COVID-19 in pregnancy influences the progression of labor: A single-institutional and observational study in Japan

COVID-19 in pregnancy influences the progression of labor: A single-institutional and observational study in Japan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article COVID-19 in pregnancy influences the progression of labor: A single-institutional and observational study in Japan Kiichiro Furuya, Yoshitomo Tanaka, Naoto Komatsu, Rikuto Hirose, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2291276/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The management of vaginal delivery during the COVID-19 pandemic remains unclear due to lack of information on labor characteristics. We aimed to clarify the effects of COVID-19 on the progression of vaginal labor. The single-institutional and observational study of COVID-19 women in pregnancy (COVID-19 group, n = 50) delivering from 2020 to 2022, was conducted. Patients’ backgrounds, perinatal outcomes, labor characteristics (labor time and Bishop score), and the details of maternal COVID-19 were analyzed and compared with non-COVID-19 pregnant women (control group, n = 258). The COVID-19 group showed rapidly progressing labor without adverse effect. The 1 st and 2 nd stage of labor time, and labor time after rupture of membrane were significantly shorter in the COVID-19 group than in the control group ( P < 0.01; P < 0.01; and P < 0.05, respectively). The COVID-19 group had a higher Bishop score on initiation of labor ( P < 0.01). Precipitous delivery in the COVID-19 group also significantly increased ( P < 0.05). These results indicated that COVID-19 in pregnancy can affect the progression of labor rapidly. This is the first report focusing on the characteristics of labor progression in COVID-19 women, indicating that COVID-19 can affect the progression of labor without complication. Health sciences/Diseases/Infectious diseases Health sciences/Diseases/Infectious diseases/Viral infection Health sciences/Signs and symptoms/Reproductive signs and symptoms Health sciences/Diseases/Reproductive disorders Figures Figure 1 Figure 2 Figure 3 Introduction Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been spreading. [ 1 ] Obstetricians have encountered COVID-19 in pregnant women. However, the management of vaginal delivery in COVID-19 patients has remained unclear due to a lack of data. Certain meta-analyses have reported perinatal outcomes on vaginal delivery during the COVID-19 pandemic, mainly focusing on maternal morbidity, mortality, and psychological issues. [ 2 – 6 ] However, to the best of our knowledge, there has been no convincing article focusing on the characteristics of labor during the COVID-19 pandemic. Moreover, in Japan, the cesarean section has remained a “standard” mode of delivery for COVID-19 pregnant women, [ 7 ] as some articles sensationally reported the potential risk of vertical transmission in the early period of the pandemic. [ 6 , 8 ] These articles have contributed to obstetricians’ hesitancy to try vaginal delivery for COVID-19 women. Guidance from the UK and USA indicated the cesarean section based on obstetrical issues because of the low-risk of vertical transmission. [ 9 , 10 ] Current meta-analyses have also suggested that there is no advantage of iatrogenic cesarean section for preventing vertical transmission. [ 11 , 12 ] Although the evidence indicated the safety of vaginal delivery during the COVID-19 pandemic, the cesarean section has remained implemented due to a lack of information about the labor characteristics. Thus, we focused on the clinical characteristics of vaginal delivery in patients who were infected with and recovered from COVID-19. The objectives of our study were 1) to reveal the effects of COVID-19 on vaginal labor at term gestation and ii) to verify the absence of vertical transmission via vaginal labor in COVID-19 patients. Methods Study design and participants This is a single-institutional and observational study on COVID-19 in pregnancy with term gestation. To reveal the effects of COVID-19 on vaginal delivery, we included women who underwent vaginal delivery in our hospital with confirmed COVID-19 infection and recovery during pregnancy. These patients were defined as the COVID-19 group, the research participants. The observational period was from September 2020 to March 2022. During the observational period, 114 pregnant COVID-19 patients were transferred to our hospital. Nine were excluded due to undergoing cesarean section with deterioration of maternal respiratory function and obstetrical indications, including breech presentation, prior cesarean section, and abnormal fetal status. Forty-five women were also excluded because they returned to their previous medical institute after ceasing isolation. Ten women were discharged preterm and underwent maternal check-ups in our outpatient clinic. Finally, we included 50 women undergoing vaginal delivery during and after isolation for COVID-19 in this study (Figure 1A). These patients were divided into under isolation and post-ceasing isolation groups. The under-isolation group included patients undergoing vaginal delivery under isolation. The post-ceasing isolation group included patients delivering after testing negative for COVID-19 (i.e., post-ceasing isolation). We collected and analyzed clinical information from these participants. To select an appropriate control group, we enrolled pregnant women undergoing vaginal delivery at term gestation without COVID-19. During the same observational period, a total of 682 women without COVID-19 infection underwent vaginal delivery at term gestation. Ninety and 146 women were excluded due to preterm birth and undergoing cesarean section, respectively. A total of 188 patients were also excluded using the following exclusion criteria: 1) prior rapid delivery, 2) uterine anomaly, 3) post-conization, 4) dysfunction of the uterine cervix, 5) vaginal delivery in women without any maternal check-up by term, 6) intrauterine growth restriction (IUGR), and 7) multiple pregnancies. These exclusion factors are closely associated with rapid delivery and the inability to estimate gestational week at delivery. Finally, the control group included 258 women (Figure 1B). To investigate the characteristics of labor, we compared the duration of labor, such as 1 st /2 nd stage of labor time, total labor time, and rupture of membrane (ROM) to delivery time between the COVID-19 group and the control group. The Bishop score on initiation of labor and percentage of precipitous delivery (vaginal delivery in less than three hours) were also compared between both groups. Additionally, to estimate the effects of virus-variants, severity of disease, and under-/post-isolation on the labor progression in the COVID-19 group, sub-group analysis of labor characteristics was performed comparing among the factors above. Clinical information of the COVID-19 and control groups was collected from the digital medical charts of our hospital. The collection and use of clinical data for this study were also approved by the Institutional Ethics Committee of Rinku General Medical Center (No. 2021-014). Our multidisciplinary management for COVID-19 pregnant women The flow-chart of our management scheme for vaginal delivery among pregnant COVID-19 patients is shown in Supplementary Figure S1. The principle of our scheme was conservative management with multidisciplinary follow-up until testing negative for COVID-19 or the timing for initiation of labor. Biweekly fetal follow-up was performed based on fetal surveillance of high-risk pregnancies, such as pregnancies impacted by severe preeclampsia and diabetes. [ 13, 14 ] Management and treatment of COVID-19 were determined depending on the severity of disease based on the criteria from the Ministry of Health, Labour and Welfare in Japan (see Supplementary Table S1). [ 15 ] Sample collection Nasopharyngeal swab samples were collected by trained medical staff. COVID-19 and variant-typing tests were performed by the clinical laboratory of our hospital using Lumipulse G SARS-CoV-2 Ag Immunoreaction Cartridges (FUJIREBIO, Japan). Negative COVID-19 status was clinically defined as having negative COVID-19 antigen tests for two consecutive days obtained from nasopharyngeal samples. COVID-19 swab testing was performed from admission to confirmation of negative results. COVID-19 tests for estimating vertical transmission were collected from pregnancy-associated materials, including amniotic fluid, umbilical cord, surfaces of the placenta (both the maternal and fetal sides), vaginal discharge, and milk. On postpartum, COVID-19 tests from milk and vaginal discharge were performed every day until obtaining negative COVID-19 tests from the maternal nasopharynx. On the other hand, COVID-19 tests of milk and vaginal discharge were conducted postpartum for post-isolating patients (i.e., COVID-19-negative patients). To estimate the profiles of systemic inflammation, blood samples were collected on admission, at the initiation of labor, and during the postpartum period. These