Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 210 Detection of Asymptomatic Cases of Covid-19 Pregnant Women: A Systematic Review Prima Soultoni Akbar1*, Santy Irene Putri2, Astri Yunita3 1Program Studi Perekam Medis dan Informasi Kesehatan, Politeknik Kesehatan Kemenkes Malang, Malang, Indonesia 2Program Studi Kebidanan, Universitas Tribhuwana Tunggadewi, Malang, Indonesia 3Program Studi Kebidanan, STIKes Bhakti Mulia Pare, Kediri, Indonesia *Corresponding author: primasoultoniakbar@gmail.com ABSTRACT Background: There have been many cases of the Covid-19 coronavirus detected in pregnant women. Data posted by the Centers for Disease Control and Prevention (CDC) shows that around 55% of pregnant women who are confirmed Covid-19 and hospitalized are asymptomatic. Purpose: The purpose of this study is to systematically review the detection of asymptomatic Covid-19 cases in pregnant women. The articles were selected from WorldCat, ProQuest, EBSCO, and PubMed Database journals published from January to April 2020. "Covid-19" or "Coronavirus" or “Coronaviruses” or "2019-nCoV" or "SARS-CoV" or "MERS-CoV" and “Asymptomatic” and “Pregnant Women” were the keywords included for this review. Articles in English or Indonesian language that were published or in press articles about Covid-19, focusing on the detection of asymptomatic Covid-19 cases of pregnant women, and the type of study is cohort were inclusion criteria. Methods: The articles using language rather than English or Indonesian were excluded. Articles for which no abstract and no provided any significant information were in the exclusion criteria. Results: A total of 628 articles achieve from the databases, the authors identified that 12 articles were analyzed. Conclusion: Based on the results of a review of several articles it can be concluded that pregnant women who do not have symptoms of Covid-19 show a large enough percentage and have a greater risk of receiving intensive care compared to women who are not pregnant. Keywords: asymptomatic, corona, covid-19, pregnant women Received March 10, 2022; Revised April 1, 2022; Accepted April 29, 2022 DOI: https://doi.org/10.30994/jnp.v5i2.201 The Journal of Nursing Practice, its website, and the articles published there in are licensed under a Creative Commons Attribution-Non Commercial- ShareAlike 4.0 International License. https://thejnp.org/ mailto:primasoultoniakbar@gmail.com https://doi.org/10.30994/jnp.v5i2.201 Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 211 BACKGROUND Pregnant women are considered vulnerable because of the adaptive physiological changes during the Covid-19 pandemic, so they may be more inclined to Covid-19 than the general population. Due to the rapid development of the Covid-19 pandemic, the care of pregnant women and the safety of the fetus are of utmost concern. However, there is little evidence on the evaluation and treatment of pregnant women infected with Covid-19, and the possible dangers of spreading the infection from mother to fetus are still puzzling (Yu et al., 2020). Obstetric patients have multiple links to health care agencies and the majority are admitted to health care services during childbirth, so they have unique challenges during the Covid-19 pandemic (City et al., 2020). Now is currently known about the proper management of pregnant women during the Covid-19 pandemic. Primarily based on an extensive literature review, the worldwide society of Infectious illnesses in Obstetrics and Gynecology (ISIDOG) presented advice to provide steering for health care professionals who treat pregnant sufferers and which turned into applied in writing in countrywide health policies. Although pregnant women do not have conceded immunity, the immunological adjustments of pregnancy can lead to a kingdom of extended susceptibility to positive intracellular pathogens, specifically viruses, microorganisms, and intracellular parasites (Jamieson et al., 2006). Measles, number one varicella, influenza, variola (smallpox), Lassa Fever, Ebola, and SARS are examples of viral infections, in which pregnant women are greater liable to infection and expand an extra intense disease trouble and better mortality fee (Journal et al., 2003; Lam et al., 2004). As for Covid-19, the reproduction rate, or in other words the average number of people