And his brothers they were Grimm,
And he’s sorry, very sorry,
But I’m sorrier than him.

And the drunken plastic surgeon who said “I know, let’s enlarge ’em!”
And the bloke who told the Light Brigade “Oh what the hell, let’s charge ’em”,
The magician with an early evening gig on the Titanic
And the Mayor who told the people of Atlantis not to panic,

And the Dong about his nose
And the Pobble re his toes,
They’re all sorry, very sorry
But I’m sorrier than those.

And don’t forget the Bible, with the Sodomites and Judas,
And Onan who discovered something nothing was as rude as,
And anyone who reckoned it was City’s year for Wembley.
And the kid who called Napoleon a shortarse in assembly,

And the man who always smiles
Cause he knows I have his files,
They’re all sorry, really sorry,
But I’m sorrier by miles.

And Robert Falcon Scott who lost the race to the Norwegian,
And anyone who’s ever split a pint with a Glaswegian,
Or told a Finn a joke or spent an hour with a Swiss-German,
Or got a mermaid in the sack and found it was a merman,

Or him who smelt a rat,
And got curious as a cat,
They’re all sorry, deeply sorry,
But I’m sorrier than that.

All the people who were rubbish when we needed them to do it,
Whose wires crossed, whose spirit failed, who ballsed it up or blew it,
All notches of nul points and all who have a problem Houston,
At least they weren’t in Kensington when they should have been at Euston.

For I didn’t build the Wall
And I didn’t cause the Fall
But I’m sorry, Lord, I’m sorry,
I’m the sorriest of all.

 

My FROSTTIE Prediction

February 25, 2020

Negative, & sceptical if positive

The FROSTTIE (FRenotomy Or breastfeeding Support for babies with Tongue-TIE) trial is testing the hypothesis that frenotomy, cutting the fold of skin under the front of the tongue, improves breast feeding in babies with ankyloglossia or tongue tie.  Commissioned by the UK Health Technology Assessment Programme (click here) and funded to the tune of over £1M, it is run by the National Perinatal Epidemiology Unit in Oxford (click here), chief investigator Professor Marian Knight, and registered here.

P – Mother baby dyads with breast feeding troubles. The baby is less than 10 weeks old and has been judged to have a tongue tie.

I – Frenotomy plus standard breast feeding support.

C – Standard breast feeding support alone.

O – Any breast feeding at age three months according to maternal self-report.

Sample size 870 dyads.  435 per group.  Apart from the misleading “Or” in the acronym, the science is great. My Aspredicted.org prediction that the result will be negative is here. What follows is no criticism of the triallists.

The trial is not justified by any meaningful science. It’s been funded because thousands of babies undergo this nonsensical “treatment” every year, such that a clear negative result would protect many in future.  But what if the result was apparently positive? By chance alone, at conventional levels of statistical significance, there is a one in twenty risk that it will be. There must also be some risk of bias; although parents are not told which treatment their baby got, it is likely that some will notice some bleeding or the lack of it, and the primary outcome is self-reported. Finally there are nine secondary outcomes; if even one is nominally “significant” enthusiasts will use it to confuse parents in future.

Why so hostile?

For hundreds, maybe thousands, of years, charlatans and the unsophisticated have blamed tongue tie for a whole range of problems (click here), including speech difficulties and stammering (click here), dribbling, poor feeding, and even autism (click here). The reason is simply that affected individuals have a frenulum connecting the underside of the tongue to the floor of the mouth. They ignore the fact that everyone has one. It’s a normal part of anatomy. It varies slightly in thickness and length but the charlatans provide no evidence that it systematically differs in affected individuals. Blaming the tongue tie and treating it with frenotomy is magical thinking.

Even if there was an anatomical tongue variant associated with breast feeding or speech problems, consider for a moment how plausible it is that dividing an adjacent band of tissue could help. The tongue is a large muscular organ, attached to the inner aspect of the lower jaw, the hyoid bone and various other ligaments and structures in the neck, and filling the whole oral cavity.

   

The anatomy varies. Some people, notably Gene Simmons the lead singer of the rock band Kiss, can protrude theirs a long way, some hardly at all, some people can roll their tongue, some not.

 

But none of these anatomical variants are anything to do with tongue tie or the lack of it. More importantly you can’t alter the function of a large muscle by diving a little skin fold at the edge of it. The only surgical way to alter a muscle’s function is to remove it from an attachment and reattach it somewhere else.  Orthopaedic surgeons occasionally do that sort of thing, but it’s major surgery, and no-one has ever contemplated it for breast-feeding problems. In the unlikely event that an adjacent band of tissue was really restricting tongue movement, the treatment would be stretching exercises or massage. Surgical release of movement-restricting tissue elsewhere, requires special techniques, such as z-plasty, to avoid worsening the problem.

The logic of frenotomy amounts to this; “Here’s a problem. Here’s a relatively avascular fold of skin conveniently to hand. Let’s cut it and claim credit if the problem improves.”

