Results
Data from 475 pregnant women with confirmed SARS-CoV-2 infection and
their deliveries were initially included in the study; however, 72 were
discarded out because of a lack of information about the timing of the
cord clamping. Therefore, 403 cases were finally analyzed. ECC was
performed on 231 neonates (57.3%), whereas 172 (42.7%) received DCC.
No significant differences were found between ECC and DCC groups in
maternal age and time between COVID-19 diagnosis and delivery (Table 1).
Regarding maternal symptomatology at the time of delivery, 82 (35.5%)
and 149 (64.5%) women showed COVID-19 symptoms or were asymptomatic in
the ECC group, respectively. In the case of DCC, 30 women (17.4%)
showed symptoms, whereas 142 (82.6%) were asymptomatic. The gestational
age at delivery with ECC was significantly lower than DCC (37+9 versus
38+8 weeks, P = .001). The number of instrumental and cesarean
deliveries were higher with ECC than DCC (13.0% versus 8.1% for
instrumental ones, and 45.9% versus 17.4% for cesarean); whereas the
number of eutocic deliveries was higher for DCC (74.4% versus 41.1%).
The weight at birth was significantly higher with DCC than ECC (3,210.4
versus 3,065.7 grams, P = .037). Although statistically
significant, this difference was not clinically relevant.
A total of 5 positive cases (1.7% of total tests performed) were
identified with the nasopharyngeal PCR tests, specifically 2 from the
ECC (1.7%) and 3 from the DCC group (3.6%; Table 2). No significant
differences between groups were found regarding neonatal tests for
COVID-19 (P = .390). All positive cases reported within 12 hours
after delivery resulted negative in the confirmation test performed
between 12 and 48 hours post-delivery. Therefore, no confirmed cases of
vertical transmission were detected. A new positive case was found
within 12–48 hours of delivery, which was possibly related with
horizontal transmission, through contact with a relative without the use
of protection measures (and unknown infection). None of the neonates
experienced COVID-19 at day 14 after delivery.
The percentage of mothers who made skin-to-skin contact within the first
24 hours after delivery was significantly higher with DCC (84.3% versus
45.9%, P = .001). Breastfeeding in the immediate postpartum
period was also significantly higher with DCC than ECC (77.3% versus
50.2%, P = .001).
No significant differences between groups were found regarding arterial
pH and Apgar score at 5 minutes in neonates. A higher percentage of
admissions to the ICU were reported in the ECC (16.5% versus 8.1%,P = .015).
Considering the temporal distribution, ECC was more prevalent than DCC
during the first few days of the pandemic (5.2% versus 2.3% between
1st and 15th March, 25.5% versus
15.1% between 16th and 31st March,
and 31.6% versus 20.9% between 1st and
15th April. Time evolution is shown in Table 3.) The
main reason for an ECC was due to maternal COVID-19 disease (37.2%)