transmitted by people infected with the virus during the peak of the epidemic was between two and three times (range 2.5 to 2.9), somewhat higher than for influenza (Peng et al., 2020). It has lengthy been recognized that pregnant women are not always more liable to viral illnesses, however, changes in their immune devices during pregnancy can be related to more intense signs. SARS-CoV and MERS-CoV are recognized to reason intense headaches through being pregnant. However, there may be currently no proof that pregnant women are greater susceptible to Covid-19 contamination or that those with Covid-19 are greater liable to excessive pneumonia. Consequently, Covid-19 all through being pregnant may boom the risk of maternal venous thromboembolism (VTE). Up to now no vertical transmission, teratogenicity or early miscarriage has been stated in the literature. Pregnant women with Covid-19 infection may experience more severe symptoms than women who are not pregnant. Limited data report rapid deterioration in women who are asymptomatic at the time of health care and are later diagnosed with severe Covid-19. In some, but not all, pregnant women, maternal comorbidities were found during examination (hypertension, diabetes, cholestasis of pregnancy) (Breslin et al., 2020). Early literature on Covid-19 in pregnant women centered on symptomatic patients who later tested high excellent for the virus (Bauer et al., 2020). But, several recent courses suggest the threat of non-symptomatic contamination amongst pregnant and childbirth women. The said prevalence of non-symptomatic Covid-19 contamination among pregnant women is specifically outstanding, as signs and symptoms and signs of past-due pregnancy and even uninvolved delivery may overlap with signs of Covid-19 contamination. curiously, the excessive percentage of asymptomatic infections amongst delivery mothers (Breslin et al., 2020; City et al., 2020) recommend that nonspecific signs in pregnant sufferers may be associated more regularly with being pregnant than with Covid-19 signs and symptoms. This https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 212 supports a low threshold for testing pregnant women with effective instances of Covid-19, even though they present with signs that occur in a normal being pregnant; this is specifically important in groups with excessive Covid-19 contamination charges. Current reviews of asymptomatic Covid-19 infections raise issues about the accuracy of current checks. In non-pregnant women, fake bad Covid-19 RT-PCR outcomes had been stated in up to 18% of radiologically shown cases (Long et al., 2020). When adjusted for data presented by Sutton and colleagues (City et al., 2020), where nearly 90% of women giving birth are non-symptomatic, this error rate implies a large number of undetected infections among obstetric sufferers, due to a combination of symptom-primarily based checking out and trying out mistakes. Ordinary, the available records advocate that a big wide variety of pregnant and transported women with Covid-19 may be non-symptomatic or may additionally have signs but the signs are related to everyday being pregnant. Furthermore, those ladies might also have false bad RT-PCR outcomes. As part of the consideration of obstetric care, and especially in communities and establishments with a high burden of Covid-19 contamination, regulations are needed to mechanically compare women giving delivery as being at excessive risk for Covid-19iinfection and to inspire conservative regulate that make sure surest patient care, and readiness of fitness carrier companies. It isn't yet recognized what's the pleasant method for handling Covid-19 all through pregnancy and childbirth. It was far pretty clear that we want to recall no longer simplest epidemiological and scientific elements, but also organizational, social, and political troubles. Assessments were performed universally on all treated pregnant ladies are an awesome opportunity to determine the incidence of most of the population. Based on this rationalization, researchers are interested in systematically reviewing the detection of Covid- 19 in pregnant women with asymptomatic cases. OBJECTIVE The objective of this systematic review was to detect asymptomatic Covid-19 cases in pregnant women. METHODS Study design This study evaluation is