key: cord-302238-l8j1vy0y authors: Shah, Prakesh S.; Diambomba, Yenge; Acharya, Ganesh; Morris, Shaun K.; Bitnun, Ari title: Classification system and case definition for SARS‐CoV‐2 infection in pregnant women, fetuses, and neonates date: 2020-04-21 journal: Acta Obstet Gynecol Scand DOI: 10.1111/aogs.13870 sha: doc_id: 302238 cord_uid: l8j1vy0y The possibility of mother-to-fetus transmission of SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), is currently a highly debated concept in perinatal medicine. It has implications for the mother, fetus, and neonate, as well as for healthcare providers present at the time of birth and caring for the child during the neonatal period, including obstetricians, midwives, family doctors, anesthetists, pediatricians, neonatologists, nurses, and respiratory therapists. At present the evidence for intrauterine transmission from mother to fetus or intrapartum transmission from mother to the neonate is sparse. There are limitations associated with sensitivity and specificity of diagnostic tests used and classification of patients based on test results has also been questioned. The possibility of mother-to-fetus transmission of SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), is currently a highly debated concept in perinatal medicine. 1 It has implications for the mother, fetus, and neonate, as well as for healthcare providers present at the time of birth and caring for the child during the neonatal period, including obstetricians, midwives, family doctors, anesthetists, pediatricians, neonatologists, nurses, and respiratory therapists. At present the evidence for intrauterine transmission from mother to fetus or intrapartum transmission from mother to the neonate is sparse. There are limitations associated with sensitivity and specificity of diagnostic tests used and classification of patients based on test results has also been questioned. [2] [3] [4] [5] [6] [7] As a result, differing recommendations have emerged regarding which samples should be collected and when, and how to distinguish infection from contamination, [8] [9] [10] [11] making it difficult for clinicians "on the ground" to know which recommendations to follow. 12 Additionally, a woman could be infected at any time during pregnancy and the impact on the fetus when maternal infection occurs earlier in pregnancy may be different than when it occurs in the two weeks prior to delivery. Infection during the first or second trimester has the potential to cause miscarriage, preterm birth, birth defects or possibly other features of congenital infection. In late gestation maternal infection, we need to consider the possibility that the newborn could have active infection and consequently at risk of adverse outcomes and also that the infant could pose a risk to healthcare workers. Therefore, in this paper, we focus solely on newborn infants whose mothers have documented or suspected COVID-19 at the time of onset of labor and delivery. Fortunately, the majority of neonates born to mothers with SARS-CoV-2 infection either do not become infected or exhibit mild symptoms at birth. However, the fact that a significant proportion of maternal and neonatal infections can be asymptomatic creates difficulty in ascertaining the disease burden on neonates and the possibility of transmission to healthcare providers during resuscitation or admission to a unit. In this paper, we present such a classification. In developing this system, we adopted an approach similar to Lebech et al 13 when there is little support for a diagnosis, but infection cannot be completely ruled out. Notably, a case may be initially assigned to one category and later moved to another category as more information is available. All five categories will not be applicable to all types of infections. We have avoided terminology such as 'vertical' or 'horizontal transmission' and rather developed a system that classifies transmission as congenital infection in intrauterine death/ stillbirth, congenital infection in live born, neonatal infection acquired intrapartum, or neonatal infection acquired postnatally, 14 which aligns with the actual pathological process as opposed to unknown directions of transmission. 15 Our classification system is presented in Table 1 . Currently, We believe that this rapid, easy, and accessible system will also facilitate the development of good clinical practice parameters and infections are unclear at this time. We expect refinements to this classification system as additional data become available and further experience is gained. All authors report no actual or potential conflicts of interest. Vertical transmission of coronavirus Disease 19 (COVID-19) from infected pregnant mothers to neonates: a review Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr. 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