Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Department of Obstetrics and Gynecology, Reproductive Health Research Center, Al-zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

2 Department of Midwifery, Zeynab School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

3 Department of Infectious Diseases, Guilan University of Medical Sciences, Rasht, Iran

4 Department of Midwifery, Reproductive Health Research Center, Al-zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

5 Department of Health, Guilan University of Medical Science, Rasht, Iran

6 Department of Epidemiology and Statistics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Background & Objective: The Covid-19 pandemic can cause complications for pregnant women and more serious maternal, fetal and neonatal care related to this disease should be considered in health systems. The aim of the present study was to investigate the maternal, fetal, and neonatal outcomes of pregnant women with COVID-19 disease.
Materials & Methods: We performed a prospective study with a longitudinal design of all pregnant women hospitalized due to moderate and severe COVID-19 referred to Al-Zahra hospital, Rasht, Iran. After patient discharge, patients were followed until delivery, maternal, fetal, and neonatal outcomes were assessed by a 4-part researcher-made questionnaire.
Results: In total, 166 pregnant women with Covid-19 were included in the study. The median gestational age in patients was 35.5 weeks and the median delivery age was 38 weeks. Delivery in 137 (82.5%) women were cesarean section and 29 (17.5%) had a vaginal delivery. The most common clinical symptoms among patients were fever, cough, and dyspnea with 50.9%, 38.5%, and 31.5% frequency, respectively, 9.6% had poor prenatal outcomes, 15 patients (9%) were admitted to ICU and 4 patients died (2.4%). Poor maternal outcomes were reported in 61.5% of patients with severe clinical symptoms, (p <0.001). There was no significant relationship between the severity of the disease and the type of delivery (p = 0.41).
Conclusion: In our study we observed an increase in poor maternal, fetal and neonatal outcomes particularly in pregnant women with severe symptoms, although careful care is still recommended for affected pregnant women to reduce fetal, neonatal, and maternal complications. Further research will be needed to devise plan for pregnancy care and future health care crises.


 In our study we observed an increase in poor maternal, fetal and neonatal outcomes particularly in pregnant women with severe symptoms, although careful care is still recommended for affected pregnant women to reduce fetal, neonatal, and maternal complications. Further research will be needed to devise plan for pregnancy care and future health care crises.


