Timing of delivery
According to the Expert Advice on Novel Coronavirus Infection in Pregnancy and Puerperium [1, 3], issued by Chinese Medical Association (CMA), the current consensus is that 2019-nCoV infection is not an absolute indication for ending pregnancy, but that expedition of delivery should be evaluated on a case-by-case basis. Maternal disease progression, gestational age and fetal intrauterine status are primary concerns. If maternal safety is assured, the timing of delivery should primarily be determined by the gestational age.
After consulting with several obstetric experts in Wuhan city, who have each dealt with COVID-19 infected pregnancies, we suggest that the timing of delivery for COVID-19 infection complicated pregnancies should be based on the following four principles:
1. If the infected pregnant women demonstrate obstetric indications for early delivery, such as placenta previa, preeclampsia, malpresentation etc., the timing of delivery should be based on the specific obstetric circumstances.
2. If the infection of COVID-19 is not improved by treatment, early delivery should be considered, even in the absence of obstetric indications.
3. If the maternal COVID-19 infection is assessed as severe or critical, according to the diagnostic criteria in the National Health and Medical Commission’s New Coronavirus Infection Pneumonia Diagnosis and Treatment Program (the fifth edition), early delivery needs to be considered to ensure maternal safety, regardless of gestational age [4].
(a) Severe: Respiratory distress (RR≥30 beats / min), or mean oxygen saturation ≤93% at rest, or arterial blood oxygen partial pressure (PaO2) / oxygen concentration (FiO2) ≤300mmHg;
(b) Critical: Respiratory failure and mechanical ventilation required, or shock, or combined with other organ failure and requires ICU monitoring and treatment.
4. Whether mild or common COVID-19 infection is an indication for delivery in the third trimester remains to be determined. During severe epidemics, delivery after 32-34 gestational weeks may be beneficial to the subsequent treatment and safety of these patients [5].
In summary, the current opinion of obstetric experts is that timing of delivery should be determined by the maternal disease status. Maternal safety is the priority; multidisciplinary consultation and the opinions of critical care medical experts should be considered carefully.