samples were used for the measurement of serum and plasma levels of endothelial damage-related factors, reflecting systemic inflammation such as maternal serum high-sensitive c-reactive protein (CRP), and plasma von Willebrand factor (vWF) antigen and vWF activity levels. All blood samples were centrifuged, and serum and/or plasma were collected, stored, and measured at the clinical laboratory unit of our hospital. Statistical analysis Results from blood tests and the Bishop score included a partial lack of data. Even though data could not be obtained consecutively, partially available data were collected and added for analysis. All data are presented as the mean and standard deviation (mean ± SD) or n (%), and nonparametric statistical analyses were conducted due to the limited number of participants in the study. The difference between the two groups was analyzed by Student’s t -test, chi-squared test, and Fisher’s exact test. The differences between multiple groups were analyzed by one-way or two-way analysis of variance with Tukey’s post-hoc test. P values of < 0.05 were considered significant. All statistical analyses were performed using Excel (Microsoft, USA) with add-in statistical software, “BellCurve for Excel version 3.21” (Social Survey Research Information Co., Ltd., Japan). Smirnov-Grubbs’ test, an outlier analysis, was performed before all statistical analyses. Ethical approval and consent to participants This study was approved by The Institutional Ethics Committee of Rinku General Medical Center (No. 2021-014). All patients voluntarily participated in this study, and informed consent for providing clinical samples and data was obtained. All methods were performed in accordance with the relevant guidelines and regulations, including Declaration of Helsinki. Results Basic characteristics Our COVID-19 group consisted of 50 pregnant women with confirmed COVID-19 infection and recovery who underwent vaginal delivery safely and successfully (see Figure 1A). The baseline characteristics of the COVID-19 group are shown in Table 1. The mean maternal age was 30.5 ± 5.5 years old. Ten patients were primiparous, and 14 were multiparous. Whereas 34% of patients (17 of 50) underwent vaginal delivery while being COVID-19 positive (i.e., under isolation group), 66% (33 of 50) delivered vaginally after testing negative for COVID-19 (i.e., post isolation group). All patients were Asian, without pre-existing maternal complications such as hypertension, diabetes, renal disease, and perinatal complications. Moreover, no study participant had any risk factors for rapid delivery. When comparing with the control group, characteristics of both groups, including parity and maternal age, were not significantly different. Details of maternal COVID-19 The details of maternal COVID-19, including symptoms, chest X-ray findings, treatments, and oxygen requirements on admission, are shown in Table 2. COVID-19-related symptoms were as follows: asymptomatic (n = 6), fever (n = 31), cough (n = 22), sore throat (n = 10), running nose (n = 5), dyspnea (n = 2), and loss of taste/smell (n = 3). Some symptoms overlapped in the same patient. Lung consolidation on X-ray imaging on admission was identified in 12 cases. Two of these 12 patients needed to receive oxygen support with intubation and mechanical respiratory support during expectant management. The severity of the disease showed that 39 patients were mild, five were intermediate I, four were intermediate II, and two were severe with temporary intubation and respiratory support. Virus variant typing tests showed that wild-type SARS-CoV-2 (W), N501Y, L451R, and BA.1 variants were found in eight, nine, eight, and 24 cases, respectively. The virus variant was not detected in just one case due to the quality of the sample. Perinatal and neonatal outcomes comparison between COVID-19 and control groups Perinatal and neonatal outcomes are shown in Table 3. All patients underwent vaginal delivery at term gestation. Comparison between the COVID-19 and control group, mode of vaginal delivery, induction of labor, and transfusion were not significantly different between both groups ( P = 0.80, 0.89, and 0.44, respectively). Regarding neonatal outcomes, no statistically significant differences between the COVID-19 and control groups were identified in all neonatal outcomes including the newborn birth weight, APGAR score (on 1 and 5 minute), the percentage of neonatal intensive care unit admission, neonatal adverse effects, and respiratory support for neonates ( P = 0.25, 0.80, 0.14, 0.66, and 0.38, respectively). No adverse effect including intrauterine fetal death (IUFD) was found in both groups. Characteristics of labor progression and Bishop score As shown in Table 3, total labor time (min) in the COVID-19 group was significantly shorter than in the control group (control vs. COVID-19; 603.9 ± 478.8 vs. 357.1 ± 237.7, P < 0.01). Labor time and Bishop score comparison between the COVID-19 and the control group are shown in Figure 2A-D. 1 st stage and 2 nd stage of labor time (min) in the COVID-19 group were significantly shorter than those in the control group (control vs. COVID-19; 545.7 ± 459.1 vs. 291.3 ± 155.2, P = 0.0001, and 38.8 ± 42.8 vs. 20.9 ± 14.6, P = 0.002, respectively). ROM to delivery time (min) of the COVID-19 group was also significantly shorter than that of the control group (control vs. COVID-19; 80.6 ± 104.3 vs. 47.9 ± 50.2, P = 0.02). The Bishop score on initiation of labor in the COVID-19 group was significantly higher than that in the control group (control vs. COVID-19; 5.1 ± 2.7 vs. 6.4 ± 2.6, P = 0.002). The incidence of precipitous delivery, defined as a total delivery time of less than three hours [ 16 ] , was significantly higher in the COVID-19 group than in the control group (see Figure 3, control vs. COVID-19; 13.2% vs. 26.0%, P = 0.04). Evaluation of vertical transmission on vaginal labor in COVID-19 COVID-19 antigen tests from the placenta, amniotic fluid, umbilical cord, and milk were negative even in labor during isolation (see Supplementary Information Table S2). Among the patients who underwent vaginal delivery while COVID-19 positive, COVID-19 tests for milk and vaginal discharge were performed daily until confirmation of a negative COVID-19 test from the maternal nasopharynx. The patients who recovered from COVID-19 also underwent COVID-19 antigen tests of milk and vaginal discharge once on postpartum day one. There were no COVID-19 antigen-positive results in either the infection group or the post-ceasing isolation group, regardless of whether the COVID-19 antigen was positive from the maternal nasopharynx. Discussion We found the following novel characteristics of labor progression in COVID-19: 1) rapidly progressing labor, 2) increasing precipitous delivery, and 3) well-ripening uterine cervix on initiation of labor compared with non-COVID-19 women. To the best of our knowledge, this is the first report focusing on the features of labor progression during the COVID-19 pandemic. As shown in Fig. 2 A-D, vaginal delivery in the COVID-19 group progressed significantly more rapidly than in the control group. Moreover, 26% of the COVID-19 women (13 of 50) manifested precipitous delivery, higher than general prevalence [ 16 ] and significantly higher than that of the control group (see Fig. 3 ). These pregnant women did not have the previous history of precipitous delivery and any factors affecting progression of labor, indicating that our findings resulted from COVID-19 but not patients’ backgrounds. We also found that COVID-19 women manifested the well-ripening of uterine cervix on initiation of labor. Regarding the prevalence of parity, there was no significant difference between the COVID-19 group and the control group (see Table 1 ). Additionally, regarding the effects of virus variants, under-/post-isolation, and severity of COVID-19 on delivery time, sub-group analysis revealed that there was no significant difference in labor time and Bishop score (see Supplementary Information Figure S3 A-L). These results indicated that the rapidly progressing labor may be affected by COVID-19 itself, regardless of parity, virus variants, under-/post-isolation, and severity of COVID-19. Considering the possible mechanisms of faster labor progression in COVID-19 women, we assumed that COVID-19-related systemic inflammation [ 17 ] could contribute to the well-ripening of the uterine cervix and tachysystole, resulting in rapidly progressing labor and/or precipitous delivery. In other words, combined with previous evidence and phenomenological points of view, we considered the effects of systemic inflammation on the change of the uterine cervix stiffness and myometrial contractility. From previous reports, certain articles indicate that maternal systemic inflammation, such as resulting from sepsis and appendicitis, can cause well-ripening of the cervix and rapid labor due to tachysystole and softening uterine cervix (i.e. cervical ripening). [ 18 – 20 ] Others have suggested that inflammation can also cause upregulation of the expression