Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19

Daniele Di Mascio 1 , Cihat Sen 2 , Gabriele Saccone 3 , Alberto Galindo 4 , Amos Grünebaum 5 , Jun Yoshimatsu 6 , Milan Stanojevic 7 , Asım Kurjak 7 , Frank Chervenak 5 , María José Rodríguez Suárez 8 , Zita Maria Gambacorti-Passerini 9 , María de los Angeles Anaya Baz 9 , 10 , Esther Vanessa Aguilar Galán 9 , 10 , Yolanda Cuñarro López 11 , Juan Antonio De León Luis 11 , Ignacio Cueto Hernández 11 , Ignacio Herraiz 4 , Cecilia Villalain 4 , Roberta Venturella 12 , Giuseppe Rizzo 13 , 14 , Ilenia Mappa 13 , Giovanni Gerosolima 15 , Lars Hellmeyer 16 , Josefine Königbauer 16 , Giada Ameli 16 , Tiziana Frusca 17 , Nicola Volpe 17 , Giovanni Battista Luca Schera 17 , Stefania Fieni 17 , Eutalia Esposito 18 , Giuliana Simonazzi 19 , Gaetana Di Donna 19 , Aly Youssef 19 , Anna Nunzia Della Gatta 19 , Mariano Catello Di Donna 20 , Vito Chiantera 20 , Natalina Buono 20 , Giulio Sozzi 20 , Pantaleo Greco 21 , Danila Morano 21 , Beatrice Bianchi 21 , Maria Giulia Lombana Marino 21 , Federica Laraud 22 , Arianna Ramone 22 , Angelo Cagnacci 22 , Fabio Barra 22 , Claudio Gustavino 22 , Simone Ferrero 22 , Fabio Ghezzi 23 , Antonella Cromi 23 , Antonio Simone Laganà 23 , Valentina Laurita Longo 24 , 25 , 26 , Francesca Stollagli 25 , Angelo Sirico 24 , Antonio Lanzone 24 , 25 , Lorenza Driul 27 , Fabiana Cecchini D 27 , Serena Xodo 27 , Brian Rodriguez 28 , Felipe Mercado-Olivares 28 , Deena Elkafrawi 28 , Giovanni Sisti 28 , Rosanna Esposito 3 , Antonio Coviello 3 , Marco Cerbone 3 , Maddalena Morlando 29 , Antonio Schiattarella 29 , Nicola Colacurci 29 , Pasquale De Franciscis 29 , Ilaria Cataneo 30 , Marinella Lenzi 30 , Fabrizio Sandri 30 , Riccardo Buscemi 31 , Giorgia Gattei 31 , Francesca della Sala 31 , Eleonora Valori 31 , 32 , Maria Cristina Rovellotti 31 , Elisa Done 33 , Gilles Faron 33 , Leonardo Gucciardo 33 , Valentina Esposito 34 , Flaminia Vena 1 , Antonella Giancotti 1 , Roberto Brunelli 1 , Ludovico Muzii 1 , Luigi Nappi 35 , Felice Sorrentino 35 , Lorenzo Vasciaveo 35 , Marco Liberati 36 , Danilo Buca 36 , Martina Leombroni 36 , Francesca Di Sebastiano 36 , Luciano Di Tizio 36 , Diego Gazzolo 37 , Massimo Franchi 38 , Quintino Cesare Ianniciello 38 , Simone Garzon 38 , Giuliano Petriglia 39 , Leonardo Borrello 39 , Albaro Josè Nieto-Calvache 40 , 41 , Juan Manuel Burgos-Luna 40 , 41 , Caroline Kadji 42 , Andrew Carlin 42 , Elisa Bevilacqua 42 , Marina Moucho 43 , Pedro Viana Pinto 43 , Rita Figueiredo 43 , José Morales Roselló 44 , Gabriela Loscalzo 44 , Alicia Martinez-Varea 44 , Vincente Diago 44 , Jesús S Jimenez Lopez 45 , Alicia Yeliz Aykanat 46 , Stefano Cosma 47 , Andrea Carosso 47 , Chiara Benedetto 47 , Amanda Bermejo 48 , Otto Henrique May Feuerschuette 49 , Ozlem Uyaniklar 50 , Sakine Rahimli Ocakouglu 50 , Zeliha Atak 50 , Reyhan Gündüz 51 , Esra Tustas Haberal 52 , Bernd Froessler 53 , Anupam Parange 53 , Peter Palm 53 , Igor Samardjiski 54 , Chiara Taccaliti 55 , Erhan Okuyan 56 , George Daskalakis 57 , Renato Augusto Moreira de Sa 58 , Alejandro Pittaro 59 , Maria Luisa Gonzalez-Duran 60 , Ana Concheiro Guisan 60 , Şerife Özlem Genç 61 , Blanka Zlatohlávková 62 , Anna Luengo Piqueras 63 , Dolores Esteban Oliva 63 , Aylin Pelin Cil 64 , Olus Api 64 , Panos Antsaklis 57 , Liana Ples 65 , Ioannis Kyvernitakis 66 , Holger Maul 66 , Marcel Malan 66 , Albert Lila 67 , Roberta Granese 68 , Alfredo Ercoli 68 , Giuseppe Zoccali 68 , Andrea Villasco 69 , Nicoletta Biglia 69 , Ciuhodaru Madalina 70 , Elena Costa 71 , Caroline Daelemans 71 , Axelle Pintiaux 71 , Elisa Cueto 72 , Eran Hadar 73 , Sarah Dollinger 73 , Noa A. Brzezinski Sinai 73 , Erasmo Huertas 74 , Pedro Arango 74 , Amadeo Sanchez 74 , Javier Alfonso Schvartzman 75 , Liviu Cojocaru 76 , Sifa Turan 76 , Ozhan Turan 76 , Maria Carmela Di Dedda 77 , Rebeca Garrote Molpeceres 78 , Snezana Zdjelar 79 , Tanja Premru-Srsen 80 , Lilijana Kornhauser Cerar 80 , Mirjam Druškovič 80 , Valentina De Robertis 81 , Vedran Stefanovic 82 , Irmeli Nupponen 82 , Kaisa Nelskylä 82 , Zulfiya Khodjaeva 83 , Ksenia A. Gorina 83 , Gennady T. Sukhikh 83 , Giuseppe Maria Maruotti 3 , Silvia Visentin 84 , Erich Cosmi 84 , Jacopo Ferrari 84 , Alessandra Gatti 85 , Daniela Luvero 85 , Roberto Angioli 85 , Ludovica Puri 25 , Marco Palumbo 86 , Giusella D’Urso 86 , Francesco Colaleo 86 , Agnese Maria Chiara Rapisarda 86 , Ilma Floriana Carbone 87 , Antonio Mollo 90 , Giovanni Nazzaro 3 , Mariavittoria Locci 3 , Maurizio Guida 3 , Attilio Di Spiezio Sardo 3 , Pierluigi Benedetti Panici 1 , Vincenzo Berghella 88 , Maria Elena Flacco 89 , Lamberto Manzoli 89 , Giuseppe Bifulco 3 , Giovanni Scambia 24 , Fulvio Zullo 3 , and Francesco D’Antonio 36
  • 1 Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
  • 2 Perinatal Medicine Foundation and Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey
  • 3 Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • 4 Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • 5 Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
  • 6 Department of Perinatology and Gynaecology, National Cerebral and Cardiovascular Center, Osaka, Japan
  • 7 Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
  • 8 Hospital Universitario Central de Asturias, Asturias, Spain
  • 9 Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
  • 10 University of Castilla-La Mancha, Ciudad Real, Spain
  • 11 Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • 12 Department of Obstetrics and Gynaecology, School of Medicin, Magna Graecia University of Catanzaro, Catanzaro, Italy
  • 13 University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
  • 14 Department of Obstetrics and Gynaecology The First I.M, Sechenov Moscow State Medical University, Moscow, Russia
  • 15 Department of Obstetrics and Gynaecology, Ospedale AOSG Moscati, Avellino, Italy
  • 16 Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
  • 17 Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
  • 18 Department of Obstetrics and Gynaecology, Ospedale di San Leonardo, Castellammare di Stabia, Italy
  • 19 Department of Obstetrics and Gynaecology, University of Bologna, Sant’Orsola- Malpighi University Hospital, Bologna, Italy
  • 20 Department of Gynaecologic Oncology, University of Palermo, Palermo, Italy
  • 21 Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant’ Anna, University of Ferrara, Ferrara, Italy
  • 22 Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Italy
  • 23 Department of Obstetrics and Gynaecology, “Filippo Del Ponte” Hospita University of Insubria, Varese, Italy
  • 24 Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
  • 25 Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
  • 26 Queen Margaret University,Institute for Global Health and Development, Edinburgh, UK
  • 27 Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy
  • 28 Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, USA
  • 29 Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
  • 30 Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
  • 31 Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • 32 Hospital Castelli, Verbania, Italy
  • 33 UZ Brussel, Universitair Ziekenhuis, Brussel, Belgium
  • 34 University of Milan, Milan, Italy
  • 35 Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  • 36 Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
  • 37 Neonatal Intensive Care Unit, University of Chieti, Chieti, Italy
  • 38 Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
  • 39 Maternal and Child Health Department, Santa Maria Hospital, Terni, Italy
  • 40 Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
  • 41 Postgraduate Department, Universidad Icesi, Cali, Colombia
  • 42 Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
  • 43 Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
  • 44 Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
  • 45 Hospital Regional Universitario de Málaga, Malaga, Spain
  • 46 Department of Obstetrics and Gynaecology, Istanbul University-Cerrahpasa Medical School, Istanbul, Turkey
  • 47 Department of Obstetrics and Gynaecology, Sant’Anna Hospital, University of Turin, Turin, Italy
  • 48 Hospital Universitario de Móstoles, Mostoles, Spain
  • 49 Departamento de Ginecologia e Obstetrícia, Hospital Universitário Polydoro Ernani, Santiago, Brazil
  • 50 Bursa City Hospital, Bursa, Turkey
  • 51 Department of Obstetrics and Gynaecology, University of Dicle, Diyarbakır, Turkey
  • 52 Hisar Intercontinental Hospital, Istanbul, Turkey
  • 53 Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
  • 54 University Clinic of Obstetrics and Gynaecology, Skopje, North Macedonia
  • 55 Ospedale Generale Regionale “F. Miulli”, Acquaviva delle Fonti, Italy
  • 56 Batman Maternity and Child Health Hospital, Batman, Turkey
