COVID-19孕妇母婴结局的系统综述  

Maternal and neonatal outcomes in pregnant women with COVID-19:a systemic review

作　　者：曹羽明 陈慧君[1] 郭娟娟[1] 余雪琛[1] 文雪[1] 张元珍[1] Cao Yuming;Chen Huijun;Guo Juanjuan;Yu Xuechen;Wen Xue;Zhang Yuanzhen(Department of Obstetrics and Gynecology,Zhongnan Hospital of Wuhan University,Prenatal Diagnostic and Birth Health Clinical Medicine Research Center of Hubei Province,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院妇产科,湖北省产前诊断与优生临床医学研究中心,430071

出　　处：《中华围产医学杂志》2020年第7期447-455,共9页Chinese Journal of Perinatal Medicine

基　　金：湖北省科学技术厅新型肺炎应急科技攻关项目(2020FCA011)。

摘　　要：目的通过分析已发表经同行评议的妊娠合并COVID-19的研究,总结COVID-19孕妇的临床表现、实验室检查及母婴结局,全面了解COVID-19孕妇的母婴情况,探索新型冠状病毒的宫内垂直传播证据。方法检索2019年12月1日至2020年4月9日PubMed、Embase、中国知网、中华全文数据库、万方数据库发表的妊娠合并COVID-19的文献,并在世界卫生组织COVID-19数据库和纳入文献的参考文献中进行补充检索,纳入新型冠状病毒核酸检测阳性、报告母婴结局或COVID-19孕妇继续妊娠并报告母胎情况的文献。分别通过阅读摘要和全文进行文献筛选,对最终纳入的文献提取并分析孕产妇临床表现、围产期结局及新生儿结局进行系统回顾。结果 (1)最终纳入29篇文献中,146例病毒核酸阳性确诊孕妇,其中114例(2例双胎)孕妇分娩116例新生儿。8例(5.5%,8/146)重症孕妇,包括5例重型COVID-19,3例未明确分型但入住重症监护室治疗。69.9%(102/146)剖宫产,8.2%(12/146)阴道分娩,20.5%(30/146)继续妊娠,1例(0.7%,1/146)双向情感障碍发作中孕期(孕26周)引产,1例(0.7%,1/146)早孕期(孕6周)人工流产。发热(58.2%,85/146)、咳嗽(32.9%,48/146)是常见的症状;15.8%(23/146)入院时无感染相关症状;20.5%(30/146)产后出现感染相关症状或原有症状加重。实验室检查中,主要为淋巴细胞减少(49.6%,56/113)和C-反应蛋白升高(58.4%,66/113)。肺部CT以双肺多发斑片状毛玻璃影多见(79.7%,94/118)。(2)92.2%(107/116)新生儿结局良好。7.8%(9/116)新生儿有不同程度异常,其中6例有呼吸困难、发绀及呕吐等表现,包括1例进展为多器官功能障碍、弥散性血管内凝血死亡;1例生后36 h病毒核酸检测阳性;1例死产,死亡原因未述,但排除宫内垂直传播;1例病情较重孕妇剖宫产分娩的新生儿死亡。结论 COVID-19孕妇重症比例低,妊娠结局良好,虽有新生儿不良结局报道,但缺乏宫内垂直传播证据。Objective To fully understand the maternal and neonatal outcomes in pregnant women with COVID-19 and explore the evidence of intrauterine vertical transmission of 2019-nCoV by analyzing clinical and laboratory information in peer-reviewed publications on COVID-19 in pregnant women.Methods PubMed,Embase,China National Knowledge Infrastructure,China Academic Journals,and Wanfang Databases were searched to retrieve articles on COVID-19 in pregnancy published from December 1,2019,to April 9,2020.In addition,the World Health Organization COVID-19 Database and the reference lists in each included article were also searched.All included cases were positive for 2019-nCoV nucleic acid with maternal and neonatal outcomes regardless of delivery or not.Clinical manifestations,perinatal and neonatal outcomes were analyzed systematically.Results This study reviewed 29 publications involving 146 pregnant women who tested positive for 2019-nCoV nucleic acid and their 116 newborns(including two twins).Five cases of severe COVID-19 and three cases of unidentified type that were admitted to ICU for treatment were severe symptoms,accounting for 5.5%(8/146)of all cases.Totally,69.9%(102/146)of the women underwent cesarean section and 8.2%(12/146)gave birth vaginally.Thirty(20.5%)women continued their pregnancies.One case(0.7%,1/146)terminated the pregnancy at 26 weeks of gestation due to bidirectional affective disorder and one(0.7%,1/146)received artificial abortion at 6 weeks of gestation.Fever(58.2%,85/146)and cough(32.9%,48/146)were the most common symptoms.However,15.8%(23/146)of the pregnant women were asymptomatic on admission and symptoms appeared or became worse after delivery in 20.5%(30/146).Lymphocytopenia(49.6%,56/113)and elevated C-reactive protein(58.4%,66/113)were the main laboratory findings.The most common computed tomography(CT)finding was bilateral multiple patchy ground-glass opacity in lungs(79.7%,94/118).The outcomes of 92.2%(107/116)of the newborns were good,and the rest 7.8%(9/116)showed different abnormaliti

关 键 词：新型冠状病毒肺炎 传染性疾病传播 垂直 妊娠结局 回顾性研究 

分 类 号：R714.253[医药卫生—妇产科学]