of oxytocin receptors, leading to increased myometrial contractility and promotion of vaginal labor. [ 21 – 23 ] From our results, the Bishop score in COVID-19 women on initiation of labor was significantly higher than that in controls. Moreover, we have often experienced unexplained and sudden-onset tachysystole in spontaneous labor on COVID-19 women (see Supplementary Information Figure S2-A and B). No histological findings of abruptio placentae and chorioamnionitis were found from placenta in these cases (no data was shown). Considering previous evidence, this unexplained phenomenon possibly occurred through maternal inflammation due to COVID-19, resulting in rapid delivery. To verify our hypothesis, we preliminarily investigated endothelial damage marker profiles, which reflect systemic inflammatory conditions [ 24 ] and can be easily checked in our hospital (see Supplementary Information Figure S4). We measured vWF antigen/activity and high-sensitive CRP, recently being spotlighted as the COVID-19-related systemic inflammatory markers. The mean vWF antigen/antigen and high-sensitive CRP levels represented with higher levels on admission and on initiation of labor compared with normal ranges. The profiles of all markers except for high-sensitive CRP increased on initiation of labor. Interestingly, despite high-sensitive CRP levels decreasing in labor, the rest of the factor profiles increased in parallel with progression of labor. Although the reasons for the discrepancy between high-sensitive CRP and other factors were unclear, a recent article indicated that endothelial inflammation is sustained after ceasing isolation and treatment. [ 25 ] Therefore, together with previous evidence, our results indicate that COVID-19-related systemic inflammatory responses may persist beyond treatment and affect the progression of delivery and be associated with rapid delivery. Limitations The limitations of our study are as follows: 1) limited patient numbers, 2) possibility of variations in the COVID-19 detection procedure depending on prior hospitals and health care centers, 3) inability to analyze the effects of systemic inflammation on rapid labor using basic research procedures, and 4) no data on the effects of COVID-19 in the preterm period on vaginal labor, i.e., the long-term effects of infection on vaginal labor. of the most significant research limitation in this study was the lack of data when searching for mechanisms of labor progression in COVID-19. Conclusion In conclusion, we found that pregnant women infected with/recovered from COVID-19 showed rapidly progressing labor. To the best of our knowledge, this is the first report focusing on and revealing the characteristics of labor progression in COVID-19 women. Our results indicated that robust systemic inflammation due to COVID-19 may affect the progression of labor by promoting cervical ripening and/or myometrial contractility. Excessive interventions have been implemented in the early pandemic; however, preliminary management systems should be updated. Our novel findings should contribute to perinatal management in the pandemic era and minimize iatrogenic cesarean sections by updating preliminary management. Declarations Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Acknowledgements : Dr. Fuyuki Ichikawa, Dr. Misako Kuroda, Dr. Asuka Tanaka, and Dr. Katsumi Kozasa contributed to management of vaginal delivery in COVID-19 pregnant women as nightshift working. Our research had the Best oral presentation award in FAOPS 2022“. We also thank to all medical staffs committing our scheme. Author contributions KF mainly contributed to conducting this study, managing vaginal labor in COVID-19 patients, writing the manuscript, and revising this manuscript. YT (2 nd author), NK, RH, AN, YT (6 th author), HK, HH, SF, and SY also contributed to managing vaginal labor, collecting samples, and analyzing clinical data. MS and MY worked together with the obstetrics team and treated patients from the internal medicine point of view. They checked and provided suggestions for this manuscript. YC, KS, and HT checked and supervised this work. Finally, KO conducted this study together with KF, checked, advised, and revised the first draft of manuscript and approved the final version. All authors read and approved the final version of the manuscript. Funding information: The authors receive funding from a Grant-in-aid for Perinatal Emergency Medical Care (Osaka Medical Association). This funding was used for the English grammatical editing service of Editage . The funder did not contribute to the study design, data collection, data analysis, interpretation, or writing of the manuscript. Competing interests: The authors declare that there are no conflicts of interest. Additional Informat ion Correspondence and requests for materials should be addressed to KF. Supplementary Information The online version contains supplementary material available. Presentation at the meetings: Some of the data from this study were reported in both Fertility 2021 Online, 2021/1/6-1/10, UK and FIGO XXIII, World Congress of Gynecology and Obstetrics, 2021/10/21-10/28, Sydney, Australia (hybrid) , as a poster presentation. We also had oral presentation in FAOPS (Federation of Asia Oceania Perinatal Societies) 2022 in Malaysia, 2022/8/25-8/28 , and finally received “The best oral presentation award (Obstetrics)”. References Hu, Y. et al. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. J. Clin. 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Gynecol. Investig. 9 , 15–21 (2002). Genc, M. R. & Ford, C. E. The clinical use of inflammatory markers during pregnancy. Curr. Opin. Obstet. Gynecol. 22 , 116–121 (2010). Willems, L. H. et al. Sustained inflammation, coagulation activation and elevated endothelin-1 levels without macrovascular dysfunction at 3 months after COVID-19. Thromb. Res. 209 , 106–114 (2022). Tables Table 1. Baseline characteristics and details of COVID-19 group compared with the control group. Data are n (%) or mean ± SD unless otherwise specified. P value was determined by Student's t test, Fisher's exact test, or chi-square test. Abbreviations: COVID-19, coronavirus disease 2019; GDM, gestational diabetes mellitus; HDP, hypertensive disorders of pregnancy; IUFD, intrauterine fetal death; IUGR, intrauterine growth restriction; NC, not calculated COVID-19 (n = 50) n (%) Control (n = 258) n (%) P-value † Age (years) 30.5 ± 5.5 30.7 ± 5.8 P = 0.79 < 20 1 (2) 5 (1.9) P = 0.98 20-29 20 (40) 100 (38.8) P = 0.87 30-39 27 (54) 137 (53.1) P = 0.91 ≧ 40 2 (4) 16 (6.2) P = 0.54 Ethnicity Japanese (Asian) 50 (100) 254 (98.4) P = 0.38 Others 0 (0) 4 (1.6) NC Parity Primiparous 20 (40) 125 (48.4) Multiparous 30 (60) 133 (51.6) P = 0.55 Maternal pre-existing Complications Respiratory disease 0 (0) 5 (1.9) P = 0.32 Cardiac disease 0 (0) 2 (0.8) P = 0.53 Renal disease 0 (0) 2 (0.8) P = 0.53 Diabetes 0 (0) 3 (1.2) P = 0.44 Chronic hypertension 0 (0) 2 (0.8) P = 0.53 Endocrinological disease 0 (0) 8 (3.1) P = 0.21 Pregnancy complications HDP 0 (0) 24 (9.3) P = 0.02 GDM 0 (0) 28 (10.9) P = 0.01 IUGR 0 (0) 3 (1.2) P = 0.44 Multiple pregnancy 0 (0) 0 (0) NC Maternal death 0 (0) 0 (0) NC Table 2. Details of COVID-19-related symptoms, X-ray findings, severity, treatments, and virus variant types in the COVID-19 group. Abbreviations: BA.1, omicron variant; COVID-19, coronavirus disease 2019; L452R, delta variant; N501Y, alpha variant; REGN-COV, COVID-19-antibody cocktail treatment; L452R, delta variant; N501Y, alfa variant; N.P., not performed; W, wild type of SARS-CoV-2. Total (n = 50) Delivery under isolation group (n = 17) Delivery on post-ceasing isolation group (n = 33) n (%) n (%) n (%) COVID-19-related symptoms † Asymptomatic 6 (12) 2 (11.8) 4 (12.1) Fever 31 (62) 10 (58.8) 20 (60.6) Cough 22 (44) 9 (52.9) 13 (39.4) Sore throat 10 (20) 2 (11.8) 8 (24.2) Running nose 5 (10) 3 (17.6) 2 (6.1) Loss of taste and/or smell 3 (6) 1 (5.9) 2 (6.1) Dyspnea 2 (4) 0 (0) 2 (6.1) Chest X-ray findings ‡ ,§ Pneumonia 12 (24) 4 (23.5) 8 (24.2) Unremarkable change 37(74) 13 (76.5) 24 (72.7) Oxygen requirement || 10 (20) 2 (11.8) 8 (24.2) Respiratory support ¶ (for maternity) 2 (4) 1 (5.9) 1 (3.0) Treatments of COVID-19 † Steroid 5 (10) 2 (11.8) 3 (9.1) Remdesivir 3 (6) 2 (11.8) 1 (3.0) REGN-COV2 0 (0) 0 (0) 0 (0) Severity of Infection †† Mild 39 (78) 15 (88.2) 24 (72.7) Intermediate I 5 (10) 0 (0) 5 (15.2) Intermediate II 4 (8) 1 (5.9) 3 (9.1) Severe 2 (4) 1 (5.9) 1 (3.0) Virus variant Wild type 8 (16) 4 (23.5) 4 (12.1) N501Y 9 (18) 1 (5.9) 8 (24.2) L452R 8 (16) 4 (23.5) 4 (12.1) BA.1 24 (48) 8 (47.1) 16 (48.5) Undetectable ‡‡ 1 (2) 0 (0) 1 (3.0) † : Some symptoms and treatments overlapped in the same patient. ‡ : X-ray imaging examinations included chest X-P and/or computed tomography (CT). § : We could not check chest X-P imaging in one case because the patient strongly declined X-ray imaging on admission. || : Oxygen was supplied in the case of SpO 2 below 95% in room air or if the patient complained of respiratory discomfort. ¶ : Respiratory support for mothers included mechanical respiration with intubation and a respirator and/or nasal high-flow oxygen supply. †† : Severity of COVID-19 was defined according to the criteria provided by the Ministry of Health, Labour, and Welfare (MHLW). ‡‡ : The virus variant was not detected in this case due to the quality of the sample. Table 3. Perinatal outcomes comparison between COVID-19 and control group . Data are n (%) or mean ± SD unless otherwise specified. P value was determined by Student's t test or Fisher's exact test. Abbreviations: COVID-19, coronavirus disease 2019; IUFD, intrauterine fetal death; NC, not calculated; NICU, neonatal intensive care unit; N.P., not performed; NSVD, normal spontaneous vaginal delivery; VD, vacuum delivery All participants underwent vaginal delivery at the end of the gestational period. Well-ripening uterine cervix (Bishop score ≥ 6) was shown in many cases on initiation of labor, even in primiparous. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2291276","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":155721328,"identity":"9a85101b-7b38-424f-b501-817120226959","order_by":0,"name":"Kiichiro 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Center","correspondingAuthor":false,"prefix":"","firstName":"Yangsil","middleName":"","lastName":"Chang","suffix":""},{"id":155721346,"identity":"1a9271c1-d98e-4220-a476-4104621dd653","order_by":11,"name":"Kayoko Shikado","email":"","orcid":"","institution":"Department of Obstetrics and Gynecology, Rinku General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kayoko","middleName":"","lastName":"Shikado","suffix":""},{"id":155721348,"identity":"ef0bbfa2-97ec-4211-b759-c56b5285dd41","order_by":12,"name":"Hiroaki Tsubouchi","email":"","orcid":"","institution":"Department of Obstetrics and Gynecology, Rinku General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Hiroaki","middleName":"","lastName":"Tsubouchi","suffix":""},{"id":155721349,"identity":"dc1e8672-0b33-4fbb-bed7-2eae5f08d265","order_by":13,"name":"Masayuki Seki","email":"","orcid":"","institution":"Department of General Internal Medicine and Infectious Diseases, Rinku General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Masayuki","middleName":"","lastName":"Seki","suffix":""},{"id":155721350,"identity":"27bc3078-7d8b-4fd5-aaf4-f6ff1fda7231","order_by":14,"name":"Masaya Yamato","email":"","orcid":"","institution":"Department of General Internal Medicine and Infectious Diseases, Rinku General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Masaya","middleName":"","lastName":"Yamato","suffix":""},{"id":155721352,"identity":"5be4de0e-8d06-4d89-a1d2-b5ac836d9dfa","order_by":15,"name":"Kazuhide Ogita","email":"","orcid":"","institution":"Department of Obstetrics and Gynecology, Rinku General Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kazuhide","middleName":"","lastName":"Ogita","suffix":""}],"badges":[],"createdAt":"2022-11-19 12:44:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2291276/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2291276/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":29731244,"identity":"18db4a13-57c4-4726-9013-4980b0238e1b","added_by":"auto","created_at":"2022-11-30 16:29:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62816,"visible":true,"origin":"","legend":"\u003cp\u003eStudy participants, study design (A), and enrollment of control (non-COVID-19 in pregnancy) group (B). Abbreviations: COVID-19, coronavirus disease 2019\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2291276/v1/47eb2f51cee2faa59680c5b7.png"},{"id":29731230,"identity":"cc9d11bc-6d3c-43ca-a097-1226d01b1120","added_by":"auto","created_at":"2022-11-30 16:29:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":42053,"visible":true,"origin":"","legend":"\u003cp\u003e1\u003csup\u003est\u003c/sup\u003e stage (A) and 2\u003csup\u003end\u003c/sup\u003e stage (B) of labor time, rupture of the membrane to delivery time (C), and Bishop score on initiation of labor (D) comparison between control (non-COVID-19) and COVID-19 group on dot plots. Control group; n = 258, COVID-19 group; n = 50. *\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 and **\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01 vs. control group, respectively. Abbreviations: COVID-19, coronavirus disease 2019; Control, non-COVID-19 pregnant women group; ROM, rupture of membrane\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2291276/v1/1b85f25f03823cedc2a57952.png"},{"id":29731269,"identity":"ac5cf560-1ed4-4233-8984-7af4738d2d99","added_by":"auto","created_at":"2022-11-30 16:29:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":8760,"visible":true,"origin":"","legend":"\u003cp\u003eThe incident of precipitous delivery (%) comparison between COVID-19 and control groups. *\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 vs. control group. Abbreviations: COVID-19, coronavirus disease 2019; Control, non-COVID-19 pregnant women group\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2291276/v1/fcafd99d0ef2c57da6c8d5c5.png"},{"id":35318378,"identity":"2f3fa809-2d97-4693-bf11-e6c62521a687","added_by":"auto","created_at":"2023-04-05 09:14:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":534408,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2291276/v1/248e0aa5-bbe4-4d4a-b475-a2b0958d8804.pdf"},{"id":29731268,"identity":"fb0b5360-1dc6-4836-aaf9-979ea1174875","added_by":"auto","created_at":"2022-11-30 16:29:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":498069,"visible":true,"origin":"","legend":"","description":"","filename":"2022.11.18SupplementaryInformationforSciRep.docx","url":"https://assets-eu.researchsquare.com/files/rs-2291276/v1/c8dff47fbff4b0ffdede52da.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"COVID-19 in pregnancy influences the progression of labor: A single-institutional and observational study in Japan","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCoronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been spreading.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Obstetricians have encountered COVID-19 in pregnant women. However, the management of vaginal delivery in COVID-19 patients has remained unclear due to a lack of data. Certain meta-analyses have reported perinatal outcomes on vaginal delivery during the COVID-19 pandemic, mainly focusing on maternal morbidity, mortality, and psychological issues.\u003csup\u003e[\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e However, to the best of our knowledge, there has been no convincing article focusing on the characteristics of labor during the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eMoreover, in Japan, the cesarean section has remained a \u0026ldquo;standard\u0026rdquo; mode of delivery for COVID-19 pregnant women,\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e as some articles sensationally reported the potential risk of vertical transmission in the early period of the pandemic.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e These articles have contributed to obstetricians\u0026rsquo; hesitancy to try vaginal delivery for COVID-19 women. Guidance from the UK and USA indicated the cesarean section based on obstetrical issues because of the low-risk of vertical transmission.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e Current meta-analyses have also suggested that there is no advantage of iatrogenic cesarean section for preventing vertical transmission.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e Although the evidence indicated the safety of vaginal delivery during the COVID-19 pandemic, the cesarean section has remained implemented due to a lack of information about the labor characteristics. Thus, we focused on the clinical characteristics of vaginal delivery in patients who were infected with and recovered from COVID-19. The objectives of our study were 1) to reveal the effects of COVID-19 on vaginal labor at term gestation and ii) to verify the absence of vertical transmission via vaginal labor in COVID-19 patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a single-institutional\u0026nbsp;and observational study on COVID-19 in pregnancy with term gestation. To reveal the effects of COVID-19 on vaginal delivery, we included women who underwent vaginal delivery in our hospital with confirmed COVID-19 infection and recovery during pregnancy. These patients were defined as the COVID-19 group, the research participants. The observational period was from September 2020 to March 2022.