  • 57 Alexandra Hospital – National and Kapodistrian, University of Athens, Athens, Greece
  • 58 Assistência Obstétrica do Grupo Perinatal, Rio de Janeiro, Brazil
  • 59 Hospital Raul F. Larcade, Buenos Aires, Argentina
  • 60 Alvaro Cunqueiro University Hospital of Vigo, Vigo, Spain
  • 61 Karaman Public Hospital, Karaman, Turkey
  • 62 Department of Obstetrics and Gynaecology, Division of Neonatology, General Hospital in Prague and First Faculty of Medicine,Charles University, Prague, Czech Republic
  • 63 Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
  • 64 American Hospital, Istanbul, Turkey
  • 65 Department of Obstetrics and Gynaecology, Saint John Hospital, UMF Carol Davila, Bucharest, Romania
  • 66 Asklepios Hospital Barmbek, Hamburg, Germany
  • 67 Regional Hospital Gjakova, Kosovo, Republic of Kosovo
  • 68 Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
  • 69 Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
  • 70 Universitatea de Medicină și Farmacie Grigore T. Popa Iași, Iasi, Romania
  • 71 Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
  • 72 Hospital Virgen De La Luz, Cuenca, Spain
  • 73 Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • 74 Instituto Nacional Materno Perinatal, Lima, Peru
  • 75 Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, Buenos Aires, Argentina
  • 76 Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, USA
  • 77 Department Gynaecology and Obstetrics, Fornaroli Hospital, Magenta, Italy
  • 78 University Clinic Hospital Of Valladolid, Valladolid, Spain
  • 79 Kbc Dr Dragisa Misovic Dedinje Belgrade, Beograd, Serbia
  • 80 Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  • 81 Fetal Medicine Unit, Di Venere Hospital, Bari, Italy
  • 82 Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • 83 National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
  • 84 Department of Woman’ and Child’s Health, University of Padova, Padova, Italy
  • 85 Campus Bio Medico, University of Rome, Rome, Italy
  • 86 Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
  • 87 Ospedale Maggiore Policlinico Milano, Milan, Italy
  • 88 Maternal Fetal Medicine Division, Sidney Kimmel Medical College at Thomas Jefferson University, Obstetrics and Gynaecology Department, Philadelphia, USA
  • 89 Department of Medical Sciences, University of Ferrara, Ferrara, Italy
  • 90 University of Salerno, Salerno, Italy
Daniele Di Mascio
  • Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Cihat Sen
  • Corresponding author
  • Perinatal Medicine Foundation and Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Gabriele Saccone
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Alberto Galindo
  • Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Amos Grünebaum
  • Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Jun Yoshimatsu
  • Department of Perinatology and Gynaecology, National Cerebral and Cardiovascular Center, Osaka, Japan
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Milan Stanojevic
  • Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Asım Kurjak
  • Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Frank Chervenak
  • Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, María José Rodríguez Suárez, Zita Maria Gambacorti-Passerini
  • Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, María de los Angeles Anaya Baz
  • Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
  • University of Castilla-La Mancha, Ciudad Real, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Esther Vanessa Aguilar Galán
  • Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
  • University of Castilla-La Mancha, Ciudad Real, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Yolanda Cuñarro López
  • Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Juan Antonio De León Luis
  • Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ignacio Cueto Hernández
  • Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ignacio Herraiz
  • Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Cecilia Villalain
  • Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Roberta Venturella
  • Department of Obstetrics and Gynaecology, School of Medicin, Magna Graecia University of Catanzaro, Catanzaro, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giuseppe Rizzo
  • University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
  • Department of Obstetrics and Gynaecology The First I.M, Sechenov Moscow State Medical University, Moscow, Russia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ilenia Mappa
  • University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giovanni Gerosolima, Lars Hellmeyer
  • Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Josefine Königbauer
  • Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giada Ameli
  • Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Tiziana Frusca, Nicola Volpe, Giovanni Battista Luca Schera, Stefania Fieni, Eutalia Esposito
  • Department of Obstetrics and Gynaecology, Ospedale di San Leonardo, Castellammare di Stabia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giuliana Simonazzi
  • Department of Obstetrics and Gynaecology, University of Bologna, Sant’Orsola- Malpighi University Hospital, Bologna, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Gaetana Di Donna
  • Department of Obstetrics and Gynaecology, University of Bologna, Sant’Orsola- Malpighi University Hospital, Bologna, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Aly Youssef
  • Department of Obstetrics and Gynaecology, University of Bologna, Sant’Orsola- Malpighi University Hospital, Bologna, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Anna Nunzia Della Gatta
  • Department of Obstetrics and Gynaecology, University of Bologna, Sant’Orsola- Malpighi University Hospital, Bologna, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Mariano Catello Di Donna
  • Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Vito Chiantera
  • Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Natalina Buono
  • Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giulio Sozzi
  • Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Pantaleo Greco
  • Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant’ Anna, University of Ferrara, Ferrara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Danila Morano
  • Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant’ Anna, University of Ferrara, Ferrara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Beatrice Bianchi
  • Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant’ Anna, University of Ferrara, Ferrara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Maria Giulia Lombana Marino
  • Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant’ Anna, University of Ferrara, Ferrara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Federica Laraud
  • Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Arianna Ramone
  • Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Angelo Cagnacci
  • Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Fabio Barra
  • Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Claudio Gustavino
  • Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Simone Ferrero
  • Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Fabio Ghezzi
  • Department of Obstetrics and Gynaecology, “Filippo Del Ponte” Hospita University of Insubria, Varese, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Antonella Cromi
  • Department of Obstetrics and Gynaecology, “Filippo Del Ponte” Hospita University of Insubria, Varese, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Antonio Simone Laganà
  • Department of Obstetrics and Gynaecology, “Filippo Del Ponte” Hospita University of Insubria, Varese, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Valentina Laurita Longo
  • Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
  • Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
  • Queen Margaret University,Institute for Global Health and Development, Edinburgh, UK
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Francesca Stollagli
  • Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Angelo Sirico
  • Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Antonio Lanzone
  • Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
  • Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Lorenza Driul, Fabiana Cecchini D, Serena Xodo, Brian Rodriguez
  • Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Felipe Mercado-Olivares
  • Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Deena Elkafrawi
  • Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giovanni Sisti
  • Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Rosanna Esposito
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Antonio Coviello
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Marco Cerbone
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Maddalena Morlando
  • Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Antonio Schiattarella
  • Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Nicola Colacurci
  • Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Pasquale De Franciscis
  • Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ilaria Cataneo, Marinella Lenzi, Fabrizio Sandri, Riccardo Buscemi
  • Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giorgia Gattei
  • Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Francesca della Sala
  • Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Eleonora Valori
  • Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Hospital Castelli, Verbania, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Maria Cristina Rovellotti
  • Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Elisa Done, Gilles Faron, Leonardo Gucciardo, Valentina Esposito, Flaminia Vena
  • Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Antonella Giancotti
  • Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Roberto Brunelli
  • Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ludovico Muzii
  • Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Luigi Nappi
  • Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Felice Sorrentino
  • Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Lorenzo Vasciaveo
  • Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Marco Liberati
  • Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Danilo Buca
  • Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Martina Leombroni
  • Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Francesca Di Sebastiano
  • Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Luciano Di Tizio
  • Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Diego Gazzolo, Massimo Franchi
  • Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Quintino Cesare Ianniciello
  • Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Simone Garzon
  • Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giuliano Petriglia, Leonardo Borrello, Albaro Josè Nieto-Calvache
  • Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
  • Postgraduate Department, Universidad Icesi, Cali, Colombia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Juan Manuel Burgos-Luna
  • Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
  • Postgraduate Department, Universidad Icesi, Cali, Colombia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Caroline Kadji
  • Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Andrew Carlin
  • Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Elisa Bevilacqua
  • Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Marina Moucho
  • Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Pedro Viana Pinto
  • Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Rita Figueiredo
  • Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
  • Search for other articles:
  • degruyter.comGoogle Scholar
, José Morales Roselló
  • Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Gabriela Loscalzo
  • Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Alicia Martinez-Varea
  • Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Vincente Diago
  • Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Jesús S Jimenez Lopez, Alicia Yeliz Aykanat
  • Department of Obstetrics and Gynaecology, Istanbul University-Cerrahpasa Medical School, Istanbul, Turkey
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Stefano Cosma
  • Department of Obstetrics and Gynaecology, Sant’Anna Hospital, University of Turin, Turin, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Andrea Carosso
  • Department of Obstetrics and Gynaecology, Sant’Anna Hospital, University of Turin, Turin, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Chiara Benedetto
  • Department of Obstetrics and Gynaecology, Sant’Anna Hospital, University of Turin, Turin, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Amanda Bermejo, Otto Henrique May Feuerschuette
  • Departamento de Ginecologia e Obstetrícia, Hospital Universitário Polydoro Ernani, Santiago, Brazil
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ozlem Uyaniklar, Sakine Rahimli Ocakouglu, Zeliha Atak, Reyhan Gündüz
  • Department of Obstetrics and Gynaecology, University of Dicle, Diyarbakır, Turkey
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Esra Tustas Haberal, Bernd Froessler, Anupam Parange, Peter Palm, Igor Samardjiski, Chiara Taccaliti, Erhan Okuyan, George Daskalakis
  • Alexandra Hospital – National and Kapodistrian, University of Athens, Athens, Greece
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Renato Augusto Moreira de Sa, Alejandro Pittaro, Maria Luisa Gonzalez-Duran, Ana Concheiro Guisan, Şerife Özlem Genç, Blanka Zlatohlávková
  • Department of Obstetrics and Gynaecology, Division of Neonatology, General Hospital in Prague and First Faculty of Medicine,Charles University, Prague, Czech Republic
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Anna Luengo Piqueras, Dolores Esteban Oliva, Aylin Pelin Cil, Olus Api, Panos Antsaklis
  • Alexandra Hospital – National and Kapodistrian, University of Athens, Athens, Greece
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Liana Ples
  • Department of Obstetrics and Gynaecology, Saint John Hospital, UMF Carol Davila, Bucharest, Romania
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ioannis Kyvernitakis, Holger Maul, Marcel Malan, Albert Lila, Roberta Granese, Alfredo Ercoli, Giuseppe Zoccali, Andrea Villasco
  • Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Nicoletta Biglia
  • Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ciuhodaru Madalina, Elena Costa
  • Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Caroline Daelemans
  • Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Axelle Pintiaux
  • Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Elisa Cueto, Eran Hadar
  • Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Sarah Dollinger
  • Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Noa A. Brzezinski Sinai
  • Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Erasmo Huertas, Pedro Arango, Amadeo Sanchez, Javier Alfonso Schvartzman
  • Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, Buenos Aires, Argentina
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Liviu Cojocaru
  • Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Sifa Turan
  • Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ozhan Turan
  • Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Maria Carmela Di Dedda, Rebeca Garrote Molpeceres, Snezana Zdjelar, Tanja Premru-Srsen
  • Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Lilijana Kornhauser Cerar
  • Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Mirjam Druškovič
  • Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Valentina De Robertis, Vedran Stefanovic
  • Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Irmeli Nupponen
  • Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Kaisa Nelskylä
  • Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Zulfiya Khodjaeva
  • National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ksenia A. Gorina
  • National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Gennady T. Sukhikh
  • National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giuseppe Maria Maruotti
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Silvia Visentin, Erich Cosmi, Jacopo Ferrari, Alessandra Gatti, Daniela Luvero, Roberto Angioli, Ludovica Puri
  • Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Marco Palumbo
  • Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giusella D’Urso
  • Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Francesco Colaleo
  • Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Agnese Maria Chiara Rapisarda
  • Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Ilma Floriana Carbone, Antonio Mollo, Giovanni Nazzaro
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Mariavittoria Locci
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Maurizio Guida
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Attilio Di Spiezio Sardo
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Pierluigi Benedetti Panici
  • Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Vincenzo Berghella
  • Maternal Fetal Medicine Division, Sidney Kimmel Medical College at Thomas Jefferson University, Obstetrics and Gynaecology Department, Philadelphia, PA, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Maria Elena Flacco, Lamberto Manzoli, Giuseppe Bifulco
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Giovanni Scambia
  • Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Fulvio Zullo
  • Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar
and Francesco D’Antonio
  • Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
  • Search for other articles:
  • degruyter.comGoogle Scholar

