Invasive prenatal diagnosis during COVID-19 pandemic

Abstract

COronaVIrus Disease 2019 (COVID-19) has been declared by the World Health Organization (WHO) as pandemic on the 11th of March 2020. However, the first reported cases in Italy dated on the 30th of January 2020, when a Chinese couple was diagnosed as affected by SARS-COV-2 (Severe Acute Respiratory Syndrome COronaVirus-2) in Rome. Since then, the infection rapidly spread through Italy, and the Italian Prime Minister issued a decree for a strict lockdown of all non-necessary activities since the 8th of March 2020 [1]. Hospitals reorganized their units to provide care for COVID-19 patients. Moreover, elective and non-life saving procedures were reduced to save hospital beds, and to reduce crowding in hospitals and further spread of the disease. Pregnant women have been considered soon as an at-risk category for the additional risks of transmitting infection to the fetus, with unknown consequences both for fetal and pregnancy outcomes. Little evidence exist so far on maternal–fetal transmission [2]. Many national and international societies issued their recommendations on how to manage pregnancy during this unprecedented outbreak, encouraging telehealth unless faceto-face appointments are needed, and addressing the best practice for antepartum, intrapartum and postpartum care [3, 4]. Although vaccines against SARS-COV-2 infection have been started to be administered to the general population, actually, pregnant women show contrasting feelings regarding the chance to get the vaccine [5, 6]. In reference to invasive procedures, Deprest et al. [7], on Behalf of the International Fetal Medicine and Surgery Society, analyzed potential modifications to obstetric management and fetal procedures during the pandemic. In addition, Deprest et al. [8] addressed the issue of prenatal invasive interventions during the COVID-19 pandemic. On one side, the authors express concerns for patients going to hospitals, and therefore, increasing the risk of COVID-19 infection. On the other side, they acknowledge that invasive procedures should not be declined just for the fear of vertical transmission. Moreover, they advise to avoid transplacental access (due to possible damage to maternal–fetal barrier) or to postpone procedures in COVID-19-positive or -suspected cases. We performed a multicentre observational retrospective cohort study for comparing invasive procedures for prenatal diagnosis performed during the trimester March–May 2020 to those performed during the same trimester of the year 2019. The aim of our study was to assess if COVID-19 pandemic had caused a significant decrease in the number of invasive procedures for prenatal diagnosis, such as chorionic villous sampling (CVS) and amniocentesis. We searched medical records and electronic clinical databases for all patients undergone CVS or amniocentesis at the Obstetrics and Gynecology Unit of the Department of Giuseppe Rizzo and Giuseppe Maria Maruotti share the last authorship.