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring the observational period, 114 pregnant COVID-19 patients were transferred to our hospital. Nine were excluded due to undergoing cesarean section with deterioration of maternal respiratory function and obstetrical indications, including breech presentation, prior cesarean section, and abnormal fetal status. Forty-five women were also excluded because they returned to their previous medical institute after ceasing isolation. Ten women were discharged preterm and underwent maternal check-ups in our outpatient clinic. Finally, we included 50 women undergoing vaginal delivery during and after isolation for COVID-19 in this study (Figure 1A). These patients were divided into under isolation and post-ceasing isolation groups. The under-isolation group included patients undergoing vaginal delivery under isolation. The post-ceasing isolation group included patients delivering after testing negative for COVID-19 (i.e., post-ceasing isolation). We collected and analyzed clinical information from these participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo select an appropriate control group, we enrolled pregnant women undergoing vaginal delivery at term gestation without COVID-19. During the same observational period, a total of 682 women without COVID-19 infection underwent vaginal delivery at term gestation. Ninety and 146 women were excluded due to preterm birth and undergoing cesarean section, respectively. A total of 188 patients were also excluded using the following exclusion criteria: 1) prior rapid delivery, 2) uterine anomaly, 3) post-conization, 4) dysfunction of the uterine cervix, 5) vaginal delivery in women without any maternal check-up by term, 6) intrauterine growth restriction (IUGR), and 7) multiple pregnancies. These exclusion factors are closely associated with rapid delivery and the inability to estimate gestational week at delivery. Finally, the control group included 258 women (Figure 1B).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo investigate the characteristics of labor, we compared the duration of labor, such as 1\u003csup\u003est\u003c/sup\u003e /2\u003csup\u003end\u003c/sup\u003e stage of labor time, total labor time, and rupture of membrane (ROM) to delivery time between the COVID-19 group and the control group. The Bishop score on initiation of labor and percentage of precipitous delivery (vaginal delivery in less than three hours) were also compared between both groups. Additionally, to estimate the effects of virus-variants, severity of disease, and under-/post-isolation on the labor progression in the COVID-19 group,\u0026nbsp;sub-group analysis of labor characteristics was performed comparing among the factors above.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical information of the COVID-19 and control groups was collected from the digital medical charts of our hospital. The collection and use of clinical data for this study were also approved by the Institutional Ethics Committee of Rinku General Medical Center (No. 2021-014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOur multidisciplinary management for COVID-19 pregnant women\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe flow-chart of our management scheme for vaginal delivery among pregnant COVID-19 patients is shown in Supplementary Figure S1. The principle of our scheme was conservative management with multidisciplinary follow-up until testing negative for COVID-19 or the timing for initiation of labor. Biweekly\u0026nbsp;fetal\u0026nbsp;follow-up was performed based on fetal surveillance of high-risk pregnancies, such as pregnancies impacted by severe preeclampsia and diabetes.\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e13, 14\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e Management and treatment of COVID-19 were determined depending on the severity of disease based on the criteria from the Ministry of Health, Labour and Welfare in Japan (see Supplementary Table S1).\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e15\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNasopharyngeal swab samples were collected by trained medical staff. COVID-19 and variant-typing tests were performed by the clinical laboratory of our hospital using Lumipulse G SARS-CoV-2 Ag Immunoreaction Cartridges (FUJIREBIO, Japan). Negative COVID-19 status was clinically defined as having negative COVID-19 antigen tests for two consecutive days obtained from nasopharyngeal samples. COVID-19 swab testing was performed from admission to confirmation of negative results. COVID-19 tests for estimating vertical transmission were collected from pregnancy-associated materials, including amniotic fluid, umbilical cord, surfaces of the placenta (both the maternal and fetal sides), vaginal discharge, and milk. On postpartum, COVID-19 tests from milk and vaginal discharge were performed every day until obtaining negative COVID-19 tests from the maternal nasopharynx. On the other hand, COVID-19 tests of milk and vaginal discharge were conducted postpartum for post-isolating patients (i.e., COVID-19-negative patients).\u003c/p\u003e\n\u003cp\u003eTo estimate the profiles of systemic inflammation, blood samples were collected on admission, at the initiation of labor, and during the postpartum period. These samples were used for the measurement of serum and plasma levels of endothelial damage-related factors, reflecting systemic inflammation such as maternal serum high-sensitive c-reactive protein (CRP), and plasma von Willebrand factor (vWF) antigen and vWF activity levels. All blood samples were centrifuged, and serum and/or plasma were collected, stored, and measured at the clinical laboratory unit of our hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults from blood tests and the Bishop score included a partial lack of data. Even though data could not be obtained consecutively, partially available data were collected and added for analysis. All data are presented as the mean and standard deviation (mean ± SD) or n (%), and nonparametric statistical analyses were conducted due to the limited number of participants in the study. The difference between the two groups was analyzed by Student’s \u003cem\u003et\u003c/em\u003e-test, chi-squared test, and Fisher’s exact test. The differences between multiple groups were analyzed by one-way or two-way analysis of variance with Tukey’s post-hoc test. \u003cem\u003eP\u003c/em\u003e values of \u0026lt; 0.05 were considered significant. All statistical analyses were performed using Excel (Microsoft, USA) with add-in statistical software, “BellCurve for Excel version 3.21” (Social Survey Research Information Co., Ltd., Japan). Smirnov-Grubbs’ test, an outlier analysis, was performed before all statistical analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by The Institutional Ethics Committee of Rinku General Medical Center (No. 2021-014). All patients voluntarily participated in this study, and informed consent for providing clinical samples and data was obtained. All methods were performed in accordance with the relevant guidelines and regulations, including Declaration of Helsinki.\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBasic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur COVID-19 group consisted of 50 pregnant women with confirmed COVID-19 infection and recovery who underwent vaginal delivery safely and successfully (see Figure 1A). The baseline characteristics of the COVID-19 group are shown in Table 1. The mean maternal age was 30.5 ± 5.5 years old. Ten patients were primiparous, and 14 were multiparous. Whereas 34% of patients (17 of 50) underwent vaginal delivery while being COVID-19 positive (i.e., under isolation group), 66% (33 of 50) delivered vaginally after testing negative for COVID-19 (i.e., post isolation group). All patients were Asian, without pre-existing maternal complications such as hypertension, diabetes, renal disease, and perinatal complications. Moreover, no study participant had any risk factors for rapid delivery. When comparing with the control group, characteristics of both groups, including parity and maternal age, were not significantly different.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDetails of maternal COVID-19\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe details of maternal COVID-19, including symptoms, chest X-ray findings, treatments, and oxygen requirements on admission, are shown in Table 2. COVID-19-related symptoms were as follows: asymptomatic (n = 6), fever (n = 31), cough (n = 22), sore throat (n = 10), running nose (n = 5), dyspnea (n = 2), and loss of taste/smell (n = 3). Some symptoms overlapped in the same patient. Lung consolidation on X-ray imaging on admission was identified in 12 cases. Two of these 12 patients needed to receive oxygen support with intubation and mechanical respiratory support during expectant management. The severity of the disease showed that 39 patients were mild, five were intermediate I, four were intermediate II, and two were severe with temporary intubation and respiratory support. Virus variant typing tests showed that wild-type SARS-CoV-2 (W), N501Y, L451R, and BA.1 variants were found in eight, nine, eight, and 24 cases, respectively. The virus variant was not detected in just one case due to the quality of the sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerinatal and neonatal outcomes comparison between COVID-19 and control groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerinatal and neonatal outcomes are shown in Table 3. All patients underwent vaginal delivery at term gestation.