Aspectos clínicos e obstétricos de gestantes com COVID-19: Uma revisão sistemática

Revisão sistemática da literatura nas bases: MEDLINE/PubMed, LILACS, SCIELO e CNKI, realizada de março a maio de 2020, com os descritores Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Elegeram-se títulos originais, sem restrição de idioma e período e que abordassem gestantes com diagnóstico clínico e/ou laboratorial de COVID-19. Excluíram-se revisões, editoriais, títulos duplicados. As escalas de Newcastle-Ottawa (NOS, na sigla em inglês) e a de Murad et al. foram utilizadas para avaliar a qualidade dos estudos.

Resultados

Foram incluídos 34 artigos com 412 gestantes infectadas pela síndrome respiratória aguda grave (SARS-Cov, na sigla em inglês) com idade média de 27,5 anos e média de 36,0 semanas gestacionais. O sintoma mais incidente foi a febre (49,7%;205). e 89 (21,6%) gestantes evoluíram para pneumonia viral grave. Os exames laboratoriais demonstraram aumento da proteína C reativa (37,8%; 154) e os radiológicos mostraram pneumonia com padrão em vidro fosco periférico (51,4%; 172). O parto cesáreo de emergência foi indicado para a maior parte das gestantes, e a complicação gestacional mais comum foi a ruptura prematura de membranas ovulares (3,4%; 14). Foram detectados 2 (0,5%) mortes neonatais, 2 (0,5%) natimortos, e 1 (0,2%) morte materna.

Conclusão

Gestantes com doença coronavírus (COVID-19, na sigla em inglês apresentaram quadro clínico semelhante a gestantes não infectadas, com poucas repercussões obstétricas ou neonatais. Houve uma maior indicação de partos cesáreos antes do agravamento da doença e não se observaram evidências de transmissão vertical da infecção.

Palavras-chave
gravidez; infecções por coronavírus; síndrome respiratória aguda grave; vírus da SARS; betacoronavírus

PICO	MEANING	DESCRIPTORS
Population (P):	Pregnant women of any age	(("Pregnant Women" [MeSH Terms]))
Intervention (I):	COVID-19 infection	(("coronavirus" [MeSH Terms] OR "coronavirus" [All Fields]) OR ("COVID-19" [All Fields] OR"2019-nCoV" [All Fields] OR "SARS-CoV-2" [All Fields]).
Comparison (C):	Non-pregnant women	Not applicable
Outcomes (O):	COVID-19 interference in the pregnancy	(("Pregnancy" [MeSH Terms]))

Art	Author/ year/ country;	N	Diagnostic method	Maternal age	Trimester average GA	Main signs and symptoms	Radiological/laboratory manifestations	Maternal/gestational/fetal repercussions
1	Xiong et al. (2020)¹²12 Xiong X, Wei H, Zhang Z, et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID–19. J Med Virol. 2020;92(09):1657–1659. Doi: 10.1002/jmv.25857 https://doi.org/10.1002/jmv.25857... ; China	1	RT-PCR	(25)	2^nd (26 GW)	38°C fever, dry cough, and tremor	Radiological: pulmonary opacity Laboratory: neutrophilia and lymphocytopenia	Without repercussions
