The impact of the mode of delivery on the prognosis of pregnant women with COVID-19: a multicentre observational study

ABSTRACT

Objective. The aim of this study was to assess the maternal and fetal outcomes in pregnant women with COVID-19 infection at birth and the impact of the mode of delivery on the prognosis of these patients.
Materials and Methods. This is a multicenter observational study including pregnant women delivering while infected with COVID-19 from January 2021 to June 2022 in 3 regions in the south of Tunisia. To assess the impact of the mode of delivery among patients included, they were divided into 2 groups: Group 1 included patients who had cesarean delivery. Group 2: included patients who had vaginal delivery.
The maternal and fetal outcomes were compared between the 2 groups. Multivariable logistic regression was performed to assess the association between the mode of delivery and maternal and fetal adverse outcomes.
Results. We included 201 patients: 129 cesarean deliveries and 72 vaginal deliveries.  Demographic parameters and the severity of COVID-19 signs before delivery were comparable in both groups. We noted higher rates of increased need for oxygen, maternal complications, and intensive care unit referral in the cesarean group (p < 0.001).Cesarean birth was significantly associated with the risk of clinical deterioration (aOR = 12.9, 95%CI 4.89- 34.4, p < 0.001), maternal death (aOR = 3.84, 95%CI  0.839-17.5,  p = 0.042), and an increased risk of neonatal intensive care unit  admission (aOR = 3.72; 95%CI 1.63-8.48, with p = 0.001).
Conclusions. Cesarean delivery may worsen the prognosis of pregnant women with COVID-19. It was also associated with adverse fetal outcomes.