\u0026nbsp;Comparison between the COVID-19 and control group, mode of vaginal delivery, induction of labor, and transfusion were not significantly different between both groups (\u003cem\u003eP\u003c/em\u003e = 0.80, 0.89, and 0.44, respectively).\u0026nbsp;Regarding neonatal outcomes, no statistically significant differences between the COVID-19 and control groups were identified in all neonatal outcomes including the newborn birth weight, APGAR score (on 1 and 5 minute), the percentage of neonatal intensive care unit admission, neonatal adverse effects, and respiratory support for neonates (\u003cem\u003eP\u003c/em\u003e = 0.25, 0.80, 0.14, 0.66, and 0.38, respectively). No adverse effect including intrauterine fetal death (IUFD) was found in both groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of labor progression and Bishop score\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 3, total labor time (min) in the COVID-19 group was significantly shorter than in the control group (control vs. COVID-19; 603.9 ± 478.8 vs. 357.1 ± 237.7, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01).\u0026nbsp;Labor time and Bishop score comparison between the COVID-19 and the control group are shown in Figure 2A-D. 1\u003csup\u003est\u003c/sup\u003e stage and 2\u003csup\u003end\u003c/sup\u003e stage of labor time (min) in the COVID-19 group were significantly shorter than those in the control group (control vs. COVID-19; 545.7 ± 459.1 vs. 291.3 ± 155.2, \u003cem\u003eP\u003c/em\u003e = 0.0001, and 38.8 ± 42.8 vs. 20.9 ± 14.6, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.002, respectively). ROM to delivery time (min) of the COVID-19 group was also significantly shorter than that of the control group (control vs. COVID-19; 80.6 ± 104.3 vs. 47.9 ± 50.2, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.02). The Bishop score on initiation of labor in the COVID-19 group was significantly higher than that in the control group (control vs. COVID-19; 5.1 ± 2.7 vs. 6.4 ± 2.6,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e= 0.002). The incidence of precipitous delivery, defined as a total delivery time of less than three hours\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e16\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, was significantly higher in the COVID-19 group than in the control group (see Figure 3, control vs. COVID-19; 13.2% vs. 26.0%,\u003cem\u003e\u0026nbsp;P\u0026nbsp;\u003c/em\u003e=\u0026nbsp;0.04).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEvaluation of vertical transmission on vaginal labor in COVID-19\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCOVID-19 antigen tests from the placenta, amniotic fluid, umbilical cord, and milk were negative even in labor during isolation (see Supplementary Information Table S2). Among the patients who underwent vaginal delivery while COVID-19 positive, COVID-19 tests for milk and vaginal discharge were performed daily until confirmation of a negative COVID-19 test from the maternal nasopharynx. The patients who recovered from COVID-19 also underwent COVID-19 antigen tests of milk and vaginal discharge once on postpartum day one. There were no COVID-19 antigen-positive results in either the infection group or the post-ceasing isolation group, regardless of whether the COVID-19 antigen was positive from the maternal nasopharynx.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe found the following novel characteristics of labor progression in COVID-19: 1) rapidly progressing labor, 2) increasing precipitous delivery, and 3) well-ripening uterine cervix on initiation of labor compared with non-COVID-19 women. To the best of our knowledge, this is the first report focusing on the features of labor progression during the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-D, vaginal delivery in the COVID-19 group progressed significantly more rapidly than in the control group.\u003c/p\u003e \u003cp\u003eMoreover, 26% of the COVID-19 women (13 of 50) manifested precipitous delivery, higher than general prevalence\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e and significantly higher than that of the control group (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These pregnant women did not have the previous history of precipitous delivery and any factors affecting progression of labor, indicating that our findings resulted from COVID-19 but not patients\u0026rsquo; backgrounds.\u003c/p\u003e \u003cp\u003eWe also found that COVID-19 women manifested the well-ripening of uterine cervix on initiation of labor. Regarding the prevalence of parity, there was no significant difference between the COVID-19 group and the control group (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, regarding the effects of virus variants, under-/post-isolation, and severity of COVID-19 on delivery time, sub-group analysis revealed that there was no significant difference in labor time and Bishop score (see Supplementary Information Figure S3 A-L). These results indicated that the rapidly progressing labor may be affected by COVID-19 itself, regardless of parity, virus variants, under-/post-isolation, and severity of COVID-19.\u003c/p\u003e \u003cp\u003eConsidering the possible mechanisms of faster labor progression in COVID-19 women, we assumed that COVID-19-related systemic inflammation\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e could contribute to the well-ripening of the uterine cervix and tachysystole, resulting in rapidly progressing labor and/or precipitous delivery.\u003c/p\u003e \u003cp\u003eIn other words, combined with previous evidence and phenomenological points of view, we considered the effects of systemic inflammation on the change of the uterine cervix stiffness and myometrial contractility.\u003c/p\u003e \u003cp\u003eFrom previous reports, certain articles indicate that maternal systemic inflammation, such as resulting from sepsis and appendicitis, can cause well-ripening of the cervix and rapid labor due to tachysystole and softening uterine cervix (i.e. cervical ripening).\u003csup\u003e[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e Others have suggested that inflammation can also cause upregulation of the expression of oxytocin receptors, leading to increased myometrial contractility and promotion of vaginal labor. \u003csup\u003e[\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e From our results, the Bishop score in COVID-19 women on initiation of labor was significantly higher than that in controls. Moreover, we have often experienced unexplained and sudden-onset tachysystole in spontaneous labor on COVID-19 women (see Supplementary Information Figure S2-A and B). No histological findings of abruptio placentae and chorioamnionitis were found from placenta in these cases (no data was shown). Considering previous evidence, this unexplained phenomenon possibly occurred through maternal inflammation due to COVID-19, resulting in rapid delivery. To verify our hypothesis, we preliminarily investigated endothelial damage marker profiles, which reflect systemic inflammatory conditions\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e and can be easily checked in our hospital (see Supplementary Information Figure S4). We measured vWF antigen/activity and high-sensitive CRP, recently being spotlighted as the COVID-19-related systemic inflammatory markers. The mean vWF antigen/antigen and high-sensitive CRP levels represented with higher levels on admission and on initiation of labor compared with normal ranges. The profiles of all markers except for high-sensitive CRP increased on initiation of labor. Interestingly, despite high-sensitive CRP levels decreasing in labor, the rest of the factor profiles increased in parallel with progression of labor. Although the reasons for the discrepancy between high-sensitive CRP and other factors were unclear, a recent article indicated that endothelial inflammation is sustained after ceasing isolation and treatment.\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e Therefore, together with previous evidence, our results indicate that COVID-19-related systemic inflammatory responses may persist beyond treatment and affect the progression of delivery and be associated with rapid delivery.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe limitations of our study are as follows: 1) limited patient numbers, 2) possibility of variations in the COVID-19 detection procedure depending on prior hospitals and health care centers, 3) inability to analyze the effects of systemic inflammation on rapid labor using basic research procedures, and 4) no data on the effects of COVID-19 in the preterm period on vaginal labor, i.e., the long-term effects of infection on vaginal labor. of the most significant research limitation in this study was the lack of data when searching for mechanisms of labor progression in COVID-19.