Type of delivery and perinatal outcomes in pregnant women diagnosed with COVID-19: A systematic review and meta-analysis

Background: There is paucity in the literature that provides a comprehensive and evidence-based conclusion regarding this topic.Objective: To compare perinatal outcomes of vaginal and caesarean section delivery in women diagnosed with COVID-19 by meta-analysis of literature.Search Strategy: The search was conducted on MEDLINE, EMBASE, LILACS, CINAHL, Scopus, Web of Science and Cochrane Database of Systematic Reviews by 25th May 2022.Selection criteria: The inclusion criteria involved pregnant women diagnosed with COVID-19 who underwent caesarean section and those who had vaginal deliveries.Data collection and analysis: The included studies were meta-analyzed for various outcomes including: Gestational age, maternal intensive care unit admission, maternal death, prematurity, newborn birth weight, newborn intensive care unit admission, Apgar scores, newborn death, and newborn vertical transmission of COVID-19. The meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) software, version 3.3.070.Main results: The meta-analyses included 2,566 deliveries (866 caesarean sections and 1,700 vaginal deliveries) and identified that caesarean section was significantly associated with increased prematurity (OR 2.5 [1.7; 3.6], p < 0.001), lower birth weight (-118 g [-170;-66], p < 0.001), and a higher need for maternal (OR 9.54 [5.22; 17.43], p < 0.01) and neonatal intensive care unit intervention (OR 3.67 [2.71; 4.96], p < 0.01) compared to vaginal delivery.Conclusion: COVID-19 infection alone should not be an indication for caesarean section as there is insufficient evidence that caesarean section reduces mortality, improves birth conditions, or prevents vertical transmission. Additionally, caesarean section is associated with poorer perinatal outcomes compared to vaginal delivery.