COVID-19 and Indications for Delivery: a Prospective Cohort Study

Studies have shown that COVID-19 affects intrapartum management, resulting in higher rates of cesarean delivery. However, it is unknown if COVID-19 infection increases rates of medically indicated deliveries. The primary objective was to determine if there are differences in medical indications for delivery in COVID-19 positive patients. This is a prospective cohort study of patients admitted for delivery at an urban obstetrical unit from April-November 2020 where patients were tested for COVID-19 following admission. Baseline demographics, labor and delivery information, and outcomes were recorded, and composite maternal and neonatal outcomes were compared between COVID-19 positive and negative patients using Fisher’s exact tests and a Poisson regression analysis to adjust for confounders. 545 deliveries were included, with 56 (10.33%) COVID-19 positive and 486 (89.67%) negative patients. There were no differences in rate of medical indications for delivery. There was a higher rate of cesarean delivery in the COVID-19 positive group (46.43% versus 31.28%, p=.034), although there was no difference in indications for cesarean delivery. Additionally, for COVID-19 positive patients, there were higher rates of preterm births (p=.014) but no increase in preterm labor. There was an increase in composite adverse neonatal outcomes (p= <0.05), but not composite adverse maternal outcomes. Despite an increase in cesarean delivery, there was no difference in medical indications for delivery in COVID-19 patients. Although there was an increase in composite adverse neonatal outcomes, this may be attributed to an increase in admission of exposed newborns to the neonatal intensive care unit.