Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 14 , ISSUE 5 ( September-October, 2022 ) > List of Articles


Determinants for Mode of Delivery in COVID-19 Pregnancy: A Single-center Retrospective Observational Study

Sabnam Sreedharan Nambiar, Ajith Sreedharan Nair, Rashmi Vadakke Puthanveettil, Ashitha Naser, Athulya Babu

Keywords : Cesarean section, COVID-19, Growth restriction, Meconium, Obesity

Citation Information : Nambiar SS, Nair AS, Puthanveettil RV, Naser A, Babu A. Determinants for Mode of Delivery in COVID-19 Pregnancy: A Single-center Retrospective Observational Study. J South Asian Feder Obs Gynae 2022; 14 (5):592-595.

DOI: 10.5005/jp-journals-10006-2113

License: CC BY-NC 4.0

Published Online: 16-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: With the rise in COVID-19 cases round the world, we have the problem of COVID-19 positive pregnancies at hand. Various case series and reports around the world have shown a high incidence of cesarian deliveries in these patients. We have attempted to study the factors predicting an increase in cesarean section (CS) rates in COVID-19 positive pregnancies admitted to our institution. Methods: Retrospective analysis of all deliveries of COVID-19 affected pregnancies in a tertiary care center in north Kerala from 15 April 2020 to 31 October 2020. There were 253 deliveries during this period with 183 cases of cesarean and 70 vaginal deliveries. The data were entered in Microsoft Excel and analyzed with appropriate statistical software. Results: There was 71.42% cesarean section rate in women below 35 years of age compared to 100% in those above 35 years. The rate was higher among nullipara (77.77%) compared to 67.32% among multipara. There was also a positive correlation between cesarean with obesity [prepregnancy body mass index (BMI) more than 30]. There were 70.22% term cesareans compared to 89.28% in preterm. Induction of labor also seemed to increase rate of cesarean. Fetal growth restriction (88.88%) contributed more to cesarean rates unlike those without (71.06%) preterm rupture of membranes (PROM) and meconium staining of amniotic fluid (MSAF) was also seen to increase the possibility of cesarean. Cardiotocogram abnormalities (13.83%) were another important contributing factor. A total of 100% of patients with abnormal cardiotocogram (CTG) underwent cesarean section when compared to only 67.88% in those with normal CTG. In patients delivered while still positive, the incidence of cesarean section was 77.63%, while this reduced to 63.04% in those whom delivery was delayed till seronegativity achieved. A total of 75.95% cases were done in the morning. There were 19.67% cases of fetal distress which added to the cesarean numbers. Conclusions: We found increased maternal age, obesity, nulliparity, fetal growth restriction, PROM, MSAF as factors which contributed to increased cesarean section rates in COVID-19 positive pregnancies. Hence these pregnancies need careful monitoring.

  1. Chen H, Guo J, Wang C, et al. Clinical characteristics and Intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet 2020;395(10226):809–815. DOI: 10.1016/S0140-6736(20)30360-3.
  2. Zhang J, Zhang Y, Ma Y, et al. The associated factors of cesarean section during COVID-19 pandemic: A cross-sectional study in nine cities of China. Environ Health Prev Med 2020;25(1):60. DOI: 10.1186/s12199-020-00899-w.
  3. Bisht R, Kandalgaonkar VP, Shinde KK. Cesarean section rates among COVID-19 mothers and its classification through Robson's criteria. J South Asian Feder Obst Gynae 2021;13(5):355–359. DOI: 10.5005/jp-journals-10006-1921.
  4. Parpillewar M, Prashanthi S, Waikar M. Maternal and neonatal outcomes of pregnant women with COVID-19: A case–control study at a tertiary cate centre in India. J South Asian Feder Obst Gyna 2021;13(1):44–49. DOI: 10.5005/jp-journals-10006-1850a.
  5. Akhtar H, Patel C, Abuelgasim E, et al. COVID-19 (SARS-CoV-2) infection in pregnancy: A systematic review. Gynecol Obstet Invest 2020;85:295–306.
  6. Agarwal N, Garg R, Singh S, et al. Coronavirus disease 2019 in pregnancy: Maternal and perinatal outcome. J Edu Health Promot 2021;10(1):194. DOI: 10.4103/jehp.jehp_954_20.
  7. Capobiancoa G, Saderib L, Alibertic S, et al. COVID-19 in pregnant women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020;252:543–558. DOI: 10.1016/j.ejogrb.2020.07.006.
  8. Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020;9(1):51–60. DOI: 10.21037/tp.2020.02.06.
  9. Bullo M, Tschumi S, Bucher BS, et al. Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists. Hypertension 2012;60:444–450. DOI: 10.1161/HYPERTENSIONAHA.112.196352.
  10. He J, Lu YP, Li J, et al. Fetal but not maternal angiotensin converting enzyme (ACE)-2 gene Rs2074192 polymorphism is associated with increased risk of being a small for gestational age (SGA) newborn. Kidney Blood Press Res 2018;43(5):1596–1606. DOI: 10.1159/000494449.
  11. Wang Z, Wang P, Wang X, et al. Significant association between angiotensin-converting enzyme gene insertion/deletion polymorphism and risk of recurrent miscarriage: A systematic review and meta-analysis. Metabolism 2013;62:1227–1238. DOI: 10.1016/j.metabol.2013.03.003.
  12. Gracia-Perez-Bonfils A, Martinez-Perez O, Llurba E, et al. Fetal heart rate changes on the cardiotocograph trace secondary to maternal COVID-19 infection. Eur J Obstet Gynecol Reprod Biol 2020;252:286–293. DOI: 10.1016/j.ejogrb.2020.06.049.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.