Objective: Experts have suggested that earlier delivery, even in non-severe cases, may be beneficial for patients with COVID, and that patients with COVID have higher rates of cesarean section. Factors associated with this increase are currently unclear. We sought to assess demographic and clinical factors associated with cesarean section (CS) in pregnant patients diagnosed with COVID. Study Design: Retrospective cohort of PCR-confirmed COVID positive pregnant patients in a single health system who delivered between March-December of 2020. Fetal death or planned CS excluded. Demographic data, pregnancy characteristics, and specifics of COVID infection ed and compared between patients who had vaginal delivery(SVD) and CS. Secondary analysis performed for symptomatic(sx) and asymptomatic(asx) patients separately. Bivariate statistics used to analyze the data. Multivariate Poisson regression performed to estimate adjusted relative risks. Results: Of 109 COVID positive patients, 19(17.4%) had planned CS. Of 91 with labor, 22(24%) had CS. CS was associated with overall BMI > 39.9(Table1). Non-private insurance and higher maternal age were associated with significantly higher rates of CS. Multiparity was not associated with SVD. Hypertensive disorders(PEC) of pregnancy and intraamniotic infection(IAI) were also associated with CS(Table 1). In regression analyses, symptomatic disease was associated with SVD [aRR 0.41, 95%CI 0.18, 0.93]. Relative risk of CS was 3-fold higher in patients with IAI[95% CI 1.6, 5.5], and 2.3-fold-higher in BMI > 39.9[95% CI 1.1, 5.0](Table2). Among sx patients, BMI > 39.9 was associated with 4-fold increase risk of CS;while in asx patients, IAI was associated with 4-fold increase risk of CS(Table 2). Maternal age and PEC were not associated with mode of delivery. Conclusion: Some known risk factors for severe and critical COVID, including higher BMI, were associated with CS in COVID positive pregnant patients. Symptomatic disease at time of delivery was more associated with SVD. [Formula presented] [Formula presented]
Factors associated with cesarean section in patients with COVID