Abstract

Objectives

To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19.

Methods

Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI).

Results

Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8–0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09–1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3–7.9; p=0.001) were independently associated with composite adverse fetal outcome.

Conclusions

Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Introduction

Towards the end of 2019, a novel Coronavirus mutation ‐ labelled as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) ‐ was identified as the cause of a respiratory illness called COVID-19, that suddenly became epidemic in China, and then dramatically spread in many other countries worldwide as a global pandemic [1], [2], [3], [4], [5], [6], [7], [8], [9].

Despite rigorous mitigation measures adopted by governments to reduce both the virus spread and its detrimental effects on healthcare systems and therefore on the whole worldwide economy [10], COVID-19 has currently affected about five millions of people with more than 300,000 deaths [11].

Although evidence is accumulating rapidly, there are still several outstanding issues that need to be settled soon regarding the effect of COVID-19 on perinatal outcomes to guide the antenatal counselling and management of women with COVID-19 during pregnancy.

In a large multinational cohort study, we have recently shown that COVID-19 in pregnant women is associated with low rate of maternal mortality, but 11.1% rate of admission to intensive care unit (ICU) [12].

However, an accurate risk stratification of women with COVID-19 is needed to ascertain the association between different maternal characteristics or clinical findings and adverse perinatal outcomes, in order to more appropriately tailor their management.

The primary aim of this study was to report perinatal outcome in pregnancies complicated by COVID-19 infection; the secondary aim was to elucidate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcome in these pregnancies.

Materials and methods

Study design and participants

This is a secondary analysis of the World Association of Perinatal Medicine (WAPM) study [12]. The WAPM study was a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries (Argentina, Australia, Belgium, Brazil, Colombia, Czech Republic, Finland, Germany, Greece, Israel, Italy, North Macedonia, Peru, Portugal, Republic of Kosovo, Romania, Russia, Serbia, Slovenia, Spain, Turkey, and United States)

COVID-19 was diagnosed on the basis of The World Health Organization (WHO) interim guidance [13]. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens [14], [15].

The study was approved by the IRB of the University of Naples Federico II (April 2020, approval number: 145/2020).

A composite adverse fetal outcome was defined as the presence of either:

  • Abortion, defined as pregnancy loss before 22 weeks of gestations,
  • Stillbirth, defined as intrauterine fetal death after 22 weeks of gestation,
  • Neonatal death, defined as death of a live-born infant within the first 28 days of life,
  • Perinatal death, defined as either stillbirth or neonatal death.

Statistical analysis

Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) v. 19.0 (IBM Inc., Armonk, NY, USA). Continuous variables were reported as means ± standard deviation (SD), while categorical as numbers (percentage). Univariate comparisons of dichotomous data were performed with the use of the χ2-test with continuity correction. Comparisons between groups were performed with the use of the T-test to test group means by assuming equal within-group variances for parametric data, and with the use of Wilcoxon and Mann‐Whitney tests for nonparametric data. We also planned to test the strength of association between different maternal and pregnancy characteristics, and clinical, radiological, and laboratory findings, with a composite adverse fetal outcome. Logistic regression analysis was also performed to evaluate parameters independently associated with a composite adverse fetal outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). For the purpose of the analysis, this analysis was performed including only women with completed pregnancy. A p-value <0.05 was considered statistically significant.

Results

The WAPM study involved 388 singleton pregnancies positive to COVID-19 at RT-PCR nasal and pharyngeal swab, in 73 centers from 22 different countries.

Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. Included women were asymptomatic in 24.2% of cases. The most common symptom at the time of triage was cough (52.1%), followed by fever (44.1%), while shortness of breath was complained by 60 women (15.5%). 11.1% of women were admitted to ICU, and 6.4% requiring intubation. There were three cases of maternal deaths, accounting for a maternal mortality rate of 0.8% [12].

Evaluation of the potential risk factors associated with the occurrence of the composite adverse fetal outcome was performed only in women with completed pregnancy.

