5Shanghai Municipal Key Clinical Specialty,
Shanghai, China
Correspondence: He-feng Huang, E-mail:huanghefg@hotmail.com;Postal address: No.910 Hengshan Road, Shanghai, China. Postal
code: 200030. Work phone: +86-021-64070434
The author report no conflict of interest.
Word Count: 463
Funding: None
Sir,
We read with great interests the article by
Anat
Schwartz and colleagues, entitled “Detection of SARS‐CoV‐2 in vaginal
swabs of women with acute SARS‐CoV‐2 infection: a prospective study”.
In their findings, of the 35 patients sampled, 2 (5.7%) had a positive
vaginal RT‐PCR for SARS‐CoV‐2, one was pre-menopausal and the other was
a post-menopausal woman, they did not detect the presence of viral
colonization in the vagina in five pregnant women. Although the
possibility of false positive results could not be ruled out, the
prospective study contained important information, with inclusion of the
participant women in both reproductive and non-reproductive years.
The detections of virus in the vagina and breast milk in pregnant women
have been reported in several studies, and concluded that vaginal
delivery or breast milk feeding might be low risk, for the major sampled
vagina and breast milk had negative RT‐PCR for SARS‐CoV‐2.
However, the transmission of virus by droplets between the mother and
newborn might have been seriously underestimated. SARS-CoV-2 spreads
through contact (via larger droplets and aerosols), and longer-range
transmission via aerosols, especially in conditions where ventilation is
poor. Its high infectivity, combined with the susceptibility of
unexposed populations to a new virus, creates conditions for rapid
community spread. A retrospective study of 42 pregnant women with
COVID‐19, two women had a new diagnosis of COVID-19 infection in the
postpartum period and breast-fed without a surgical mask; both newborns
had a positive test for COVID-19 infection at day 1 and 3, respectively.
In another case after vaginal delivery, the newborn of an infected woman
had a positive test and the first test for SARS-CoV-2 was equivocal a
few hours after delivery, and positive 3 days later, whereas, in 10
cases infected women with elective caesarean section for conditions
related to COVID-19 respiratory syndrome, no newborn was diagnosed with
positivity to SARS-Cov-2. Although the authors concluded that vaginal
delivery was associated with a low risk of intrapartum SARS-Cov-2
transmission to the newborn, we would like to emphasize the virus
concentrations in the delivery room between vaginal birth and Caesarean
delivery might be very different.
COVID-19 infected mother may release lots of droplets containing virus
in the room when using deep breathing and abdominal pressure in the
process of vaginal delivery, even if taking a mask, COVID-19 characters
as strong infectivity, rapid and wide spread. The neonate might breathe
the virus into the lung with crying, and the first crying might be the
important time-point for the neonates exposing to COVID-19. And they are
the main differences in COVID-19 infection risks between vaginal and
cesarean deliveries, we should not solely consider whether the vagina
secretion and breast milk contain virus. The importance of
possible intrapartum transmission
and prevention in COVID-19 infected pregnant women should be considered
in clinic.