Main Subjects

1. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;222(5):415-26. [DOI:10.1016/j.ajog.2020.02.017] [PMID] [PMCID]
2. Qiao J. What are the risks of COVID-19 infection in pregnant women? lancet. 2020;395(10226):760-2. [DOI:10.1016/S0140-6736(20)30365-2] [PMID]
3. Wu C, Yang W, Wu X, Zhang T, Zhao Y, Ren W, et al. Clinical Manifestation and Laboratory Characteristics of SARS-CoV-2 Infection in Pregnant Women. Virol Sin. 2020;35(3):305-10. [DOI:10.1007/s12250-020-00227-0] [PMID] [PMCID]
4. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009;374(9688):451-8. [DOI:10.1016/S0140-6736(09)61304-0] [PMID]
5. Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7. [DOI:10.1016/j.ajog.2003.11.019] [PMID] [PMCID]
6. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, 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):809-15. [DOI:10.1016/S0140-6736(20)30360-3] [PMID]
7. Ranjbar F, Allahqoli L, Ahmadi S, Mousavi R, Gharacheh M, Eshraghi N, et al. Changes in pregnancy outcomes during the COVID-19 lockdown in Iran. BMC Pregnancy Childbirth. 2021;21(1):577. [DOI:10.1186/s12884-021-04050-7] [PMID] [PMCID]
8. Khalil A, von Dadelszen P, Kalafat E, Sebghati M, Ladhani S, Ugwumadu A, et al. Change in obstetric attendance and activities during the COVID-19 pandemic. Lancet Infect Dis. 2021;21(5):e115. [DOI:10.1016/S1473-3099(20)30779-9] [PMID]
9. Khalil A, Von Dadelszen P, Draycott T, Ugwumadu A, O'Brien P, Magee L. Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic. Jama. 2020;324(7):705-6. [DOI:10.1001/jama.2020.12746] [PMID] [PMCID]
10. Takemoto MLS, Menezes MO, Andreucci CB, Knobel R, Sousa L, Katz L, et al. Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis. Int J Gynaecol Obstet. 2020;127(13):1618-26. [DOI:10.1111/1471-0528.16470] [PMID] [PMCID]
11. Aski SK, Sharami SH, Hosseinzadeh F, Hesni E, Heirati SFD, Ghalandari M, et al. Risk factors, clinical symptoms, laboratory findings and imaging of pregnant women infected with COVID-19 in North of Iran. Arch Iran Med. 2020;23(12):856-63. [DOI:10.34172/aim.2020.114] [PMID]
12. Heidary Z, Kohandel O, Fathi H, Zaki-Dizaji M, Ghaemi M, Rashidi BH. Maternal and neonatal complications, outcomes and possibility of vertical transmission in iranian women with COVID-19. Arch Iran Med. 2021;24(9):713-21. [DOI:10.34172/aim.2021.104] [PMID]
13. Samadi P, Alipour Z, Ghaedrahmati M, Ahangari R. The severity of COVID‐19 among pregnant women and the risk of adverse maternal outcomes. Int J Gynaecol Obstet. 2021;154(1):92-9. [DOI:10.1002/ijgo.13700] [PMID] [PMCID]
14. Vaezi M, Mirghafourvand M, Hemmatzadeh S. Characteristics, clinical and laboratory data and outcomes of pregnant women with confirmed SARS-CoV-2 infection admitted to Al-Zahra tertiary referral maternity center in Iran: a case series of 24 patients. BMC Pregnancy Childbirth. 2021;21(1):378. [DOI:10.1186/s12884-021-03764-y] [PMID] [PMCID]
15. Kotlar B, Gerson EM, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health. 2021;18(1):10. [DOI:10.1186/s12978-021-01070-6] [PMID] [PMCID]
16. Delahoy MJ, Whitaker M, O'Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(38):1347-54. [DOI:10.15585/mmwr.mm6938e1] [PMID] [PMCID]
17. Vakili S, Savardashtaki A, Jamalnia S, Tabrizi R, Nematollahi MH, Jafarinia M, et al. Laboratory Findings of COVID-19 Infection are Conflicting in Different Age Groups and Pregnant Women: A Literature Review. Arch Med Sci. 2020;51(7):603-7. [DOI:10.1016/j.arcmed.2020.06.007] [DOI:10.1101/2020.04.24.20078568]
18. Vouga M, Favre G, Martinez-Perez O, Pomar L, Acebal LF, Abascal-Saiz A, et al. Maternal outcomes and risk factors for COVID-19 severity among pregnant women. Sci Rep. 2021;11(1):13898. [DOI:10.1038/s41598-021-92357-y] [PMID] [PMCID]
19. Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ. 2021;193(16):E540-E8. [DOI:10.1503/cmaj.202604] [PMID] [PMCID]
20. Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. [DOI:10.1136/bmj.m2107] [PMID] [PMCID]