Table 1 shows perinatal outcomes from the WAPM study. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 248 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler (reverse end diastolic flow in the umbilical artery, increased ductus venosus pulsatility index, absent or reverse a wave in the ductus venosus). Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. Unfortunately, amniotic fluid was not tested, and specimens from placenta were not obtained, thus questioning whether the infection occurred in utero (antenatal vertical transmission) or after immediately prior or after birth (perinatal vertical transmission).

Table 1:

Perinatal outcomes from the WAPM study [12].

Women with completed pregnancies(n=266)% (95% CI)
Elective termination of pregnancy31.1 (0.4–3.3)
Stillbirth62.3 (1.0–4.8)
Perinatal death114.1 (2.3–7.3)
IUGR103.8 (2.1–6.8)
Preterm birth7026.3 (21.4–31.9)
Live-born infants25194.4 (90.9–96.6)
Women with live-born infants(n=251)% (95% CI)
Possible vertical transmission10.4 (0.07–2.2)
Neonatal deatha52.0 (0.9–4.6)
Admission to NICU6927.5 (22.3–33.3)
Breastfeeding10140.2 (34.4–46.4)
Skin to skin6927.5 (22.3–33.3)
Low birth weight5220.7 (16.2–26.2)
Cesarean delivery13654.2 (48.0–60.2)
Spontaneous first-trimester abortionb6/3119.4 (9.2–36.3)
Gestational age at delivery, years, mean ± SD37.2 ± 3.9
Birth weight, grams, mean ± SD2919 ± 772

Data are presented as number (percentage) or as mean ± standard deviation (SD). NICU, neonatal intensive care unit; LBW, low birth weight; IUGR, intrauterine growth restriction.

aIncluding only live-born infants. bIncluding only women with first trimester infection.

When exploring maternal and pregnancy characteristics, gestational age at diagnosis was lower (23.2±10.9 vs. 35.0±4.6, p<0.001) in fetuses with composite adverse outcome, while there was no difference in maternal age at the infection between the two study groups. Similarly, the incidence of composite adverse fetal outcome was significantly higher when the infection occurred in the first trimester (35.3 vs. 2%, p<0.001). The incidence of composite adverse fetal outcome was significantly higher in fetuses with lower birthweight (2007±1014 g vs. 2939±755, p<0.001), while it was similar in nulliparous women, women smoking during pregnancy or with chronic, pre-existing conditions, women undergone flu vaccination, and those with a positive CT scan.

When focusing on clinical, radiological and laboratory findings, maternal need for oxygen (41.2 vs. 17.3%, p=0.02) and CPAP (29.4 vs. 8.5%, p=0.02) were significantly associated with composite adverse fetal outcome

Finally, no difference was found when evaluating the effect different pharmacologic treatments (LMWH, azithromycin, antiviral drugs or hydroxychloroquine) on composite adverse fetal outcome

At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8–0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09–1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3–7.9; p=0.001) were independently associated with composite adverse fetal outcome.

Discussion

Summary of the main findings

The findings from this study showed that, in pregnancies complicated by COVID-19 infection, the rate of perinatal death was about 4%, mainly related to prematurity. Early gestational age at diagnosis, gestational age at diagnosis, birthweight and maternal ventilatory support were the only factors independently associated with adverse fetal outcome. Finally, the risk of vertical transmission was negligible.

Strengths and limitations

To our knowledge, this may be the largest cohort of COVID-19 during pregnancy published so far. Strengths and limitations of this secondary analysis are those inherent in the WAPM study. The enrollment of only of women with laboratory-confirmed COVID-19 and the inclusion of both University Hospitals and Community Hospitals from different countries represent the major strengths of this study. The major limitation of the study is the incidence of the composite adverse perinatal outcome in the overall population is low, thus making our sample size potentially underpowered to drawn any convincing evidence. Another limitation is the inclusion of only high-income and middle-income countries, and therefore we acknowledge that in low-income countries perinatal outcomes might be even worse [3].

Implications for clinical practice and research

COVID-19 has brought the scientific community into unprecedented times and currently represents the major global public health issue. Despite the growing number of reports published so far [16], [17], [18], evidence is still limited particularly when focusing on vulnerable conditions, such as pregnancy.

We have recently shown that COVID-19 in pregnant women is associated with low rate of maternal mortality, but 11.1% rate of admission to ICU. Furthermore, earlier gestational age at presentation, shortness of breath as presenting symptom, and increased lactate dehydrogenase (LDH) levels were independently associated with composite adverse maternal outcome including either admission to intensive care unit, use of mechanical ventilation or death [12].

In this secondary analysis, we planned to ascertain whether different maternal and pregnancy characteristics; clinical, laboratory or radiological findings and pharmacological treatments could be associated with serious adverse perinatal outcomes, including stillbirths and neonatal deaths, and we found that earlier gestational age at diagnosis, birthweight and maternal ventilatory support were independently associated with a composite adverse perinatal outcome.

Gestational age at diagnosis is a peculiar issue when assessing pregnancies affected by viral infections and the occurrence of the infection earlier in pregnancy is usually associated with worse fetal outcomes. In a large meta-analysis of cohort and case-control studies, maternal seasonal influenza or influenza-like illness in the first trimester was associated with a significantly higher risk of congenital abnormalities, such as cleft lip, neural tube defects, hydrocephaly, and congenital heart defects [19]. Moreover, recent data on women with a primary Cytomegalovirus infection and an infected child aged at least 1 year at the time of the analysis show that the infection can be severe only when the virus hits the fetus in the embryonic or early fetal period [20]. Alongside the high burden of fetal morbidity, parvovirus B19 infection in the first trimester of pregnancy was associated with an increased risk of fetal loss [21] and fetal death is generally observed when the infection occurs before the completed 20 weeks of gestation [22].

These data are concordant with our results, as COVID-19 infection in the first trimester was significantly associated with the occurrence of a composite adverse fetal outcome, while there was no difference when the infection occurred during the second and the third trimester of pregnancy.

Therefore, longitudinal evaluation of pregnancies affected with COVID-19 is recommended to rule out any potential factor that may significantly impact short and long‐term prognosis. In this scenario, the use of neurosonography and fetal magnetic resonance imaging (MRI), that has significantly spread in the past few years in several fields of maternal fetal medicine [23], [24], might be judiciously considered as useful imaging techniques for a complete fetal assessment.

Perinatal death is certainly one of the main concern of maternal fetal specialists. So far, the rate of both stillbirths and neonatal deaths has been reported to be slightly increased, although the majority of neonatal deaths are considered to be related to prematurity or to critically ill mothers [3], [25], [26].

