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Reply to correspondence: Vaginal delivery in a woman infected with SARS-CoV-2 – The first case reported in Portugal

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Replytocorrespondence:Vaginaldeliveryina womaninfectedwithSARS-CoV-2–Thefirstcase reportedinPortugal

DearEditor

Wereadwithgreatinteresttherecentcasereportof Polonia-Valentetal.[1]onthefirstcaseofvaginaldeliveryofaCOVID-19 positivewomaninPortugal.Inthis theystatedthataCOVID-19 positive pregnant woman at term, with mild symptoms (dry cough)wentintolabour,andafteranoperativevaginaldelivery, due to an abnormal cardiotocography, the umbilical cord was immediatelyclampedand shewasimmediately separatedfrom the neonate. Even after the newborn was tested negative for COVID-19, theseparationcontinued until"appropriate isolation conditions"athomewereguaranteed.

Wehadconcernaboutthisapproach.RCOGguidance[2]advise that delayed cord clamping should be practiced as normal. If vaginaldeliveryispermitted,withexposuretomaternalsecretions andblood, itisunlikely that1minof furtherperfusionviathe placentamayincreasetheriskofverticaltransmission.

Currently there is no evidence of COVID-19 transmission throughbreastmilk. RCOGadvises againstroutineseparation of mother and babyand giveinstructions for individualized care. Until additional data are available, mothers who intend to breastfeed should be encouraged to do so [3]. The numerous benefitsof skin-to-skin contact and breastfeeding substantially outweighthepotentialrisksoftransmissionandillnessassociated withCOVID-19[4].

DeclarationofCompetingInterest

Theauthorshavenoconflictofintereststodeclare.

References

[1]Polónia-ValenteR,MouchoM,TavaresM,VilanA,MontenegroN,RodriguesT. VaginaldeliveryinawomaninfectedwithSARS-CoV-2-thefirstcasereported inPortugal.EurJObstetGynecolReprodBiol2020(May(11)),doi:http://dx.doi. org/10.1016/j.ejogrb.2020.05.007 S0301-2115(20)30258-X Online ahead of print.

[2]RoyalCollege ofObstetriciansandGynaecologists. Coronavirus(COVID-19) infection and pregnancy. 2020 https://www.rcog.org.uk/globalassets/docu-ments/guidelines/coronavirus-covid-19-infection-in-pregnancy-v3-20-03-18. pdf.

[3]CentersforDiseaseControlandPrevention.Interimguidanceforimplementing homecareofpeoplenotrequiringhospitalizationfor2019novelcoronavirus (2019-nCoV). Updated Jan. 31, 2020. Available at: https://www.cdc.gov/ coronavirus/2019-ncov/hcp/guidance-home-care.html.AccessedFebruary11, 2020.

[4]Clinicalmanagementofsevereacuterespiratoryinfection(SARI)when COVID-19diseaseissuspected13March2020-www.who.int/publications-detail/ clinical-management-of-severe-acuterespiratory-infection-when-novel-coro-navirus-(ncov)-infection-is-suspected.

IlmaFlorianaCarbone*

FrancescoD’Ambrosi DepartmentofObstetricsandGynecology'L.Mangiagalli', Fonda-zioneIRCCSCa'Granda,OspedaleMaggiorePoliclinico,Milan,Italy GabrieleSaccone DepartmentofNeuroscience,ReproductiveScienceand Odontosto-matology,UniversityofNaplesFedericoII,Naples,Italy *Correspondingauthor. E-mailaddress:ilma.carbone@policlinico.mi.it(I.Carbone). Received1June2020 Availableonlinexxx

https://doi.org/10.1016/j.ejogrb.2020.07.009

0301-2115/©2020ElsevierB.V.Allrightsreserved.

EuropeanJournalofObstetrics&GynecologyandReproductiveBiologyxxx(2019)xxx

GModel

EURO11481No.ofPages1

Pleasecitethisarticleinpressas:I.F.Carbone,etal.,Replytocorrespondence:VaginaldeliveryinawomaninfectedwithSARS-CoV-2–The firstcasereportedinPortugal,EurJObstetGynecol(2020),https://doi.org/10.1016/j.ejogrb.2020.07.009

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