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, we found that pregnant women infected with/recovered from COVID-19 showed rapidly progressing labor. To the best of our knowledge, this is the first report focusing on and revealing the characteristics of labor progression in COVID-19 women. Our results indicated that robust systemic inflammation due to COVID-19 may affect the progression of labor by promoting cervical ripening and/or myometrial contractility. Excessive interventions have been implemented in the early pandemic; however, preliminary management systems should be updated. Our novel findings should contribute to perinatal management in the pandemic era and minimize iatrogenic cesarean sections by updating preliminary management. \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: Dr. Fuyuki Ichikawa, Dr. Misako Kuroda, Dr. Asuka Tanaka, and Dr. Katsumi Kozasa contributed to management of vaginal delivery in COVID-19 pregnant women as nightshift working. Our research had the Best oral presentation award in FAOPS 2022“. We also thank to all medical staffs committing our scheme.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKF mainly contributed to conducting this study, managing vaginal labor in COVID-19 patients, writing the manuscript, and revising this manuscript. YT (2\u003csup\u003end\u003c/sup\u003e author), NK, RH, AN, YT (6\u003csup\u003eth\u003c/sup\u003e author), HK, HH, SF, and SY also contributed to managing vaginal labor, collecting samples, and analyzing clinical data. MS and MY worked together with the obstetrics team and treated patients from the internal medicine point of view. They checked and provided suggestions for this manuscript. YC, KS, and HT checked and supervised this work. Finally, KO conducted this study together with KF, checked, advised, and revised the first draft of manuscript and approved the final version. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information:\u0026nbsp;\u003c/strong\u003eThe authors receive funding from a Grant-in-aid for Perinatal Emergency Medical Care (Osaka Medical Association). This funding was used for the English grammatical editing service of \u003cem\u003eEditage\u003c/em\u003e. The funder did not contribute to the study design, data collection, data analysis, interpretation, or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Informat\u003c/strong\u003e\u003cstrong\u003eion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed to KF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe online version contains supplementary material available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePresentation at the meetings:\u003c/strong\u003e Some of the data from this study were reported in both \u003cem\u003eFertility 2021 Online, 2021/1/6-1/10, UK\u003c/em\u003e and \u003cem\u003eFIGO XXIII, World Congress of Gynecology and Obstetrics, 2021/10/21-10/28, Sydney, Australia (hybrid)\u003c/em\u003e, as a poster presentation. We also had oral presentation in \u003cem\u003eFAOPS (Federation of Asia Oceania Perinatal Societies) 2022 in Malaysia, 2022/8/25-8/28\u003c/em\u003e, and finally received “The best oral presentation award (Obstetrics)”.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHu, Y. \u003cem\u003eet al.\u003c/em\u003e Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. J. Clin. Virol. \u003cb\u003e127\u003c/b\u003e, 104371 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbou Ghayda, R. A. \u003cem\u003eet al.\u003c/em\u003e COVID-19 and adverse pregnancy outcome: A systematic review of 104 cases. J. Clin. 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Taiwan. J. Obstet. Gynecol. \u003cb\u003e52\u003c/b\u003e, 165\u0026ndash;170 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHelmer, H. \u003cem\u003eet al.\u003c/em\u003e Production of oxytocin receptor and cytokines in primary uterine smooth muscle cells cultivated under inflammatory conditions. J. Soc. Gynecol. Investig. \u003cb\u003e9\u003c/b\u003e, 15\u0026ndash;21 (2002).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGenc, M. R. \u0026amp; Ford, C. E. The clinical use of inflammatory markers during pregnancy. Curr. Opin. Obstet. Gynecol. \u003cb\u003e22\u003c/b\u003e, 116\u0026ndash;121 (2010).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWillems, L. H. \u003cem\u003eet al.\u003c/em\u003e Sustained inflammation, coagulation activation and elevated endothelin-1 levels without macrovascular dysfunction at 3 months after COVID-19. Thromb. Res. \u003cb\u003e209\u003c/b\u003e, 106\u0026ndash;114 (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Baseline characteristics and details of COVID-19 group compared with the control group. Data are n (%) or mean \u0026plusmn; SD unless otherwise specified. \u003cem\u003eP\u003c/em\u003e value was determined by Student\u0026apos;s t test, Fisher\u0026apos;s exact test, or chi-square test. Abbreviations: COVID-19, coronavirus disease 2019; GDM, gestational diabetes mellitus; HDP, hypertensive disorders of pregnancy; IUFD, intrauterine fetal death; IUGR, intrauterine growth restriction; NC, not calculated\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003eCOVID-19 (n\u0026nbsp;=\u0026nbsp;50)\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003eControl (n\u0026nbsp;=\u0026nbsp;258)\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e30.5\u0026nbsp;\u0026plusmn;\u0026nbsp;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e30.7\u0026nbsp;\u0026plusmn;\u0026nbsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003e\u0026lt; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e5\u0026nbsp;(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e20 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e100\u0026nbsp;(38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e27 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e137\u0026nbsp;(53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003e≧\u0026nbsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e16\u0026nbsp;(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eJapanese (Asian)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e50 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e254 (98.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e4 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003eNC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e20 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e125 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e30 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e133 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e = 0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eMaternal pre-existing\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eRespiratory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e5 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e = 0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eCardiac disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e = 0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eRenal disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e3 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eChronic hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e = 0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eEndocrinological disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e8 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003ePregnancy complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eHDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e24 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eGDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e28 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e = 0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e3 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eMultiple pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003eNC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.278688524590166%\"\u003e\n \u003cp\u003eMaternal death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.40983606557377%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.65573770491803%\"\u003e\n \u003cp\u003eNC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Details of COVID-19-related symptoms, X-ray findings, severity, treatments, and virus variant types in the COVID-19 group. Abbreviations: BA.1, omicron variant; COVID-19, coronavirus disease 2019; L452R, delta variant; N501Y, alpha variant; REGN-COV, COVID-19-antibody cocktail treatment; L452R, delta variant; N501Y, alfa variant; N.P., not performed; W, wild type of SARS-CoV-2.\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n = 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003eDelivery under isolation group (n\u0026nbsp;=\u0026nbsp;17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003eDelivery on post-ceasing isolation group (n\u0026nbsp;=\u0026nbsp;33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eCOVID-19-related symptoms\u003cspan lang=\"\"\u003e\u0026dagger;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Asymptomatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e6 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e2 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Fever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e31 (62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e10 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e20 (60.