COVID-19 may predispose the general population to a thrombotic condition, both in the venous and arterial circulations, due to inflammation, platelet activation, endothelial dysfunction, and stasis [27], [28]. This COVID-19 related hypercoagulability state might intuitively assume an important role in pregnancy due to its inherent prothrombotic state, and might represent a possible cause of the small increase of the rate of stillbirths compared with the baseline population [29], [30], [31], [32].

However, we acknowledge that the sample size potentially underpowered for this outcome and the lack of effect of low molecular weight heparin cast some doubt on this hypothesis and do not allow to obtain robust evidence on the risk of stillbirth in pregnancies affected by COVID-19.

Conclusions

Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Research funding: None declared.

Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

Competing interests: Authors state no conflict of interest.

Informed consent: Informed consent was obtained from all individuals included in this study.

Ethical approval: The study was approved by the IRB of the University of Naples Federico II (April 2020, approval number: 145/2020).

References

  • 1.

    ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol 2020;55:709–12.

    • PubMed
    • Export Citation
  • 2.

    Abu-Rustum, RS, Akolekar, R, Sotiriadis, A, Salomon, LJ, Da Silva Costa, F, Wu, Q, et al. ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in the context of COVID-19. Ultrasound Obstet Gynecol 2020;55:863–70. https://doi.org/10.1002/uog.22029.

    • Crossref
    • PubMed
    • Export Citation
  • 3.

    Mullins, E, Evans, D, Viner, RM, O’Brien, P, Morris, E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020;55:586–92. https://doi.org/10.1002/uog.22014.

    • Crossref
    • PubMed
    • Export Citation
  • 4.

    Moro, F, Buonsenso, D, Moruzzi, MC, Inchingolo, R, Smargiassi, A, Demi, L, et al. How to perform lung ultrasound in pregnant women with suspected COVID-19. Ultrasound Obstet Gynecol 2020;55:593–8. https://doi.org/10.1002/uog.22028.

    • Crossref
    • PubMed
    • Export Citation
  • 5.

    Buonsenso, D, Raffaelli, F, Tamburrini, E, Biasucci, DG, Salvi, S, Smargiassi, A, et al. Clinical role of lung ultrasound for the diagnosis and monitoring of COVID-19 pneumonia in pregnant women. Ultrasound Obstet Gynecol 2020;56:106–9 https://doi.org/10.1002/uog.22055.

    • Crossref
    • PubMed
    • Export Citation
  • 6.

    Kwiatkowski, S, Borowski, D, Kajdy, A, Poon, LC, Rokita, W, Wielgoś, M. Why we should not stop giving aspirin to pregnant women during the COVID-19 pandemic. Ultrasound Obstet Gynecol 2020;55:841–3 https://doi.org/10.1002/uog.22049.

    • Crossref
    • PubMed
    • Export Citation
  • 7.

    Kalafat, E, Yaprak, E, Cinar, G, Varli, B, Ozisik, S, Uzun, C, Azap, A, Koc, A. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol 2020;55:835–7 https://doi.org/10.1002/uog.22034.

    • Crossref
    • PubMed
    • Export Citation
  • 8.

    Mathilde, G, Rolnik, DL, Hoffman, MK, Panchaud, A, Baud, D. Should we stop aspirin prophylaxis in pregnant women diagnosed with COVID-19? [published online ahead of print, 2020 Apr 29]. Ultrasound Obstet Gynecol 2020 https://doi.org/10.1002/uog.22063.

    • PubMed
    • Export Citation
  • 9.

    Boelig, RC, Manuck, T, Oliver, EA, et al. 2020. Labor and delivery guidance for COVID-19. Am J Obstet Gynecol MFM (in press). https://doi.org/10.1111/1471-0528.16335.

  • 10.

    Di Mascio, D, Khalil, A, Saccone, G, Rizzo, G, Buca, D, Liberati, M, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020;2:100107. https://doi.org/10.1016/j.ajogmf.2020.100107.

    • Crossref
    • Export Citation
  • 11.

    Coronavirus disease 2019 (COVID-2019): situation report-123. Geneva: World Health Organization; May 2020. Accessed on May 23, 2020.

  • 12.

    Saccone, G, Sen, C, Di Mascio, D, Galindo, A, Grünebaum, A, Yoshimatsu, J, et al. Maternal and Perinatal Outcomes of Pregnant Women with SARS-COV 2 infection: The WAPM working Group on COVID-19 [First published online: 14 September 2020]. https://doi.org/10.1002/uog.23107.

  • 13.

    World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) is suspected: interim guidance; 13 March 2020.

  • 14.

    Guan, W, Ni, Z, HU, Y, Liang, L, OU, C, He, J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1702–20. https://doi.org/10.1056/NEJMoa2002032.

  • 15.

    Huang, C, Wang, Y, Li, X, Ren, L, Zhao, J, Hu, Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. https://doi.org/10.1016/s0140-6736(20)30183-5.

    • Crossref
    • PubMed
    • Export Citation
  • 16.

    Juan, J, Gil, MM, Rong, Z, Zhang, Y, Yang, H, Poon, LC. Effects of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcomes: a systematic review. Ultrasound Obstet Gynecol 2020;55:15–27.

  • 17.

    Della Gatta, AN, Rizzo, R, Pilu, G, Simonazzi, G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol 2020;223:36–41. https://doi.org/10.1016/j.ajog.2020.04.013.

    • Crossref
    • PubMed
    • Export Citation
  • 18.

    Huntley, BJF, Huntley, ESD, Di Mascio, D, Chen, T, Berghella, V, Chauhan, S. Pregnancies complicated by coronavirus disease 2019 (COVID-19) in pregnancy: rates of maternal and perinatal mortality, and vertical transmission: a systematic review. Obstet Gynecol 2020;136:303–12. https://doi.org/10.1097/AOG.0000000000004010.

  • 19.

    Luteijn, JM, Brown, MJ, Dolk, H. Influenza and congenital anomalies: a systematic review and meta-analysis. Hum Reprod 2014;29:809–23. https://doi.org/10.1093/humrep/det455.

    • Crossref
    • PubMed
    • Export Citation
  • 20.

    Faure-Bardon, V, Magny, JF, Parodi, M, Couderc, S, Garcia, P, Maillotte, AM, et al. Sequelae of congenital Cytomegalovirus following maternal primary infections are limited to those acquired in the first trimester of pregnancy. Clin Infect Dis 2019;69:1526–32. https://doi.org/10.1093/cid/ciy1128.

    • Crossref
    • PubMed
    • Export Citation
  • 21.

