Maternal-foetal Transmission of SARS-Cov-2
Condition: Maternal Fetal Infection Transmission; COVID-19; SARS-CoV 2
MeSH terms: COVID-19
Study type: Observational

Summary: 
      One case of maternal-fetal transmission of SARS Cov-2 was published (1). Ig M and Ig G were
      found at two hours after birth of a new born from a mother COVID-19. Another study on few
      newborns COVID-19 reported that the SARS-Cov-2 was not transmitted in utero but only after
      birth.

      Although there are few data on COVID-19 during pregnancy, according to our national data
      collections, it appears to be responsible for miscarriages and fetal deaths. There are also
      intrauterine growth restrictions and an increase of the rate of cesarean sections for
      maternal indications. Therefore, it is essential to know if there is a maternal viremia which
      infects the fetus because the consequences in terms of management would be completely
      different.

      In fact, the potential intrauterine infection will lead to antenatal monitoring of these
      patients with an antenatal diagnosis and may be a treatment.

      Therefore, it seems essential to explore the mode of transmission to the newborn since many
      newborns have COVID-19 infection The investigators will propose to all pregnant women SARS-
      Cov-2 positive to perform PCR SARS-Cov-2 tests and /or serology's (IgM and Ig G) on the
      amniotic fluid, the blood cord and the placenta.
    

Detailed description: 
      Pregnant women SARS cov-2 positives during pregnancy or during labor tested by a RT-PCR
      SARS-Cov-2 on nasopharyngeal swabs and/or by serologies.

      After informed consent the ivestigators will proceed during labor to:

        1. A vaginal swab of amniotic fluid during the rupture of the water pocket during labor.

        2. a blood sample from the umbilical cord after delivery of the newborn and clamping and
           sectioning of the cord. PCR Covid-19 and serologies (Ig M and Ig G) as well as
           investigating viral proteome and cytokines.

           These are additional samples in addition to the routine samples which have no impact and
           without risk for the mother the newborn since they are taken after delivery from the
           side of the placenta after clamping and sectioning of the cord.

        3. Samples of 2 fragments of placenta after delivery of the placenta for COVID-19 research,
           which usually goes to waste or to pathology depending on the clinical context or for
           infectious tests. In all cases, samples of 3 to 4 cm3 will be taken which will in no way
           interfere with current analyzes carried out on the placenta which weighs one third of
           the fetal weight on average. A viral search by COVID-19 PCR will be carried out on the
           placenta fragment and another part will be frozen for analysis by electron microscopy
           and study of the viral proteome, cytokines and immune mechanisms. Placenta samples will
           be frozen at -80 degrees.
    

Intervention name(s): Diagnosis of SARS-Cov2 by RT-PCR and : IgG, Ig M serologies in the amniotoc fluid, the blood cord and the placenta
Intervention type(s): Diagnostic Test
Intervention description(s): During labor and delivery
Sample of amniotic fluid
2 samples of blood cord after the birth of the new born
2 samples of placenta
These samples will be tested with A RT-PCR COVID-19 test and / or serology's A sample of blood cord and placenta will be frozen at -80 degree C and studied for PCR and viral proteome, cytokines , D-dimers and others inflammatory markers in the PRIMMO Laboratory (Prof. TOUMI and LESPESSAILLES) and after in the Centre of molecular biophysics of CNRS of Orleans (Prof. PICHON)
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Pregnant women COVID-19 positive or with suspected infection or presented a positive SARS
        Cov-2 PCR or serologies at any moment of the pregnancy. Symptomatic and asymptomatic
        pregnant women with SARS-Cov-2 will be included.
      
Biospecimen description: 
      Amniotic fluid, blood cord and placenta.
    
Keywords: Pregnancy; RT-PCR-COVID-19; SARS-CoV 2 serologies; Placenta; Blood cord; Amniotic fluid