2	Li et al. (2020)¹⁵15 Li N, Han L, Peng M, et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis. 2020;71(16):2035–2041. Doi: 10.1093/cid/ciaa352 https://doi.org/10.1093/cid/ciaa352... ; China	16	RT-PCR	(31,5)26–37	3^rd (35 GW)	Fever (4;25.0%)	Radiological: bilateral pneumonia 43.75% (7) and unilateral pneumonia 50% (8) Laboratory: leukopenia and neutrophilia	14 (87.5%) Cesarean deliveries 3 (18.75%) Premature births, of which: 2 (66.67%) premature rupture of ovarian membranes (RPMO) and 1 (33.3%) bleeding 2 (12.5%) fetal distress
3	Chen et al. (2020)²⁷27 Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol. 2020;92(09):1556–1561. Doi: 10.1002/jmv.25789 https://doi.org/10.1002/jmv.25789... ; China	5	RT-PCR	(28) 25–31	3^rd (39 GW)	Fever (after delivery) and dry cough (2;40.0%)	Radiological: bilateral pneumonia 60% (3) and 40% (2) unilateral Laboratory: increased CRP (4; 80.0%) and alkaline phosphates (4; 80.0%); leukopenia 40% (2)	2 (40.0%) Cesarean deliveries
4	Yu et al. (2020)¹³13 Yu N, Li W, Kang Q, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20(05):559–564. Doi: 10.1016/S1473-3099(20)30176-6 https://doi.org/10.1016/S1473-3099(20)30... ; China	7	RT-PCR	(32) 29–34	3^rd (39 GW)	Fever (86%;6), cough, dyspnea, and diarrhea (14%;1,each)	Radiological: 86% (6) bilateral pneumonia and 14% (1) unilateral Laboratory: neutrophilia (71%; 5), lymphopenia (71%; 5), thrombocytopenia (29%; 2) and elevation of D-dimer (100%; 7), alanine aminotransferase (29%; 2) and CRP (100%; 7)	Infected NB 36h after delivery
5	Kang et al. (2020)¹⁶16 Kang X, Zhang R, He H, et al. [Anesthesia management in cesarean section for a patient with coronavirus disease 2019]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49(01):249–252; China	1	RT-PCR	30	3^rd (35 GW).	Cough	Radiological: pneumonia and bilateral pleural effusion Laboratory: Without changes	Emergency cesarean delivery Fetal bradycardia
6	Liu et al. (2020)⁴⁵45 Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol. 2020;215(01): 127–132. Doi: 10.2214/AJR.20.23072 https://doi.org/10.2214/AJR.20.23072... ; China	15	RT-PCR	32 (23–40)	1^st to 3^rd (12 to 38 GW).	Fever (86.6%; 13); Cough (60.0%; 9); fatigue (26.7%; 4); myalgia (20.0%; 3); dyspnea, odynophagia, and diarrhea (6.6%; 1, each)	Radiological: ground-glass opacity and late pulmonary consolidations Laboratory: lymphocytopenia (80.0%; 12) and increased value of C-reactive protein (66.6%; 10)	10 (66.6%) cesarean deliveries 3 (20.0%) premature births
7	Chen et al. (2020)¹⁴14 Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809–815. Doi: 10.1016/S0140-6736(20)30360-3 https://doi.org/10.1016/S0140-6736(20)30... ; China	9	RT-PCR	30 (26–40)	3^rd (37 GW)	Fever (77.7%; 7); Cough (44.4%; 4); myalgia (33.3%; 3); odynophagia and malaise (22.2%; 2, each)	Radiological: ground-glass opacity (88.8%; 8) Laboratory: lymphocytopenia (55.5%; 5), elevation of aminotransferases (33.3%; 3) and C-reactive protein-PCR (66.6%; 6)	9 (100.0%) cesarean deliveries 4 (44.4%) newborns had birth weight less than 2500 g 1 (11.1%) PROM