    Lassen, J, Jensen, AK, Bager, P, Pedersen, CB, Panum, I, Nørgaard-Pedersen, B, et al. Parvovirus B19 infection in the first trimester of pregnancy and risk of fetal loss: a population-based case-control study. Am J Epidemiol 2012;176:803–7. https://doi.org/10.1093/aje/kws177.

    • Crossref
    • Export Citation
  • 22.

    Enders, M, Weidner, A, Zoellner, I, Searle, K, Enders, G. Fetal morbidity and mortality after acute human parvovirus B19 infection in pregnancy: prospective evaluation of 1018 cases. Prenat Diagn 2004;24:513–8. https://doi.org/10.1002/pd.940.

    • Crossref
    • PubMed
    • Export Citation
  • 23.

    Di Mascio, D, Sileo, FG, Khalil, A, Rizzo, G, Persico, N, Brunelli, R, et al. Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2019;54:164–71. https://doi.org/10.1002/uog.20197.

    • Crossref
    • PubMed
    • Export Citation
  • 24.

    ENSO Working Group. Role of prenatal magnetic resonance imaging in fetuses with isolated mild or moderate ventriculomegaly in the era of neurosonography: a multicenter study. Ultrasound Obstet Gynecol 2020;56:340–7. https://doi.org/10.1002/uog.21974.

    • Crossref
    • PubMed
    • Export Citation
  • 25.

    Zeng, L, Xia, S, Yuan, W, Yan, K, Xiao, F, Shao, J, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan. China JAMA Pediatrics 2020;174:722–5.

    • Crossref
    • Export Citation
  • 26.

    Elshafeey, F, Magdi, R, Hindi, N, Elshebiny, M, Farrag, N, Mahdy, S, et al. A systematic scoping review of COVID-19 during pregnancy and childbirth [published online ahead of print, 2020 Apr 24]. Int J Gynaecol Obstet 2020. https://doi.org/10.1002/ijgo.13182.

    • PubMed
    • Export Citation
  • 27.

    Bikdeli, B, Madhavan, MV, Jimenez, D, Chuich, T, Dreyfus, I, Driggin, E, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol 2020 Apr 15; S0735-1097(20)35008-7. https://doi.org/10.1016/j.jacc.2020.04.031.

  • 28.

    Connors, JM, Levy, JH. Thromboinflammation and the hypercoagulability of COVID-19 [published online ahead of print, 2020 Apr 17]. J Thromb Haemost 2020. https://doi.org/10.1111/jth.14849.

    • PubMed
    • Export Citation
  • 29.

    Boelig, RC, Manuck, T, Oliver, EA, Di Mascio, D, Saccone, G, Bellusi, F, et al. Labor and delivery guidance for COVID-19. Am J Obstet Gynecol MFM 2020;2:100110. https://doi.org/10.1016/j.ajogmf.2020.100110.

    • Crossref
    • PubMed
    • Export Citation
  • 30.

    Saccone, G, Florio, A, Aiello, F, Bifulco, G, Zullo, F, Venturella, R, et al. Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol 2020; S0002-9378(20)30527-5. https://doi.org/10.1016/j.ajog.2020.05.003.

  • 31.

    Saccone, G, Carbone, FI, Zullo, F. The novel coronavirus (2019-nCoV) in pregnancy: what we need to know. Eur J Obstet Gynecol Reprod Biol 2020;249:92–3. https://doi.org/10.1016/j.ejogrb.2020.04.006.

    • Crossref
    • PubMed
    • Export Citation
  • 32.

    Carbone, IF, Conforti, A, Farina, A, Alviggi, C. A practical approach for the management of obstetric and infertile women during the phase two of the novel coronavirus disease 2019 (COVID-19) pandemic [published online ahead of print, 2020 Jun 8]. Eur J Obstet Gynecol Reprod Biol 2020; S0301-2115(20)30368-7. https://doi.org/10.1016/j.ejogrb.2020.06.006.

    • PubMed
    • Export Citation

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1.

    ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol 2020;55:709–12.

    • PubMed
    • Export Citation
  • 2.

    Abu-Rustum, RS, Akolekar, R, Sotiriadis, A, Salomon, LJ, Da Silva Costa, F, Wu, Q, et al. ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in the context of COVID-19. Ultrasound Obstet Gynecol 2020;55:863–70. https://doi.org/10.1002/uog.22029.

    • Crossref
    • PubMed
    • Export Citation
  • 3.

    Mullins, E, Evans, D, Viner, RM, O’Brien, P, Morris, E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020;55:586–92. https://doi.org/10.1002/uog.22014.

    • Crossref
    • PubMed
    • Export Citation
  • 4.

    Moro, F, Buonsenso, D, Moruzzi, MC, Inchingolo, R, Smargiassi, A, Demi, L, et al. How to perform lung ultrasound in pregnant women with suspected COVID-19. Ultrasound Obstet Gynecol 2020;55:593–8. https://doi.org/10.1002/uog.22028.

    • Crossref
    • PubMed
    • Export Citation
  • 5.

    Buonsenso, D, Raffaelli, F, Tamburrini, E, Biasucci, DG, Salvi, S, Smargiassi, A, et al. Clinical role of lung ultrasound for the diagnosis and monitoring of COVID-19 pneumonia in pregnant women. Ultrasound Obstet Gynecol 2020;56:106–9 https://doi.org/10.1002/uog.22055.

    • Crossref
    • PubMed
    • Export Citation
  • 6.

    Kwiatkowski, S, Borowski, D, Kajdy, A, Poon, LC, Rokita, W, Wielgoś, M. Why we should not stop giving aspirin to pregnant women during the COVID-19 pandemic. Ultrasound Obstet Gynecol 2020;55:841–3 https://doi.org/10.1002/uog.22049.

    • Crossref
    • PubMed
    • Export Citation
  • 7.

    Kalafat, E, Yaprak, E, Cinar, G, Varli, B, Ozisik, S, Uzun, C, Azap, A, Koc, A. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol 2020;55:835–7 https://doi.org/10.1002/uog.22034.

    • Crossref
    • PubMed
    • Export Citation
  • 8.

    Mathilde, G, Rolnik, DL, Hoffman, MK, Panchaud, A, Baud, D. Should we stop aspirin prophylaxis in pregnant women diagnosed with COVID-19? [published online ahead of print, 2020 Apr 29]. Ultrasound Obstet Gynecol 2020 https://doi.org/10.1002/uog.22063.

    • PubMed
    • Export Citation
  • 9.

    Boelig, RC, Manuck, T, Oliver, EA, et al. 2020. Labor and delivery guidance for COVID-19. Am J Obstet Gynecol MFM (in press). https://doi.org/10.1111/1471-0528.16335.

  • 10.

    Di Mascio, D, Khalil, A, Saccone, G, Rizzo, G, Buca, D, Liberati, M, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020;2:100107. https://doi.org/10.1016/j.ajogmf.2020.100107.