21. Savasi VM, Parisi F, Patanè L, Ferrazzi E, Frigerio L, Pellegrino A, et al. Clinical findings and disease severity in hospitalized pregnant women with coronavirus disease 2019 (COVID-19). Obstet Gynecol. 2020;136(2):252-8. [DOI:10.1097/AOG.0000000000003979] [PMID]
22. Heidarnia MA, Abadi A, Motlagh ME, Heidarzadeh M, Habibelahi A, Dalili H, et al. Neonatal mortality rate in Iran: the Iranian Perinatal Mortality Surveillance System. J Pediatric Neonatal Individ Med. 2018;7(2):e070217-e.
23. Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, et al. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol. 2021;57(4):573-81. [DOI:10.1002/uog.23619] [PMID] [PMCID]
24. Murphy CA, O'Reilly DP, Edebiri O, Donnelly JC, McCallion N, Drew RJ, et al. The Effect of COVID-19 Infection During Pregnancy; Evaluating Neonatal Outcomes and the Impact of the B.1.1.7. Variant. Pediatr Infect Dis J. 2021;40(12):e475-e81. [DOI:10.1097/INF.0000000000003352] [PMID] [PMCID]
25. Yap M, Debenham L, Kew T, Chatterjee SR, Allotey J, Stallings E, et al. Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol. BMJ Open. 2020;10(12):e041868. [DOI:10.1136/bmjopen-2020-041868] [PMID] [PMCID]
26. Pereira A, Cruz‐Melguizo S, Adrien M, Fuentes L, Marin E, Perez‐Medina T. Clinical course of coronavirus disease‐2019 in pregnancy. Acta Obstet Gynecol Scand. 2020;99(7):839-47. [DOI:10.1111/aogs.13921] [PMID] [PMCID]
27. Blitz MJ, Rochelson B, Minkoff H, Meirowitz N, Prasannan L, London V, et al. Maternal mortality among women with coronavirus disease 2019 admitted to the intensive care unit. Am J Obstet Gynecol. 2020;223(4):595-9. [DOI:10.1016/j.ajog.2020.06.020] [PMID] [PMCID]
28. Lokken EM, Walker CL, Delaney S, Kachikis A, Kretzer NM, Erickson A, et al. Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol. 2020;223(6):911.e1-.e14. [DOI:10.1016/j.ajog.2020.05.031] [PMID] [PMCID]
29. Vakilian K, Ranjbaran M, Khorsandi M, Sharafkhani N, Khodadost M. Prevalence of preterm labor in Iran: A systematic review and meta-analysis. Int J Reprod Biomed. 2015;13(12):743. [DOI:10.29252/ijrm.13.12.743] [PMID] [PMCID]
30. Sharifi N, Khazaeian S, Pakzad R, Fathnezhad Kazemi A, Chehreh H. Investigating the Prevalence of Preterm Birth in Iranian Population: A Systematic Review and Meta-Analysis. J Caring Sci. 2017;6(4):371-80. [DOI:10.15171/jcs.2017.035] [PMID] [PMCID]
31. Taghavi S-A, Heidari S, Jahanfar S, Amirjani S, Aji-Ramkani A, Azizi-Kutenaee M, et al. Obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran: a retrospective, case-control study. Middle East Fertil Soc J. 2021;26(1):1-8. [DOI:10.1186/s43043-021-00059-2] [PMID] [PMCID]
32. Akbarian-Rad Z, Mojaveri MH, Bouzari Z, Sadeghi F, Yahyapour Y, Rad MN, et al. Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up. Infect Dis Obstet Gynecol. 2021;2021:9952701. [DOI:10.1155/2021/9952701] [PMID] [PMCID]
33. Karimi P, Mahmudi L, Azami M, Badfar G. Mortality in Neonatal Intensive Care Units in Iran: A Systematic Review and Meta-Analysis. Iran J Neonatol. 2019;10(3).
34. Asadi L, Tabatabaei RS, Safinejad H, Mohammadi M. New corona virus (COVID-19) management in pregnancy and childbirth. Arch Clin Infect Dis. 2020;15. [DOI:10.5812/archcid.102938]
35. Chen D, Yang H, Cao Y, Cheng W, Duan T, Fan C, et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet. 2020;149(2):130-6. [DOI:10.1002/ijgo.13146] [PMID] [PMCID]
36. Shirzad M, Shakibazadeh E, Hajimiri K, Betran AP, Jahanfar S, Bohren MA, et al. Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in Iran: a mixed-methods systematic review. Reprod Health. 2021;18(1):3. [DOI:10.1186/s12978-020-01047-x] [PMID] [PMCID]
37. Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol. 2020;223(1):36-41. [DOI:10.1016/j.ajog.2020.04.013] [PMID] [PMCID]
38. Ashokka B, Loh M-H, Tan CH, Su LL, Young BE, Lye DC, et al. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am J Obstet Gynecol. 2020;223(1):66-74. [DOI:10.1016/j.ajog.2020.04.005] [PMID] [PMCID]