A few years ago similar nonsense affected my specialty of gynecology. Surgeons blamed a convenient, but entirely innocent part of a pelvic ligament, for otherwise unexplained pelvic pain. They divided a superficial bit of it, and claimed credit for any improvement that followed (click here). Only when a large trial with sham surgery in controls (click here) showed no effect did they stop. But imagine if the LUNA trial had by chance been positive. The logic of cutting part of a random ligament near the uterus to treat unexplained pelvic pain would not have altered, but unless gynaecologists had been appropriately sceptical, thousands of women would have gone on getting an expensive placebo, and some would have been injured.

It’s easy to be sceptical if a treatment – homeopathy for example – simply cannot work.  Believing in substances in such high dilution that not a single molecule remains, means disbelieving all of physics and chemistry. Sensible people don’t even read homeopathy trials.

Cutting tongue tie isn’t quite in that class, but it’s pretty near. Be sceptical if, by chance, FROSTTIE appears to show benefit.

Jim Thornton

 

Friday Night in the Royal Station Hotel

January 28, 2020

By Philip Larkin

Hull’s Royal Station Hotel last weekend. In the bar, the light still spreads darkly down from the “high clusters of lights”, over “empty chairs that face each other”, “coloured differently”.

 

Nothing appeared to have changed since the salesmen returned to Leeds. Through “open doors” the dining-room still declared its loneliness, and in “shoeless corridors” the lights still burned, although maybe the “headed paper” is no longer made for writing home.

 

But the doorman enlightened me; the hotel was gutted by fire in 1990, so must have been refurnished by a fan. Thank you that person, for reminding me of Larkin’s descriptive powers. Here’s the poem.

Friday Night in the Royal Station Hotel

Light spreads darkly downwards from the high
Clusters of lights over empty chairs
That face each other, coloured differently.
Through open doors, the dining-room declares
A larger loneliness of knives and glass
And silence laid like carpet. A porter reads
An unsold evening paper. Hours pass,
And all the salesmen have gone back to Leeds,
Leaving full ashtrays in the Conference Room.

In shoeless corridors, the lights burn. How
Isolated, like a fort, it is –
The headed paper, made for writing home
(If home existed) letters of exile: Now
Night comes on. Waves fold behind villages.

When does NICE recommend offering induction for women with uncomplicated pregnancy?

January 23, 2020

41+0, 41+3, or 42+0?

The recent SWEPIS trial from Sweden (click here) in which no baby died after induction at 41+0 compared to six deaths among those allocated to induction at 42+0 provoked some soul searching in Scandinavia.

And last week a group of Danish obstetricians invited me to consider whether they should change the gestation at which they offered induction for women with uncomplicated pregnancy from 41+3 (click here for guideline in Danish) to 41+0, i.e. three days earlier.*

I said, “Yes. Women don’t have to accept the offer, but most will, and the earlier date will prevent baby deaths, without increasing Caesareans. Women’s labour experience will be no worse, and no more painful. It may even be better and less painful.” I cited the ARRIVE (click here) and 35-39 (click here) trials in support of the latter assertions.

As an aside I said that the UK National Institute for Clinical Excellence (NICE) recommends offering induction between 41+0 and 42+0 weeks, but that the guideline was under review and I anticipated that the new version would recommend 41+0. To my surprise the audience told me that NICE already recommended 41+0.

They were right (click here for the summary and here for the full CG70 guideline. It’s on p24).  It reads:

1.2.1.2 “Women with uncomplicated pregnancies should usually be offered induction of labour between 41+0 and 42+0 weeks to avoid the risks of prolonged pregnancy.”

I had read that as offer the induction between 41+0 and 42+0 weeks. i.e. an offer to induce as late as 42+0 was acceptable. But it goes on to say;

“The exact timing should take into account the woman’s preferences and local circumstances.”

This removes any ambiguity. I had misread it. The offer must both be made by 41+0, and include availability of induction from 41+0, so that the woman can choose the timing.

Consider a woman whose fetus died at 41+1, with an appointment at 41+2 to discuss induction. I used to believe that her carers had followed NICE’s guidelines. But the correct reading is that they had not done so.

So why does NICE not say, “Offer induction at 41+0 weeks, and let the exact timing take into account the woman’s preferences and local circumstances”? Perhaps they should.

Does it matter? If 2/3 of pregnancies are uncomplicated, 20% reach 41+0 weeks, and if the number needed to induce to prevent a stillbirth at 41+0 weeks is 500, induction then rather than at 42+0 would save 160 baby lives each year in UK. In practice the gains will be smaller because a lot of inductions are already offered at 41+0, but there would be some easy wins.

Jim Thornton

* The average pregnancy lasts 40 weeks+0 days. So 41+0 is a week over the average, albeit well within the “normal” range. 42+0 is two weeks over the average. The current Danish standard 41+3 is  Term plus ten days.

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