8	Liu et al. (2020)¹⁷17 Liu Y, Chen H, Tang K, Guo Y.Withdrawn: Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020;•••:S0163-4453(20)30109-2. Doi: 10.1016/j.jinf.2020.02.028 [ahead of print] https://doi.org/10.1016/j.jinf.2020.02.0... ; China	13	RT-PCR	29 (22–36)	2 patients in the 2^nd (26 GW); 11 patients in the 3^rd (35 GW)	Fever and fatigue (10; 77%); Dyspnea (3; 23%)	NR	10 (77%) cesarean deliveries, 5 (38.4%) of which were emergency 6 (46%) premature birth 3 (23%) fetal distress. 1 (7.6%) PROM 1 (7.6%) stillborn 1 (7.6%) maternal multiple organ dysfunction syndrome (MODS)
9	Li et al. (2020)¹⁸18 Li Y, Zhao R, Zheng S, et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis. 2020;26(06):1335–1336. Doi: 10.3201/eid2606.200287 https://doi.org/10.3201/eid2606.200287... ; China	1	RT-PCR	30	3^rd (35 GW)	Dry cough, fever, and dyspnea	Radiological: bilateral irregular pulmonary infiltrates Laboratory: slightly abnormal.	Emergency cesarean delivery Fetal bradycardia
10	Chen et al. (2020)¹⁹19 Chen S, Huang B, Luo DJ, et al. [Pregnancy with new coronavirus infection: clinical characteristics and placental pathological analysis of three cases]. Zhonghua Bing Li Xue Za Zhi. 2020;49(05): 418–423. Doi: 10.3760/cma.j.cn112151-20200225-00138 https://doi.org/10.3760/cma.j.cn112151-2... ; China	3	RT-PCR	29,6 (23–34)	3^rd (36.6 GW)	Pre or postnatal fever (100%, 3) and chest pain (33.3%; 1).	Radiological: bilateral ground-glass opacities and bronchiectasis (100%, 3) Laboratory: significant increase in CRP (100%, 3)	3 (100.0%) cesarean deliveries 1 (33.3%) premature birth 1 (33.3%) premature placental displacement 1 (33.3%) placenta previa 1 (33.3%) NB with LBW
11	Zhang et al. (2020)²⁰20 Zhang L, Jiang Y, WeiM, et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi. 2020;55(03):166–171; China	16	RT-PCR	29 (24–34)	3^rd (38 GW)	Cough; Chest pain; dyspnea, and diarrhea	NR	16 (100%) emergency cesarean section 3 (18.7%) premature births 2 (12.5%) fetal distress 3 (18.7%) rupture of membranes 1 (6.25%) fetal distress and fetal bradycardia 1 (6.25%) severe maternal pneumonia
12	Yan et al. (2020)²¹21 Yan J, Guo J, Fan C, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020; 223(01):111.e1–111.e14. Doi: 10.1016/j.ajog.2020.04.014 https://doi.org/10.1016/j.ajog.2020.04.0... ; China	116	RT-PCR	31 (24-41)	3^rd (38 GW) 1^st (4;3.4%) 2^nd (6;5.2%) 3^rd (96;91.4%)	27 (23.3%) asymptomatic Fever (50.9%; 59), cough (28.4%; 33), fatigue (12.9%; 15), dyspnea (7.8%; 9); odynophagia (8.6%; 10); myalgia (5.3%; 6); diarrhea (0.9%; 1)	Radiological: bilateral ground-glass pneumonia (96.3%; 104) Laboratory: lymphopenia and increased CRP (44.0%; 51), leukopenia (24.1%; 28)	99 deliveries, 85 (85.9%) of which were cesarean and 33 (38.8) indications due to COVID-19 21 (21.2%) premature births 6 (6.0%) PROM 1 abortion 1 neonatal death from asphyxiation. 8 (6.9%) severe pneumonia with ventilatory support
13	Ferrazzi et al. (2020)²²22 Ferrazzi EM, Frigerio L, Cetin I, et al. COVID-19 Obstetrics Task Force, Lombardy, Italy: Executive management summary and short report of outcome. Int J Gynaecol Obstet. 2020;149(03): 377–378. Doi: 10.1002/ijgo.13162 https://doi.org/10.1002/ijgo.13162... ; Itália	42	RT-PCR	NR	NR	Dyspnea (20; 48%)	Radiological: interstitial pneumonia (20; 48.0%) Laboratory: NR	18 (43%) cesarean deliveries 2 (4.7%) premature births 7 (35%) severe pneumonia with ventilatory support
