Impact of SARS-CoV-2 infection and vaccination on cesarean section outcomes: a retrospective analysis

BACKGROUND:
Pregnant individuals have faced unique challenges during the COVID-19 pandemic, necessitating a closer examination of maternal and fetal health outcomes.


OBJECTIVES:
Investigate the morbidity and mortality associated with SARS-CoV-2 infection among pregnant individuals, considering vaccination status and variant strains.


DESIGN:
Retrospective cohort


SETTING:
Tertiary state hospital


PATIENTS AND METHODS:
Patients who underwent cesarean sections were categorized into three periods: pre-vaccination (before 31 August 2021), early post-vaccination (from September 2021), and late post-vaccination (aligned with 70% immunization coverage by 2 September 2021). Data collected included demographic information (age, gravidity, parity count, gestational age, newborn APGAR scores), cesarean section indications, chronic diseases, vaccination status, vaccine type and doses, SARS-CoV-2 variant status, ICU admission, and mortality due to COVID-19.


MAIN OUTCOME MEASURES:
ICU admission and mortality rates, focusing on the impact of SARS-CoV-2 infection and vaccination status.


SAMPLE SIZE:
297 COVID PCR-positive symptomatic patients who underwent cesarean sections.


RESULTS:

In the pre-vaccination group, there were 13 mortalities (8.1%) compared to 9 (6.6%) post-vaccination (
P
=.610). Maternal ARDS was seen in 46.2% of pre-vaccination mortalities versus 11.1% post-vaccination (
P
=.045). COVID-19 delta variant patients had higher ICU admission (80%) and mortality rates (40%). Rates of COVID-19 PCR-positive cesarean sections, ICU admissions, and mortality declined significantly in early (
P
=.021,
P
=.004,
P
=.009), respectively and late post-vaccination periods (
P
<.001,
P
<.001,
P
=.0019), respectively. Vaccinated patients had no ICU admissions or mortality.



CONCLUSIONS:
Vaccination against COVID-19 is crucial for pregnant individuals as it significantly reduces the risk of severe illness. While vaccines offer substantial protection, the pandemic’s acute phase might be waning, yet COVID-19 remains a global threat, particularly in regions with limited vaccine access. Continued vigilance and proactive measures are essential to mitigate ongoing risks and the emergence of new variant strains.


LIMITATIONS:
Retrospective observational design and the single-center setting, which may affect the generalizability of the findings.