based totally on the reporting items for the PRISMA systematic overview and guidelines. A literature search was carried out from September to October 2020. Article for systematic reviews was obtained from WorldCat, ProQuest, EBSCO, and PubMed. Keywords to search for this article included: "Covid-19" or "Coronavirus" or “Coronaviruses” or "2019-nCoV" or "SARS-CoV" or "MERS-CoV" and “Asymptomatic” and “Pregnant Women”. Inclusion and exclusion criteria The inclusion criteria for articles are articles in English or Indonesian and published articles about Covid-19, with a focus on detecting asymptomatic cases of Covid-19 in pregnant women, and the type of research is a cohort. Exclusion criteria in this study include articles that use languages other than English or Indonesian, and articles that do not display abstracts and do not provide complete information. Data extraction Articles from WorldCat, ProQuest, EBSCO, and PubMed using the Mendeley program were collected and the author obtained a total of 628 articles. Articles were selected https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 213 using featured reporting items for systematic review and the PRISMA method. A total of 12 selected articles were included for analysis in this study. Data analysis Study articles are systematically reviewed and qualitatively analyzed. RESULTS From 628 articles collected through preliminary searches on WorldCat, ProQuest, EBSCO, and PubMed. The authors included 12 articles on detecting asymptomatic Covid-19 cases in pregnant women in 2019 to 2020. The selection process in detail is illustrated in Figure 1. Most of the articles explained that pregnant women who came to health care facilities did not show any symptoms of Covid-19. However, when laboratory tests were carried out, the number of positive confirmed Covid-19 was quite high. Most of these pregnant women have mild symptoms even like the symptoms of pregnant people in general. Several studies have not found any symptoms of Covid-19 such as coughing, fever, or difficulty breathing. Figure 1. PRISMA Flow Diagram Id e n ti fi c a ti o n S c re e n in g E li g ib il it y Articles assessed for eligibility (n = 37) Duplicate articles removed (n = 384) Articles identified from WorldCat, ProQuest, EBSCO, and PubMed databases (n = 628) Records after duplicate articles were removed (n = 244) Articles included (n=12) Articles excluded (n = 207) - The title is not suitable for the topic - Not available in full text - The usage of language aside from English and Indonesia Articles excluded (n = 25) -Abstract is not available -Not provided any significant information In c lu d e d https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 214 Table 1. Evidence Table No Author (Year) Purpose Study Design Sample Results 1. Viktoriya London, Rodney McLaren Jr., Fouad Atallah, Catherine Cepeda, Sandra McCala, Neli Fisher, Janet L. Stein, Shoshana Haberman, Howard Minkof (2020) This study aims to compare symptomatic and asymptomatic pregnant women with Covid-19 Retrospective cohort Pregnant mother positive for Covid-19 Eighty-one patients tested positive (symptomatic [n = 60] preexposure only [n = 21]) and 75 patients were tested (all non- symptomatic). In total, there were 46 symptomatic and 22 asymptomatic pregnant women (tested on exposure alone [n = 12] or as part of universal screening [n = 10]) with positive Covid-19. Of the symptomatic pregnant women (n = 46), 27.3% had experienced premature birth and 26.1% needed respiratory support while those who were not asymptomatic (n = 22) had preterm labor or needed respiratory support (p = 0.007 and p = 0.01) (London et al., 2020) 2. Noelle Breslin, Caitlin Baptiste, Cynthia Gyamfi- Bannerman, Russell Miller, Rebecca Martinez, Kyra Bernnstein, Laurencee Ring, Ruth Landau, Stephannie Purisch, Alexander M. Friedman, Karin Fuchs, Desmondn Sutton, Maria Andrikopoulo u, Devonn Rupley, Jean- Ju Sheen, JaniceeAubey , Noelia Zork, Leslie Moroz, Mirela Mourrad, Ronald. Presenting experience with positive Covid-19 during pregnancy in hospital of NewYork City more than 2 the week between March 13, 2020, and 27 March 2020 Cohort 43 pregnant women confirmed Covid-19 It was found that pregnant women with Covid-19 came with the usual complaints of pregnancy or that most of the referred patients were asymptomatic (Breslin et al., 2020) https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 215 Wapner, Lynn. L. Simpson, Mary E. D’Alton, Dena Goffmann (2020) 3. Atakan Tanacana, Seyit Ahmet Erola, Batuhan Turgaya, Alii Taner Anuka, Ellcin Islekk Secena, Gulin Feykann Yegina, Sebnnem Ozyera, Fisun Kircad, BeedianDin, Serpil Unlue, Elif Gul Yappar Eyia, Huseyin Levennt Keskina, DilekkSahina, Aziz Ahimett Surelf, Ozlemn Moraloglu Tekin (2020) Investigated rates of SARS-CoV-2 positive in hospitalized asymptomatic pregnant women Prospective cohort 206 asymptomati c pregnant women Three of the 206 pregnant ladies who participated in the have a look at had an advantageous RT-PCR check (1.4%) and all fantastic instances have been in the excessive-danger being pregnant group. while one of the instances within the excessive-threat being pregnant group had proven very suspicious symptoms for Covid-19, two repeated RT- PCR assessments have been bad (Tanacan et al., 2020) 4. Muratt Yassa, Cihangirr Yirmibes, G Cavusoglu, Hazaal Eksi, Cevdett Dogu, Cannberk Usta, Memis Alli. Mutlu, Pinarr Birol, Cagri Gulumser & Niyazi Tug. (2020) Presents the overall prevalence of SARS-CoV-2 infection rates and hospitalized asymptomatic pregnant women, and assesses the diagnostic accuracy of maternal symptoms and pulmonary ultrasound (LUS) findings in detecting infection Prospective cohort Women who are confirmed to be pregnant The one-month universal trial of SARS-CoV-2 infection by RT-PCR in hospitalized pregnant women showed an overall diagnosis of infection and asymptomatic rates of 7.77% and 4%, respectively (Yassa et al., 2020) https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 216 5. Asma Ansari, Farhat Karim, RabiyaaAkbar , Uzma Urooj, Hafsa Khalil, Nighat Shafiq (2020) determine the incidence of SARS CoV-2 (Covid-19) infection among hospitalized women and their severity Prospective cohort Pregnant mother Primarily based on PCR testing of 525 moms who gave beginning in the course of the study period, 43 (8.1%) had been nice for Covid-19. Of the total patients screened, 484 (92%) were symptomatic and forty-one (7.8%) have been displayed screen superb. 20 (48.7%) were additionally PCR high-quality. in step with disorder severity, 28 (65%) patients were asymptomatic 10 (23%) had moderate, 4 (9.3%) mild, and excessive (1%). Covid-19 categories for high- quality and bad screening patients have been compared and statistically extensive for advantageous screened patients (p < 0.0001) (Ansari et al., 2020) 6. MnPrabhu, K Caginno, K C Mathews, R L Friedllander, S M Glyn, J M.Kubiak, Y J Yang, Z Zhao, R N Baergen, J I DiiPace, A S Razavi, D WnSkupski, Jn R Snnyder, H K Singh, R B Kalish, C M Oxford, L.E Rilley (2020) Describe the distinction in outcomes between pregnant girls with and without COVID-19 Prospective cohort Pregnant women with gestational age > 20 weeks Of the 675 treated women, 10.4% were positive for SARS- CoV-2, 78.6% of them were asymptomatic (Prabhu et al., 2020) 7. E.Ferazi, L Frigerio, V Savasi, P Vergani, F Prefumo, S Baresi, S Bianchi, E. Cirielo, F Fachinetti, M T Gervassi, E Iurlaro, A Kustermann, G.Mangili, F Mosca, L Patanè, D Spazzini, A Spinillo, G Trojano, M Report the mode of delivery and the delivery of the baby to women infected with Covid-19 Retrospective cohort A pregnant woman who is confirmed positive for Covid-19 This is constant with the truth that this syndrome is commonly slight or moderate in pregnancy and it's miles very probably that many inflamed pregnant women are asymptomatic or with symptoms (Ferrazzi et al., 2020) https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 217 Vignalli, A Villa, G V Zuccotti, F Parazzini, I Cetin (2020) 8. Whitney R. Bender, Sindhu Srinivas, Paulina Coutifaris, Alexandra Acker, Adi Hirshberg (2020) Describe the mental reviews of asymptomatic obstetric sufferers in inpatient and early postpartum tested for breathing syndrome- coronavirus-2 (SARS-CoV- 2) acute/extreme as part of a everyday trying out application and document on the effect of this software on labor and transport fitness care people Cohort Asymptomati c pregnant women undergoing Testing for SARS-CoV- 2 318 non-symptomatic women trying out for SARS-CoV-2 over a 2-week length. Seventy- five percent who tested effective reported negative. among 310 women who