14	Kalafat et al. (2020)²³23 Kalafat E, Yaprak E, Cinar G, et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol. 2020;55(06):835–837. Doi: 10.1002/uog.22034 https://doi.org/10.1002/uog.22034... ; Turquia	1	RT-PCR	32	3^rd (35 GW and 3 days)	Cough (1; 100%), dyspnea (1; 100%)	Radiological: bilaterally thick pulmonary B lines, located in the posterior basal segments of the lung Laboratory: NR	Premature cesarean delivery Reduced fetal movements
15	Wen et al. (2020)²⁴24 Wen R, Sun Y, Xing QS. A patient with SARS-CoV-2 infection during pregnancy in Qingdao, China. J Microbiol Immunol Infect. 2020;53(03):499–500. Doi: 10.1016/j.jmii.2020.03.004 https://doi.org/10.1016/j.jmii.2020.03.0... ; China	1	RT-PCR	31	3^rd (30 GW)	Diarrhea. (1; 100%)	Radiological: irregular consolidation and bilateral ground-glass opacities, mainly distributed in the sub-plastic regions. Left pleural effusion Laboratory: NR	Without gestational changes
16	Fan et al. (2020)²⁵25 Fan C, Lei D, Fang C, et al. Perinatal Transmission of 2019 Coronavirus Disease-Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry? Clin Infect Dis. 2021;72 (05):862–864. Doi: 10.1093/cid/ciaa226 https://doi.org/10.1093/cid/ciaa226... ; China	2	RT-PCR	31 (29-34)	3^rd (36.5 GW)	Chills, fever (37.6±38.5°C), nasal congestion and odynophagia	Radiological: irregular consolidation and bilateral opacities Laboratory: lymphopenia (1; 50.0%)	2 (100%) Emergency cesarean delivery 2 (100%) NB had mild neonatal pneumonia
17	Pierce-Williams et al. (2020)²⁶26 Pierce-Williams RAM, Burd J, Felder L, et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM. 2020;2(03):100134. Doi: 10.1016/j.ajogmf.2020.100134 https://doi.org/10.1016/j.ajogmf.2020.10... ; EUA	64	RT-PCR	33	3^rd (29.9 GW)	Fever, dyspnea	Radiological: NR Laboratory: elevation of ferritin, liver enzymes, CRP, interleukin-6, d-dimer, LDH, creatine phosphokinase (CPK)	44 (69.0%) severe pneumonia 20 (31.0%) critical illness 14(22.0%)SARS 24 cesarean deliveries 31 (48.4%) premature births, 15 in critical patients 19 (30.0%) invasive mechanical ventilation 1 cardiorespiratory arrest, without maternal mortality 3 (9.0%) postpartum hemorrhage 1 neonatal COVID-19 infection
18	Blauvelt et al.(2020)²⁸28 Blauvelt CA, Chiu C, Donovan AL, et al. Acute respiratory distress syndrome in a preterm pregnant patient with Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. 2020;136(01):46–51. Doi: 10.1097/AOG.0000000000003949 https://doi.org/10.1097/AOG.000000000000... ; EUA	01	RT-PCR	34	3^rd (28 GW)	Asthenia, fever, myalgia, cough, and dyspnea	Radiological: bilateral opacities in the lower lobes Laboratory: lymphopenia and lactate elevation, D-dimer, and CRP	Cesarean and premature delivery SARS, with the need to undergo invasive mechanical ventilation NB with respiratory distress
