AFJOG

ORIGINAL RESEARCH ABSTRACT Background: An increasing number of cases of preterm labour (PTL) were observed during the COVID-19 pandemic. We determined the prevalence of COVID-19 infection in asymptomatic pregnant women presenting with PTL or preterm pre-labour rupture of membranes (PPROM). Methods: A prospective case-control study was conducted on 56 pregnant women presenting in PTL or PPROM and compared to a control group of 50 women at King Edward VIII Hospital in KwaZulu- Natal Province, South Africa, from September 2020 to October 2021. SARS-CoV-2 polymerase chain reaction (PCR) and immunoglobulin G(IgG), were performed. Results: The prevalence of COVID-19 infection was higher amongst pregnant women presenting in PTL and PPROM;14.6% of cases and 8% of controls, p= 0.503. A positive Tuberculosis (TB) history was found to be more common in the study group compared to the control group (16.1% vs. 2%; p=0.018). Urinary tract infections (UTI) were detected more commonly in the case than in the control group (8.9% vs 0.5%; p=0.002), including a history of previous PTL and recent coitus. Conclusion: Our study showed an association between COVID-19 infection and PTL. It confirms that infective causes are significant contributors to PTL and PPROM. The finding of a positive TB history and the strong association of UTIs in women with PTL and PPROM further emphasise the importance of screening in antenatal care. Contribution: The findings highlight the importance of screening and testing for infections during antenatal consultations. The early identification of infective causes and treatment thereof could improve maternal and neonatal outcomes and help to reduce the burden on neonatal facilities. Keywords: Preterm labour, pre-labour rupture of membranes, COVID-19 infection in pregnancy, tuberculosis in pregnancy, asymptomatic COVID-19 infection. INTRODUCTION Preterm birth (PTB) and its associated complications are the leading cause of death in children under 5 years old. 1 Each year, an estimated 15 million babies are born preterm. 1 The global rate ranges from 5 - 18%, with an average of 11%. 2 In South Africa, preterm labour (PTL) complicates an average of 8% of pregnancies. 3 PTL complicates about 14.8% of pregnancies at a tertiary level facility in Durban, South Africa. 3 In this setting, an increase to a mean of 19.9% was observed in April 2020. This increase coincided with the first wave of the COVID-19 pandemic in South Africa. Pregnant women are susceptible to viral respiratory infections and are at risk of developing obstetric related complications and adverse perinatal outcomes. 4 The association of COVID-19 infectionwithPTL is controversial, with studies initially reporting an increased rate of PTL with COVID-19 infection 5–9 and more recent studies, showing no association at all. 10,11 We investigated the association of COVID-19 infection in pregnant women presenting with PTL or PPROM, as well as the common causes of PTL and preterm pre-labour rupture of membranes (PPROM) in our setting. METHODS We prospectively compared pregnant women presenting with PTL or PPROM before the 37th week of gestation (exposure or case group), to women presenting for routine antenatal consultation at gestational ages of 28 to 37 weeks, not in labour and with unruptured membranes (control group), for the period September 2020 to October 2021. All pregnant women included in the study were asymptomatic for COVID-19 infection. Patients with symptoms of COVID-19 infection were classified as persons under investigation (PUIs) and these were excluded from the analysis (Fig 1). Other exclusion criteria included fetal compromise necessitating expedited delivery; and co-morbid maternal medical diseases such as cardiovascular disorders, preeclampsia, and diabetes. Data was collected during the second (Beta variant) and third waves (Delta variant) of the COVID-19 pandemic in South Africa. Figure 1: Flow Diagram representing the recruitment of the case group Patients presenting inPTL* orPPROM* n=85 SymptomaticforCOVID-19 infections n=12 Excluded Fetal compromisen=4 Co-morbidmedical conditions n=13 Excluded 56WomanwithPTLorPPROManalysed Gestational age28-33+6weeks n=31 Gestational age34-37 +0 n=25 Admitted in an Isolationward as a Person Under Investigation *PPROM: Preterm Prelabour Rupture of Membranes *PTL: Preterm Labour K Ismail 1 , K Francois 2 , HM Sebitloane 1 1 Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Clinical Medicine, University of KwaZulu Natal (UKZN), Durban, South Africa 2 Department of Virology, Faculty of Health Sciences, School of Laboratory Medicine and Medical Sciences, University of KwaZulu Natal (UKZN), Durban, South Africa CORRESPONDENCE: K Ismail| Email: kaashifah.ismail@gmail.com Association between COVID-19 infection and preterm labour. A South African experience African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 2 | 2023 | 20