examined negative, 34.4% of multiparous mentioned multiplied postpartum tension in comparison to previous deliveries due to issues approximately exposure to infectious marketers inside the hospital and lack of social help (Bender et al., 2020) 9. Mariann. Knight, Kathrynn Bunch, Nicolla Voussden, Edwardd Morris, Nigel. Simpson, Chris Gale, Patrick O’Brien, Maria Quiglley, Peter Brocklehurst, Jennifer J. Kurinczuk (2020) Describes a national cohort of pregnant women who hospitalized with severe acute respiratory syndrome (SARS-CoV- 2), identify factors associated with infection, and explain the results, along with transmission infection, for mother and baby Prospective cohort 427 pregnant women were hospitalized with Confirmation of SARS- CoV-2 infection between March 1st 2020 and April 14, 2020 In the context of the ongoing Covid-19 pandemic, the collection of data on the outcome of infection during pregnancy becomes very important. However, unanswered questions regarding the extent and effect of asymptomatic or mild infection (Knight et al., 2020) 10. Giovanni Nazzaro, Evaluate the strength of the Cohort Pregnant woman with The mean gestational age at diagnosis was 30.6 ± 9.5 weeks, https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 218 Mariavittoriaa Locci, Maurizio. Guidda, Attilio Di Spiezio Sardo, Pierluigi Beneddetti Panici, Vincenzo Berghella, Maria Elenna Flacco, Lamberto Manzoli, Giusepe Bifulco, Giovannii Scambia, Fulvio Zulo and Francesco D’Antonio (2020) relationship between characteristics of the mother and pregnancy and the risks to adverse perinatal outcome in pregnancy with confirmed Covid-19 confirmation Covid-19 with 8.0% of women diagnosed in the first case, 22.2% in the second, and 69.8% in the third trimester of pregnancy. Asymptomatic cases by 24.2% (Di Mascio et al., 2020) 11. Ignacio Heraiz, Dolores Folgueira, Cecilia Vilalaín, Laura Forcén, Rafael. Delgado and Alberto Galindo (2020) Evaluate universal performance screning for SARS-CoV-2 using quantitative reverse transcrption polymerase- chain-reaction (qRT-PCR) assay Retrospective cohort Pregnant women who are about to give birth and have given birth between April 8 and May 2 2020 at big maternity in Madrid There had been 212 deliveries. 9 cases with an analysis of Covid-19 previous to admission. 203 ladies were referred with Covid-19 signs and symptoms however simplest one had a tremendous qRT-PCR. among 194 non- symptomatic women, the most effective case (0.5%) changed into wonderful (Herraiz et al., 2020) 12. Stefano Cosma, Fulvio Borela, Andrea Caroso, Andrea Sciarone, Jessica Cusato Bsc, Silvia Corcione, Giulio Mengozzi, Mario Preti, Dionysios Katsaros, Giovanni. Di Perri, Chiara Benedeto (2020) evaluate cumulative incidents SARS-CoV-2 infection during the first trimester of pregnancy Cohort Pregnant woman The cumulative prevalence of Covid-19 all through the first trimester turned to 10.1% with a high incidence of non- symptomatic sufferers (42.8%). Just like the direction of disorder in nonpregnant adults, 80 to 90% of non-severe infection signs were suggested to be four instances higher in Covid-19 positive sufferers (57%) than in terrible people (thirteen%) (P < 0.001), this suggests that direct self-trying out should be open Covid-19 confirmatory testing (Cosma et al., 2020) https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 219 DISCUSSION From the several articles above, it is known that most pregnant women suffer from Covid-19 without symptoms (asymptomatic). One study stated that the majority of respondents (97%) were asymptomatic patients or had mild symptoms such as fever or cough so they did not require oxygen therapy (Harishchandra et al., 2020). At the time of the primary said a case of a pregnant lady with asymptomatic Covid-19 contamination and asymptomatic Covid-19 pregnant women with precise records have been rarely saying. There has been no fever, cough, or dyspnea, and everyday blood check confirmed an everyday white blood mobile don't forget and an everyday lymphocyte remember. The affected character confirmed asymptomatic infection before gift procedure surgery, considering that there are no precise antiviral pills for Covid-19 contamination and antiviral pills, this may have a chance to the protection of the fetus because the simplest conventional remedy consists