19	Hong et al. (2020)²⁹29 Hong L, Smith N, Keerthy M, et al. Severe COVID-19 infection in pregnancy requiring intubation without preterm delivery: A case report. Case Rep Womens Health. 2020;27:e00217. Doi: 10.1016/j.crwh.2020.e00217 https://doi.org/10.1016/j.crwh.2020.e002... ; China	01	RT-PCR e laboratorial	36	2^nd (23 weeks)	Fever, myalgia and dyspnea, cough, tachycardia	Radiological: opacities in pulmonary bases. Laboratory: lymphopenia and elevation of transaminases, CPK, and CRP	SARS, with the need to undergo invasive mechanical ventilation
20	Li et al. (2020)³⁰30 Li J, Wang Y, Zeng Y, et al. Critically ill pregnant patient with COVID-19 and neonatal death within two hours of birth. Int J Gynaecol Obstet. 2020;150(01):126–128. Doi: 10.1002/ijgo.13189 https://doi.org/10.1002/ijgo.13189... ; China	01	RT-PCR	31	3^rd (35 GW)	Odynophagia, dry cough, fever, and dyspnea	Radiological: diffuse opacity in bilateral ground glass Laboratory: lymphopenia, respiratory acidosis and abnormal coagulogram, elevated CRP and interleukin 6	Premature cesarean delivery SARS with multiple organ dysfunction Neonatal death
21	Schnettler et al. (2020)³¹31 Schnettler WT, Al Ahwel Y, Suhag A. Severe acute respiratory distress syndromein coronavirusdisease2019-infectedpregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM. 2020;2(03):100120. Doi: 10.1016/j.ajogmf.2020.100120 https://doi.org/10.1016/j.ajogmf.2020.10... ; EUA	01	RT-PCR	39	3^rd (31 GW)	Cough, dyspnea, fever, and asthenia	Radiological: peripheral diffuse opacities in bilateral ground glass Laboratory: leukopenia, lymphopenia, thrombocytopenia, elevated transaminases	Emergency and premature cesarean delivery. SARS, with the need to undergo invasive mechanical ventilation
22	Wu et al. (2020)³²32 Wu C, Yang W, Wu X, et al. Clinical manifestation and laboratory characteristics of SARS-CoV-2 infection in pregnant women. Virol Sin. 2020;35(03):305–310. Doi: 10.1007/s12250-020-00227-0 https://doi.org/10.1007/s12250-020-00227... ; China	08	RT-PCR	29	(26–35)	3^rd (38 GW)	Fever on admission (1 ;12.5%), and fever in the postpartum period (3; 37.5%)	Radiological: peripheral diffuse opacities in bilateral ground glass (6; 75.0%) Laboratory: leukocytosis (6; 75.0%); lymphopenia (5; 62.5%), elevation of D-dimers and creatine kinase (CK) and creatine kinase-MB (CK-MB) in 4 (50.0%) in the postpartum period	6 (75.0%) Cesarean delivery 1 fetal distress
23	Peng et al. (2020)³³33 Peng Z, Wang J, Mo Y, et al. Unlikely SARS-CoV-2 vertical transmission from mother to child: A case report. J Infect Public Health. 2020;13(05):818–820. Doi: 10.1016/j.jiph.2020.04.004 https://doi.org/10.1016/j.jiph.2020.04.0... ; China	01	RT-PCR	25	3^rd (35 SG)	Fever, fatigue and dyspnea	Radiological: peripheral diffuse opacities in bilateral ground-glass pattern Laboratory: NR	Emergency cesarean and premature delivery Fetal distress
24	Breslin et al. (2020)³⁴34 Breslin N, Baptiste C, Gyamfi-Bannerman C, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2(02):100118. Doi: 10.1016/j.ajogmf.2020.100118 https://doi.org/10.1016/j.ajogmf.2020.10... ; EUA	43	RT-PCR	27 (20–39)	3^rd (37 SG)	Cough (19; 65.6%); fever (14; 48.3%); myalgia (11; 37.9%). headache (8; 27.6%); dyspnea (7; 24.1%); chest pain (5; 17.2%)	Radiological: peripheral diffuse opacities in bilateral ground-glass pattern (1; 2.32%) Laboratory: NR	Cesarean delivery (8; 44.4%) Premature birth (4; 13.8%) 1 PROM 2 (4.6%) severe maternal pneumonia 1 newborn with respiratory distress