    • Crossref
    • Export Citation
  • 11.

    Coronavirus disease 2019 (COVID-2019): situation report-123. Geneva: World Health Organization; May 2020. Accessed on May 23, 2020.

  • 12.

    Saccone, G, Sen, C, Di Mascio, D, Galindo, A, Grünebaum, A, Yoshimatsu, J, et al. Maternal and Perinatal Outcomes of Pregnant Women with SARS-COV 2 infection: The WAPM working Group on COVID-19 [First published online: 14 September 2020]. https://doi.org/10.1002/uog.23107.

  • 13.

    World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) is suspected: interim guidance; 13 March 2020.

  • 14.

    Guan, W, Ni, Z, HU, Y, Liang, L, OU, C, He, J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1702–20. https://doi.org/10.1056/NEJMoa2002032.

  • 15.

    Huang, C, Wang, Y, Li, X, Ren, L, Zhao, J, Hu, Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. https://doi.org/10.1016/s0140-6736(20)30183-5.

    • Crossref
    • PubMed
    • Export Citation
  • 16.

    Juan, J, Gil, MM, Rong, Z, Zhang, Y, Yang, H, Poon, LC. Effects of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcomes: a systematic review. Ultrasound Obstet Gynecol 2020;55:15–27.

  • 17.

    Della Gatta, AN, Rizzo, R, Pilu, G, Simonazzi, G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol 2020;223:36–41. https://doi.org/10.1016/j.ajog.2020.04.013.

    • Crossref
    • PubMed
    • Export Citation
  • 18.

    Huntley, BJF, Huntley, ESD, Di Mascio, D, Chen, T, Berghella, V, Chauhan, S. Pregnancies complicated by coronavirus disease 2019 (COVID-19) in pregnancy: rates of maternal and perinatal mortality, and vertical transmission: a systematic review. Obstet Gynecol 2020;136:303–12. https://doi.org/10.1097/AOG.0000000000004010.

  • 19.

    Luteijn, JM, Brown, MJ, Dolk, H. Influenza and congenital anomalies: a systematic review and meta-analysis. Hum Reprod 2014;29:809–23. https://doi.org/10.1093/humrep/det455.

    • Crossref
    • PubMed
    • Export Citation
  • 20.

    Faure-Bardon, V, Magny, JF, Parodi, M, Couderc, S, Garcia, P, Maillotte, AM, et al. Sequelae of congenital Cytomegalovirus following maternal primary infections are limited to those acquired in the first trimester of pregnancy. Clin Infect Dis 2019;69:1526–32. https://doi.org/10.1093/cid/ciy1128.

    • Crossref
    • PubMed
    • Export Citation
  • 21.

    Lassen, J, Jensen, AK, Bager, P, Pedersen, CB, Panum, I, Nørgaard-Pedersen, B, et al. Parvovirus B19 infection in the first trimester of pregnancy and risk of fetal loss: a population-based case-control study. Am J Epidemiol 2012;176:803–7. https://doi.org/10.1093/aje/kws177.

    • Crossref
    • Export Citation
  • 22.

    Enders, M, Weidner, A, Zoellner, I, Searle, K, Enders, G. Fetal morbidity and mortality after acute human parvovirus B19 infection in pregnancy: prospective evaluation of 1018 cases. Prenat Diagn 2004;24:513–8. https://doi.org/10.1002/pd.940.

    • Crossref
    • PubMed
    • Export Citation
  • 23.

    Di Mascio, D, Sileo, FG, Khalil, A, Rizzo, G, Persico, N, Brunelli, R, et al. Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2019;54:164–71. https://doi.org/10.1002/uog.20197.

    • Crossref
    • PubMed
    • Export Citation
  • 24.

    ENSO Working Group. Role of prenatal magnetic resonance imaging in fetuses with isolated mild or moderate ventriculomegaly in the era of neurosonography: a multicenter study. Ultrasound Obstet Gynecol 2020;56:340–7. https://doi.org/10.1002/uog.21974.

    • Crossref
    • PubMed
    • Export Citation
  • 25.

    Zeng, L, Xia, S, Yuan, W, Yan, K, Xiao, F, Shao, J, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan. China JAMA Pediatrics 2020;174:722–5.

    • Crossref
    • Export Citation
  • 26.

    Elshafeey, F, Magdi, R, Hindi, N, Elshebiny, M, Farrag, N, Mahdy, S, et al. A systematic scoping review of COVID-19 during pregnancy and childbirth [published online ahead of print, 2020 Apr 24]. Int J Gynaecol Obstet 2020. https://doi.org/10.1002/ijgo.13182.

    • PubMed
    • Export Citation
  • 27.

    Bikdeli, B, Madhavan, MV, Jimenez, D, Chuich, T, Dreyfus, I, Driggin, E, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol 2020 Apr 15; S0735-1097(20)35008-7. https://doi.org/10.1016/j.jacc.2020.04.031.

  • 28.

    Connors, JM, Levy, JH. Thromboinflammation and the hypercoagulability of COVID-19 [published online ahead of print, 2020 Apr 17]. J Thromb Haemost 2020. https://doi.org/10.1111/jth.14849.

    • PubMed
    • Export Citation
  • 29.

    Boelig, RC, Manuck, T, Oliver, EA, Di Mascio, D, Saccone, G, Bellusi, F, et al. Labor and delivery guidance for COVID-19. Am J Obstet Gynecol MFM 2020;2:100110. https://doi.org/10.1016/j.ajogmf.2020.100110.

    • Crossref
    • PubMed
    • Export Citation
  • 30.

    Saccone, G, Florio, A, Aiello, F, Bifulco, G, Zullo, F, Venturella, R, et al. Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol 2020; S0002-9378(20)30527-5. https://doi.org/10.1016/j.ajog.2020.05.003.

  • 31.

    Saccone, G, Carbone, FI, Zullo, F. The novel coronavirus (2019-nCoV) in pregnancy: what we need to know. Eur J Obstet Gynecol Reprod Biol 2020;249:92–3. https://doi.org/10.1016/j.ejogrb.2020.04.006.

    • Crossref
    • PubMed
    • Export Citation
  • 32.

    Carbone, IF, Conforti, A, Farina, A, Alviggi, C. A practical approach for the management of obstetric and infertile women during the phase two of the novel coronavirus disease 2019 (COVID-19) pandemic [published online ahead of print, 2020 Jun 8]. Eur J Obstet Gynecol Reprod Biol 2020; S0301-2115(20)30368-7. https://doi.org/10.1016/j.ejogrb.2020.06.006.

    • PubMed
    • Export Citation