of inhaled oxygen and oral iron administration may be carried out. After a surgical procedure, mothers in labor are advised no longer to breastfeed their babies, consequently, an antiviral remedy is given (Lu et al., 2020). Caring for pregnant women all through the SARS-CoV-2 pandemic is a scientific challenge due to the fact no longer best are they more liable to infectious outbreaks because of physiological changes, however, there is additionally a vital want to hold the health of the fetus. Obstetric patients, unlike other clinically susceptible groups, still need to get the right of entry to fitness offerings on a regular foundation and are probable to require unique permission for a referral. Obstetric instances permit the early identity of asymptomatic through the examiner. This proves that it's far important to use suitable PPE and effective control of maternity services to facilitate fine patients so that they can be remoted. In a single study, thirteen pregnant women confirmed mild or asymptomatic Covid-19 nice, together with 15.4% (2/13) had a prenatal fever and 61.6% (8/13) had a postpartum fever, and 15.4% with cough, and none had myalgia or fatigue, hemoptysis, headache, palpitations, diarrhea or dyspnea (Yang et al., 2020). a high probability of asymptomatic presentation indicating fewer pregnant women and young pregnant women with Covid-19 manifest symptoms than non-pregnant women. This may be due to the universal screening strategy for Covid-19 in pregnancy and the low threshold for screening non-pregnant patients. Despite the possible strategies above for detecting pregnant women with mild disease, investigators have observed increased admittance to intensive care units and the need for invasive ventilation compared to non-pregnant women with Covid-19 (Allotey et al., 2020). Pregnant women without symptoms are at risk of receiving intensive care because it can delay diagnosis and make the virus more able to spread the disease silently (Dashraath et al., 2020). Mentioned asymptomatic being pregnant charges range from 43 percent to 89%, with an estimate of 4 to 9 undetected instances in keeping with every symptom. This helps general screening as a feasible method. In the look at there was a high charge of bias in reporting (sufferers had been asymptomatic but have been detected as advantageous cases whilst an in- depth record changed into carried out) of nearly 70%. Due to the wide variety of signs of Covid-19 overlaps with the physiological adjustments at some stage in pregnancy. The above focus on the priority of symptom evaluation according to traditional running procedures, the want for proper patient schooling about signs and signs and symptoms, and the capability https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.210-223 220 boundaries of diagnostic strategies based on patient symptom reviews, almost 50% of whom are asymptomatic. Universal screening of people who are not included in the screening group at delivery, should be examined in endemic areas that provide a good estimate of the prevalence of Covid-19 infection at the general population level, allow for adequate health team protection, appropriate patient isolation, Neonatal diagnosis immediately after birth and what follow-up should be done (Pilar et al., 2020). CONCLUSION Based on the results of a review of several kinds of literature, it can be concluded that pregnant women who do not show Covid-19 symptoms show a large percentage and have a greater risk of receiving intensive care compared to women who are not pregnant. In several articles reviewed, it was stated that during the study pregnant women tended to not show any symptoms including fever. This is different from what happened in non-pregnant patients where Covid-19 symptoms such as stones, fever, and difficulty breathing were experienced by these patients. REFERENCES Alfirevic, A., Bustamante, S., Hargrave, J., & Marciniak, D. (2020). Neuraxial Procedures in COVID-19–Positive Parturients: A Review of Current Reports. 22–24. https://doi.org/10.1213/ANE.0000000000004828. Allotey, J., Stallings, E., Bonet, M., Yap, M., Chatterjee, S., Kew, T., Debenham, L., Llavall, A. C., Dixit, A., Zhou, D., Balaji, R., Lee, S. I., Qiu, X., Yuan, M., Coomar, D., Wely, M. Van, Leeuwen, E. 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