Current evidence suggests that severe acute respiratory syndrome coronavirus 2 infection is associated with an increased incidence of adverse severe maternal and perinatal outcomes. However, vertical transmission is rare. The management of pregnant women with coronavirus disease 2019 (COVID-19) is similar to that of non-pregnant women, and effective treatments, including antiviral therapy, dexamethasone, and prophylactic anticoagulation should not be withheld during pregnancy.During the early COVID-19 pandemic period, the management of pregnant women was often delayed until the polymerase chain reaction (PCR) results came out or due to close contact, even among those without symptoms. Out of concern for the spread of infection, cesarean sections were performed instead of vaginal birth, since infection could have led to an increase in maternal and neonatal morbidities. Additionally, if the maternal PCR test was positive, the neonate was quarantined, and despite infectivity decreasing 10 days after symptom onset. It is necessary to ease the strict measures of infection control in the field of obstetrics.The presence or absence of maternal COVID-19 symptoms should be identified to stratify the risk, and vaginal delivery can be attempted in asymptomatic women with low infectivity. With more women being vaccinated safety data about vaccination is rapidly accumulating and no concerns have been detected. Globally, COVID-19 vaccines are recommended even during pregnancy. In order to prepare for future pandemics, it is necessary to apply lessons learned from this pandemic. Policymakers and healthcare leaders must determine efficient and effective strategies for preserving safe maternal care, even during an ongoing global emergency.

Purpose: To determine the clinical manifestations and maternal and perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19). Methods: We conducted a retrospective observational study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to National Health Insurance Service (NHIS) Ilsan Hospital between August 2020 and October 2021. The maternal and perinatal outcomes were investigated. Results: Among 184 pregnant women infected with SARS-CoV-2, 79 women delivered. Of the women who delivered, with 36 women giving birth during the quarantine period. At delivery, 45 women were positive for SARS-CoV-2 by polymerase chain reaction (PCR), whereas 34 women were negative. The most common clinical manifestations were cough (65.2%), fever (38.0%), and myalgia (33.2%). Regarding perinatal outcomes, none of the babies had an Apgar score <7 at 5 minutes, and none were intubated following the delivery. The preterm birth rate and small-for-gestational-age (SGA) rate were 15.2% and 16.5%, respectively. All babies who was delivered at NHIS Ilsan Hospital were negative for SARS-CoV-2 infection by PCR, which was evaluated using amniotic fluid, cord blood, neonatal nasopharyngeal and oropharyngeal swabs in the 1st and 2nd days following delivery, although 45 women were positive for SARS-CoV-2 infection by PCR at the time of delivery. Conclusion Most pregnant women with COVID-19 in South Korea were unlikely to manifest symptoms or present with a severe disease progression. The observed preterm birth rate and SGA rate were higher in women with COVID-19 than in those without COVID-19. However, there was no evidence of vertical transmission, and all babies were negative for SARS-CoV-2 infection during pregnancy.

Pregnancy has been shown to be associated with an adverse clinical course and symptomatic patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Extracorporeal membrane oxygenation (ECMO) is rarely used in pregnant or postpartum women with severe coronavirus disease 2019 (COVID-19). Here, we report the rare case of a pregnant woman diagnosed with SARS-CoV-2 infection placed on ECMO postpartum who subsequently received treatment for active rectal ulcer bleeding. Despite being placed on ECMO for 38 days and receiving a massive transfusion of 95 packs of red blood cells, she recovered and was discharged on hospital day 112. ECMO can be used in most patients with severe COVID-19, including pregnant patients, although potential coagulopathy complications must be considered.

PURPOSE: Demand of specialized maternity ward is increasing as national income level rises. However, the National Health Insurance limits the number of hospital's non-standard room to less than 50% of total hospital beds. Therefore, this research was performed to investigate the utilization rate of non-standard room among the Korean women who recently delivered baby in medical facilities in order to examine the factors affecting their selection. METHODS: One hundred sixty six medical facilities which deliver a minimum of ten cases in 2011 were selected and categorized by type, region, and size. A cross-sectional survey was done in November 2012 by a professional research survey company. Eight hundred and two pregnant women answered the questionnaire through a face-to-face interview. RESULTS: Of the 802 expecting mothers, 690 (86%) occupied non-standard room and 684 (85.2%) preferred non-standard room to the standard room. Satisfaction levels were significantly higher in mothers occupying non-standard room [5.9+/-1.0 vs. 5.4+/-1.2 (0-7 scale), P<0.01] and high-income families used non-standard room more often. Reasons for using non-standard room included adequate convalescence (78%), separate place for breastfeeding (6.1%), and convenience on receiving visitors (5.4%). Preference for non-standard room on next visit was higher in case of delivery compared to other cause of hospitalization (81.8% vs. 44.9%, P<0.001). CONCLUSIONS: Preference and actual use of non-standard room after delivery were significant. In spite of concrete preference, there was certain barrier in use of non-standard room according to the income and types of hospitals. Therefore, changes of policy such as insurance support for room charge may be needed in case of delivery.
Breast Feeding ; Convalescence ; Cross-Sectional Studies ; Female ; Hospitalization ; Humans ; Insurance ; Maternal Health Services ; Mothers* ; National Health Programs ; Patients' Rooms ; Postpartum Period ; Pregnant Women ; Surveys and Questionnaires ; Maternal Health