25	Karami et al. (2020)³⁵35 Karami P, Naghavi M, Feyzi A, et al. WITHDRAWN: Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Med Infect Dis. 2020;101665:101665. Doi: 10.1016/j.tmaid.2020.101665 [ahead of print] https://doi.org/10.1016/j.tmaid.2020.101... ; Irã	01	RT-PCR	27	3^rd (30 SG)	Dyspnea, fever, cough, myalgia, and tachypnea	Radiological: bilateral diffuse peripheral ground-glass opacities and pleural effusion Laboratory: leukopenia, thrombocytopenia, elevated CRP, lactic dehydrogenase (LDH) Echocardiogram: severe systolic dysfunction right	Maternal death from severe acute respiratory syndrome (SARS) and MODS; stillborn
26	Iqba et al. (2020)³⁶36 Iqbal SN, Overcash R, Mokhtari N, et al. An Uncomplicated Delivery in a Patient with Covid-19 in the United States. N Engl J Med. 2020;382(16):e34. Doi: 10.1056/NEJMc2007605 https://doi.org/10.1056/NEJMc2007605... ; EUA	01	RT-PCR	34	3^rd (39 GW)	Fever, cough, chills, and myalgia	Radiological: diffuse pulmonary opacities Laboratory: lymphopenia	NR
27	Xia et al. (2020)³⁷37 Xia H, Zhao S, Wu Z, Luo H, Zhou C, Chen X. Emergency Caesarean delivery in a patient with confirmed COVID-19 under spinal anaesthesia. Br J Anaesth. 2020;124(05):e216–e218. Doi: 10.1016/j.bja.2020.02.016 https://doi.org/10.1016/j.bja.2020.02.01... ; China	01	RT-PCR	27	3^rd (36 GW)	Fever, cough, drop in oxygen saturation (92%)	Radiological: bilateral diffuse peripheral ground-glass opacities Laboratory: neutrophilia, lymphopenia, and elevated CRP	Cesarean delivery Fetal distress
28	Buonsenso et al. (2020)³⁸38 Buonsenso D, Costa S, Sanguinetti M, et al. Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Am J Perinatol. 2020;37(08):869–872. Doi: 10.1055/s-0040-1710541 https://doi.org/10.1055/s-0040-1710541... ; Itália	07	RT-PCR	40	3^rd (36 GW)	Cough	Radiological: diffuse interstitial lung disease Laboratory: NR	2 (28.5%) Cesarean delivery 1 Premature Birth 1 Abortion 2 Neonatal COVID-19 infections
29	Qiancheng et al. (2020)³⁹39 Qiancheng X, Jian S, Lingling P, et al; sixth batch of Anhui medical team aiding Wuhan for COVID-19. Coronavirus disease 2019 in pregnancy. Int J Infect Dis. 2020;95:376–383. Doi: 10.1016/j.ijid.2020.04.065 https://doi.org/10.1016/j.ijid.2020.04.0... ; China	28	RT-PCR	30 (18–41)	3^rd (38 GW)	Fever (5; 17.9%), asthenia (1; 3.6%), cough (7; 25%), dyspnea (2; 7.1%), abdominal pain (5; 17.9%)	Radiological: bilateral peripheral diffuse ground-glass opacities (26; 92.9%) Laboratory: Leukocytosis (10; 35.7%), increased CRP (17; 68.0%), lymphopenia (8; 28.6)	17 (60.0%) Cesarean delivery 1 (4.3%) Premature birth 4 (14.2%) Induced abortion 2 (7.1%) Severe pneumonia
