C-section may put mothers with Covid-19 at higher risk of developing complications: Study
C-section may put Covid-19-positive women at higher risk of developing severe conditions such as organ dysfunction and respiratory distress, suggests a small study. What is more, the newborns may also wind up in a hospital's critical care. Researchers think the stress from the surgery could be behind these complications.
In China, where the outbreak first emerged, most coronavirus positive expectant mothers underwent a cesarian section. Dr David Baud from Lausanne University Hospital, Switzerland, told MEA WorldWide (MEAWW) that he was surprised by these high rates of surgery. So Baud and his colleagues from Spain and Switzerland set out to assess whether the mode of delivery — C-section versus vaginal delivery — influenced the severity of the disease.
"We were not so surprised to discover that vaginal delivery is safer in the case of patients infected by SARS-CoV-2 (the virus that causes Covid-19). Do not perform a cesarean section just because the patient is Covid-19 or to prevent transmission of the virus to the baby." Dr Baud said. He added that surgery did not seem to prevent newborns from contracting the infection.
In this study, the team looked at 78 pregnant patients delivering in Spain between March 12 and April 6, 2020. They had had mild or no symptoms before delivery. Of them, 41 delivered vaginally and 37 by cesarean section. They then looked at complications post-labor.
They found that patients with a vaginal delivery did not develop severe adverse outcomes, while nearly 14% with cesarean delivery required ICU admission. As for the worsening of conditions, about 5% in the former group and 22 % in the latter experienced them. Additionally, the team observed a significant link between C-section and maternal complications.
Among newborns, eight born vaginally and 11 by cesarean delivery needed critical care. About 4% of the newborn tested positive shortly after birth but seemed to have recovered later. "A few babies get infected after birth and had only mild symptoms," Dr Baud said.
Commenting on the study, Dr Vincenzo Berghella, Professor at Jefferson University Hospitals, Philadelphia, said: "Cesarean is major surgery, so the stress of major surgery can worsen outcomes compared to vaginal delivery." He was not involved in the study.
Typically, experts recommend cesarian when pregnant women experience risks such as complications from Covid-19, or a toxic condition that is characterized by high blood pressure and excess protein in the urine. Doctors also opt for the procedure when the fetus is not getting enough oxygen. "Cesarean delivery is considered when the mother and/or the baby appear too sick to undergo vaginal delivery. If a mother is critically ill with Covid-19, she and/or the baby might not be able to tolerate labor," Dr Berghella explained.
Dr Berghella pointed out that stress from surgery may not be the culprit. Instead, the complications could be because Covid-19 women who had cesarean deliveries are sicker than those who gave birth vaginally. However, he added: "Cesarean indeed can ‘stress’ the mother’s medical status more than a vaginal delivery, so it should be avoided if not necessary," he added.
The study appeared in JAMA as a Research letter.