OBJECTIVE: To critically compare the benefits and risks of labor induction versus spontaneous labor in uncomplicated nulliparous women at 39 or more weeks of gestation. METHODS: We conducted a retrospective, observational study of 237 nulliparous women who were at 39 or more weeks of a singleton pregnancy with vertex presentation and intact membranes. We compared maternal outcomes including the Cesarean section rate and neonatal outcomes in the induced labor and spontaneous labor groups. RESULTS: Among the 237 women, 199 delivered vaginally (84.0%). The spontaneous labor group and induced labor group had a similar incidence of Cesarean delivery (17.7% vs. 12.3%, P=0.300). The length of stay and blood loss during delivery were also similar between the groups (4.3±1.5 vs. 3.9±1.5 days and 1.9±1.3 vs. 1.8±1.0 mg/sL, respectively; all P > 0.05). Regarding neonatal outcomes, the rate of meconium-stained amniotic fluid, Apgar score < 7 at 5 minutes, and intubation rate were similar between the groups (18.9% vs. 24.7%, 7.9% vs. 4.1%, and 6.1% vs. 4.4%, respectively, all P > 0.05). Only the neonatal intensive care unit admission rate was significantly lower in the induction group than in the spontaneous labor group (28.0% vs. 13.2%, P=0.001). CONCLUSION: Maternal adverse outcomes of labor induction at 39 weeks of gestation were similar to those in a spontaneous labor group in uncomplicated nulliparous women. Neonatal adverse events were also similar between the groups. It may be acceptable to schedule labor induction as long as 7 days before the estimated date, even when the indication is only relative.
Amniotic Fluid ; Apgar Score ; Appointments and Schedules ; Cesarean Section ; Delivery, Obstetric ; Female ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Intubation ; Labor, Induced ; Length of Stay ; Membranes ; Observational Study* ; Postpartum Period ; Pregnancy ; Retrospective Studies* ; Risk Assessment*

Purpose: To investigate potential differences in the frequency of preterm births (PTB) between pregnancies with or without prophylactic cerclage in women with a history of conization. Materials and Methods: We identified women who had their first singleton delivery after conization between 2013 and 2018 using records in the National Health Insurance Service of Korea claims database. We only included women who had undergone a health examination and interview within 2 years before delivery. We used timing of maternal serum alpha-fetoprotein (MSAFP) tests to differentiate early (before) from late (after the MSAFP test) cerclage. The frequency of adverse pregnancy outcomes, including PTB, preterm labor and premature rupture of membranes, antibiotics and tocolytics use, cesarean delivery, and number of admissions before delivery, were compared. Results: A total of 8322 women was included. Compared to the no cerclage group (n=7147), the risks of adverse pregnancy outcomes were higher in the cerclage group (n=1175). After categorizing patients with cerclage into two groups, the risk of PTB was still higher in the early cerclage group than in the no cerclage group after adjusting for baseline factors (4.48%, 30/669 vs. 2.77%, 159/5749, odds ratio 2.42, 95% confidence interval 1.49, 3.92). Other adverse pregnancy outcomes were also more frequent in the early cerclage group than the no cerclage group. Conclusion Early cerclage performed before MSAFP testing does not prevent PTB in pregnancy with a history of conization, but increases the risk of adverse pregnancy outcomes, including PTB.

It is unclear how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects pregnant women and their fetuses or newborns. We report two infants born to mothers with coronavirus disease 2019 (COVID-19) in Korea. The first case was a healthy female baby born at 39 +3 weeks' gestation from a mother diagnosed with COVID-19. The second case was a female baby born at 38 +0 weeks' gestation. The newborn in the second case had symptoms of respiratory distress immediately after birth, and nasal continuous positive airway pressure support was applied for 8 hours. Real-time polymerase chain reaction test results for SARSCoV-2 using amniotic fluid, neonatal nasopharyngeal and oropharyngeal swabs, blood, urine, stool, and rectal swab were all negative in the 1st and 2nd days of life in both cases. Placental pathology showed acute necrotizing deciduitis and intervillous fibrin deposition with acute intervillositis. Although clinical evidence of vertical transmission was not found in our cases, with the possibility of placental inflammation, close monitoring of SARS-CoV-2 positive mothers and their newborn is required.