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Cough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e22 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e9 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e13 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Sore throat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e10 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e2 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e8 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Running nose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e5 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e3 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e2 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Loss of taste\u0026nbsp; \u003c/p\u003e\n \u003cp\u003e and/or smell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e2 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Dyspnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e2 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eChest X-ray findings\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003csup\u003e,\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e12 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e4 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e8 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Unremarkable change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e37(74)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e13 (76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e24 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eOxygen requirement\u003csup\u003e||\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e10 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e2 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e8 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eRespiratory support\u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e(for maternity)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e1 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eTreatments of COVID-19\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Steroid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e5 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e2 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e3 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Remdesivir\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e3 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e2 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e1 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e REGN-COV2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eSeverity of Infection\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e39 (78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e15 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e24 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Intermediate I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e5 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Intermediate II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e4 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e3 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e1 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eVirus variant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e Wild type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e8 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e4 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e N501Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e9 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e8 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e L452R\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e8 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e4 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003e BA.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e24 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e8 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e16 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\"\u003e\n \u003cp\u003eUndetectable\u003csup\u003e\u0026Dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e1 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e: Some symptoms and treatments overlapped in the same patient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e: X-ray imaging examinations included chest X-P and/or computed tomography (CT).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003e: We could not check chest X-P imaging in one case because the patient strongly declined X-ray imaging on admission.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e||\u003c/sup\u003e: Oxygen was supplied in the case of SpO\u003csub\u003e2\u003c/sub\u003e below 95% in room air or if the patient complained of respiratory discomfort.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026para;\u003c/sup\u003e: Respiratory support for mothers included mechanical respiration with intubation and a respirator and/or nasal high-flow oxygen supply.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e: Severity of COVID-19 was defined according to the criteria provided by the Ministry of Health, Labour, and Welfare (MHLW).\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026Dagger;\u0026Dagger;\u003c/sup\u003e: The virus variant was not detected in this case due to the quality of the sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Perinatal outcomes \u003cspan lang=\"\"\u003ecomparison between COVID-19 and control group\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003eData are n (%) or mean \u0026plusmn; SD unless otherwise specified. \u003cem\u003eP\u003c/em\u003e value was determined by Student\u0026apos;s t test or Fisher\u0026apos;s exact test. Abbreviations: COVID-19, coronavirus disease 2019; IUFD, intrauterine fetal death; NC, not calculated; NICU, neonatal intensive care unit; N.P., not performed; NSVD, normal spontaneous vaginal delivery; VD, vacuum delivery\u003c/p\u003e\n\u003cp\u003eAll participants underwent vaginal delivery at the end of the gestational period. Well-ripening uterine cervix (Bishop score \u0026ge; 6) was shown in many cases on initiation of labor, even in primiparous.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-2291276/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2291276/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe management of vaginal delivery during the COVID-19 pandemic remains unclear due to lack of information on labor characteristics. We aimed to clarify the effects of COVID-19 on the progression of vaginal labor.\u003c/p\u003e\n\u003cp\u003eThe single-institutional and observational study of COVID-19 women in pregnancy (COVID-19 group, n = 50) delivering from 2020 to 2022, was conducted. Patients’ backgrounds, perinatal outcomes, labor characteristics (labor time and Bishop score), and the details of maternal COVID-19 were analyzed and compared with non-COVID-19 pregnant women (control group, n = 258).\u003c/p\u003e\n\u003cp\u003eThe COVID-19 group showed rapidly progressing labor without adverse effect. The 1\u003csup\u003est\u003c/sup\u003e and 2\u003csup\u003end\u003c/sup\u003e stage of labor time, and labor time after rupture of membrane were significantly shorter in the COVID-19 group than in the control group (\u003cem\u003eP \u003c/em\u003e\u0026lt; 0.01; \u003cem\u003eP \u003c/em\u003e\u0026lt; 0.01; and \u003cem\u003eP \u003c/em\u003e\u0026lt; 0.05, respectively). The COVID-19 group had a higher Bishop score on initiation of labor (\u003cem\u003eP \u003c/em\u003e\u0026lt; 0.01). Precipitous delivery in the COVID-19 group also significantly increased (\u003cem\u003eP \u003c/em\u003e\u0026lt; 0.05). These results indicated that COVID-19 in pregnancy can affect the progression of labor rapidly.\u003c/p\u003e\n\u003cp\u003eThis is the first report focusing on the characteristics of labor progression in COVID-19 women, indicating that COVID-19 can affect the progression of labor without complication.\u003c/p\u003e","manuscriptTitle":"COVID-19 in pregnancy influences the progression of labor: A single-institutional and observational study in Japan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-30 16:29:27","doi":"10.21203/rs.3.rs-2291276/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"afcf529b-4947-498a-85ee-6318f7708ea7","owner":[],"postedDate":"November 30th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":17348202,"name":"Health sciences/Diseases/Infectious diseases"},{"id":17348203,"name":"Health sciences/Diseases/Infectious diseases/Viral infection"},{"id":17348204,"name":"Health sciences/Signs and symptoms/Reproductive signs and symptoms"},{"id":17348205,"name":"Health sciences/Diseases/Reproductive disorders"}],"tags":[],"updatedAt":"2023-04-05T09:14:18+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-30 16:29:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2291276","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2291276","identity":"rs-2291276","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}