30	Lyra et al.(2020)⁴⁰40 Lyra J, Valente R, Rosário M, Guimarães M. Cesarean section in a pregnant woman with COVID-19: first case in Portugal. Acta Med Port. 2020;33(06):429–431. Doi: 10.20344/amp.13883 https://doi.org/10.20344/amp.13883... ; Portugal	01	RT-PCR	35	3^rd (39 GW)	Cough	NR	Cesarean delivery
31	Kelly et al. (2020)⁴¹41 Kelly JC, Dombrowksi M, O’Neil-Callahan M, Kernberg AS, Frolova AI, Stout MJ. False-negative testing for severe acute respiratory syndrome coronavirus 2: consideration in obstetrical care. Am J Obstet Gynecol MFM. 2020;2(03):100130. Doi: 10.1016/j.ajogmf.2020.100130 https://doi.org/10.1016/j.ajogmf.2020.10... ; EUA	01	RT-PCR	–	3^rd (33 GW)	Vomiting, cough, and tachycardia	Radiological: Radiography showed subsegmental atelectasis without consolidation Laboratory: lymphopenia and mild elevation of liver enzymes	Cesarean and premature delivery 1 SARS, with the need to undergo invasive mechanical ventilation
32	Browne et al. (2020)⁴²42 Browne PC, Linfert JB, Perez-Jorge E. Successful treatment of preterm labor in association with acute COVID-19 infection. Am J Perinatol. 2020;37(08):866–868. Doi: 10.1055/s-0040-1709993 https://doi.org/10.1055/s-0040-1709993... ; EUA	01	RT-PCR e Serological (IgG/lgM)	33	2^nd (23 GW)	Fever, cough, and myalgia	Radiological: NR Laboratory: leukocytosis	Premature cesarean delivery
33	Indraccolo (2020)⁴³43 Indraccolo U. A pregnant woman and the SARS-CoV-2 infection: howare barriers easily crossed? Recenti Prog Med. 2020;111(04): 259–260. Doi: 10.1701/3347.33190 https://doi.org/10.1701/3347.33190... ; Itália	01	RT-PCR	NR	3^rd (32 GW)	Cough, epigastric pain, and chest pain	NR	NR
34	Lu et al. (2020)⁴⁴44 LuD, Sang L, Du S, Li T, Chang Y, Yang XA. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol. 2020;92(09):1660–1664. Doi: 10.1002/jmv.25927 https://doi.org/10.1002/jmv.25927... ; China	01	RT-PCR	22	3^rd (38 GW)	Asymptomatic	Radiological: bilateral pleural effusion Laboratory: hyperproteinemia, elevated transaminases and LDH	Cesarean delivery
Total	N 412	Diagnostic method RTC-PCR (412;100%)	Average age 27.5		GA 36.0	Symptoms Fever (49.7%; 205); dyspnea (31.5%; 130); cough (26.5%; 109), fatigue (8.2%; 34); myalgia (7.0%; 29); chest pain (5.5%; 23), diarrhea (4.8%; 20); odynophagia (3.6%; 15)	Main radiological findings Pneumonia/ground-glass pattern (51.4%; 212), 51.5% (172) of which were bilateral Main laboratory findings Increased CRP (37.8%; 154); lymphopenia (20.3%; 84); leukopenia (14.2%; 58); neutrophilia (5.5%; 23);	Maternal and Gestacional repercussions Cesarean delivery (36.2%; 149); premature birth (18.4%; 76); abortion (1.0%; 4); PROM (3.4%; 14); hemorrhage (1.0%; 4); placental abruption (0.2%; 1);p previa (0.2%; 1); severe maternal pneumonia (21.6%; 89); maternal death (0.2%; 1); Fetal repercussions Stillborn (0.5%; 2); neonatal death (0.5%; 2); fetal distress (2.7%; 11); fetal bradycardia (0.7%; 3); LBW (1.0%; 4); neonatal COVID infection (1.0%; 4)

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[1] Address for correspondence Sarah Nilkece Mesquita Araújo Nogueira Bastos, Doutora em Enfermagem, Avenida São Sebastião, 2819, 64001-020, Parnaíba, PI, Brazil (e-mail: sarahnilkece@hotmail.com).