Purpose: There is limited information on the clinical characteristics and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and risk factors for hypoxemia development were investigated in pregnant women with coronavirus disease-2019 (COVID-19). Materials and Methods: From August 2020 to February 2022, we performed a retrospective cohort study of 410 pregnant women with COVID-19. The clinical characteristics and prognoses were compared between pregnant COVID-19 patients requiring oxygen and those who did not. Results: Of 410 patients, 100 (24.4%) required oxygen therapy. Among them, fever [163 (52.6%) vs. 81 (81.0%), p<0.001] and cough [172 (56.4%) vs. 73 (73.0%), p=0.003] were more frequently observed than in non-oxygen group. The proportion of unvaccinated women was higher in oxygen group than in non-oxygen group [264 (85.2%) vs. 98 (98.0%), p=0.003]. During the Omicron wave, patients were more likely to have no oxygen requirement [98 (31.6%) vs. 18 (18.0%), p=0.009]. The risk of hypoxemic respiratory difficulty increased if SARS-CoV-2 infection occurred during the third trimester [adjusted odds ratio (aOR) 5.083, 95% confidence interval (CI): 1.095–23.593, p=0.038] and C-reactive protein (CRP) was elevated (≥1.0 mg/dL) at admission (aOR 5.878, 95% CI:3.099–11.146, p<0.001). The risk was higher in unvaccinated patients (aOR 5.376, 95% CI: 1.193-24.390, p=0.028). However, the risk was lower in patients during the Omicron wave (aOR 0.498, 95% CI: 0.258–0.961, p=0.038). Conclusion A quarter of SARS-CoV-2-infected women developed hypoxemic respiratory difficulty during pregnancy. SARSCoV-2 infection during the third trimester, CRP elevation at admission, and no vaccination increased the risk of hypoxemia in pregnant women.

OBJECTIVE: The Bishop score and length of the uterine cervix are good predictors of successful labor induction. However, little is known about the association between the funneling of the uterine cervix and successful labor induction. The study aimed to evaluate cervical funneling as a predictor of successful labor induction. METHODS: This study was designed as a prospective observational study. Subjects who delivered a baby by labor induction were enrolled in the study from July 2011 to August 2013. Cervical funneling and length were examined with transvaginal ultrasonography. The Bishop score was rated by digital pelvic examination. RESULTS: A total of 163 primigravida women were recruited for the study. Of these, 137 participants (84.0%) delivered vaginally by labor induction. Cervical funneling was observed in 93 women (57.1%). Successful labor induction was significantly higher in patients with cervical funneling than those without it (91.4% vs. 74.3%, P<0.01), and was significantly associated with cervical funneling, as well as the Bishop score and cervical length. In a multivariate analysis, cervical funneling was an independent predictor for successful vaginal delivery by labor induction ( odd ratio, 2.70; 95% confidence interval, 1.02 to 7.10; P=0.04). However, the Bishop score and cervical length had no association with successful vaginal delivery. CONCLUSION: This study showed that cervical funneling could be a predictive marker for vaginal delivery during labor induction.
Cervix Uteri* ; Cesarean Section ; Female ; Gynecological Examination ; Humans ; Multivariate Analysis ; Observational Study ; Pregnancy ; Prospective Studies ; Ultrasonography

OBJECTIVE: The Bishop score and length of the uterine cervix are good predictors of successful labor induction. However, little is known about the association between the funneling of the uterine cervix and successful labor induction. The study aimed to evaluate cervical funneling as a predictor of successful labor induction. METHODS: This study was designed as a prospective observational study. Subjects who delivered a baby by labor induction were enrolled in the study from July 2011 to August 2013. Cervical funneling and length were examined with transvaginal ultrasonography. The Bishop score was rated by digital pelvic examination. RESULTS: A total of 163 primigravida women were recruited for the study. Of these, 137 participants (84.0%) delivered vaginally by labor induction. Cervical funneling was observed in 93 women (57.1%). Successful labor induction was significantly higher in patients with cervical funneling than those without it (91.4% vs. 74.3%, P<0.01), and was significantly associated with cervical funneling, as well as the Bishop score and cervical length. In a multivariate analysis, cervical funneling was an independent predictor for successful vaginal delivery by labor induction ( odd ratio, 2.70; 95% confidence interval, 1.02 to 7.10; P=0.04). However, the Bishop score and cervical length had no association with successful vaginal delivery. CONCLUSION: This study showed that cervical funneling could be a predictive marker for vaginal delivery during labor induction.
Cervix Uteri* ; Cesarean Section ; Female ; Gynecological Examination ; Humans ; Multivariate Analysis ; Observational Study ; Pregnancy ; Prospective Studies ; Ultrasonography