The correlation between pregnant women with COVID-19 and mode of delivery

Background :COVID-19 is a virus caused by the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2). Pregnant women with COVID-19 will likely pose a greater risk compared to nonpregnant women. The Indonesian Society of Obstetrics and Gynecology Association (ISOG) stated that 13.7% of pregnant women are more susceptible to COVID-19. In the maternity management of mothers with COVID-19, the management for the mother and her child should be comprehended. Objectives :This research aims to determine the relationship between the characteristics of pregnant women with COVID-19 with the current mode of delivery at Bagas Waras Hospital, Klaten. Methods: This is quantitative


INTRODUCTION
COVID- 19 Pregnant women exposed to COVID-19 will likely to undergo a greater risk than nonpregnant women because during pregnancy oxygen consumption will increase and functional residual capacity will decrease. Pregnancy condition will suppress immunity and disrupt the immune system, leading women to be more susceptible to infection (4

MATERIALS AND METHODS
This is a quanlitative analysis study conducted by employing retrospective approach using secondary data. This research was carried out for 8 months from January to August 2021.
The population in the study were women with COVID-19 giving birth at Bagas Waras Regional Public Hospital, Klaten, and 183 women were used as samples. The independent variable was respondents' characteristics and the dependent variable was the mode of delivery currently performed. The inclusion criteria included mothers tested positive before the delivery and the mode of delivery carried out, while those with incomplete data were excluded. The statistical test was performed using Spearman's rho.

Respondents' Characteristics in Bagas Waras
Regional Public Hospital, Klaten

Current Mode of Delivery of Mother Confirmed
with COVID-19  (10,11). In the group of babies born to mothers with COVID-19, it has been agreed that the preferred mode of delivery is by caesarean section to reduce the risk of transmission to either the babies at birth or to the health workers who help the mothers (7). This is in accordance with a recommendation issued by The Royal College of Obstetricians and Gynecologists in 2020 which stated that there is no prohibition of conducting vaginal delivery if the conditions can be met for the mother, fetus, and the surrounding environment to help prevent horizontal transmission (7).
As can be seen in Table 3  indicates that there is no relationship between gravida status and cesarean delivery (13).

The current mode of delivery and the number of children
The majority of respondents (174 women) had no more than two children, 22 of whom underwent spontaneous delivery (12.6%), 146  (18). The compliance of pregnant women in consuming iron tablets was 51.5% and 50.8% of whom had anemia which was influenced by the limited frequency of visiting the health care facilities due to the COVID-19 pandemic; those who do not take iron tablets regularly will experience a decrease both in haemoglobin and immunity level, even lead to COVID-19 susceptibility (19). The results of this study exhibit no relationship between the history of pregnancy and the type of delivery.
In addition, there was significant relationship between the number of children and maternal age, as evidenced by P-value of 0.0001 (<0,05) and sufficient correlation (r=353). This result is in accordance with that suggested by Sary (2014) who discovered that that there is a relationship between the number of desired children and the (83.9%) underwent section caesarea, and 6 (3.4%) underwent AVM, as can be seen in Table   3. Likewise, Evi Soviati (2016) also suggested that 2-3 is the safest parity for pregnancy and childbirth. Based on the incidence of maternal mortality, high parity (more than 3 children) has a higher mortality rate compared to low parity (having 1 child); an unpleasant birth experience will have an impact on the next delivery, while for women with first experience of pregnancy, will usually be anxious by myths about labor pain before delivery (14).The correlation among maternal age, history of pregnancy, and the number of children in Bagas Waras Regional Public Hospital, Klaten

DISCUSSION
The Spearman's rho test result showed p-value of 0.0001, which means that there was a significant (<0.05) and a sufficient correlation (r=0.323). It indicates that there was adequate or moderate relationship between maternal age and a history of pregnancy at Bagas Waras Regional Public Hospital, Klaten. The result obtained in the present study can be concluded and can be linked to that conducted by Suryaningrum, et al (2019) who argued that there is a relationship between maternal age and pregnancy history. A person's age can affect his mindset (16).
The age of 20-35 years, which is said to be a healthy productive age, makes pregnant women think more rationally compared to the age classified into the high-risk factor. Because they think more rationally, it is possible for pregnant women to have higher enthusiasm and motivation in antenatal care and reduce their fear of the risk of being infected with COVID-19 (16). Meanwhile, factors that were not related to maternal age in this study were occupation and methods of delivery, in contrast to the results of previous studies which suggested that there is a relationship between age and type of delivery where pregnant women in the risk group number of maternal age. The analysis explained that the percentage of mothers who want more than 2 children is increasing along with their age. On the contrary, the younger the mother is, the more she will regard that only having 2 children is enough. This opinion is also supported by the results of statistical tests (p value = 0.000) and it can be concluded that there is a significant relationship between maternal age and the number of children desired. In this study, however, there was no relationship between the number of children with maternal occupation and the current type of delivery.
According to the result of this study, the majority of mothers exposed to COVID-19 gave birth using sectio caesarea. Similarly, Risnawati, et al (2021) also claimed that there is a concern that complication will occur in the middle of the delivery process which may endangers the condition of the mother and fetus. In addition, cesarean delivery process is expected to minimize the occurrence of virus transmission from patients to medical personnels who assist in the delivery process. A literature review also stated that up to date, there is no strong clinical evidence that recommends one method of delivery; thus, the labor is carried out based on obstetric indications by taking into account the wishes of the mother and her family, except for those with respiratory problems who require immediate delivery in the form of cesarean section or vaginal surgery (21).  Table 4. This is in contrast to previous study which found no relation between gravida status and sectio caesarea as evidenced by the result of multiple logistic regression test with p = 0.567 (p>0,05) (13).

The Current Mode of Delivery and the Number of Children
The repondents were dominated by those who have no more than 2 children (174 people), 22 of whom (12.6%) underwent spontaneous delivery, 146 (83.9%) underwent section caesarea, and 6 (3.4%) underwent AVM. The result is in line with that conducted by Evi Soviati (2016), stating that parity 2-3 is the safest parity for pregnancy and childbirth. Based on the incidence of maternal death, high parity (more than 3 children) has a higher incidence than that of lower parity (having 1 child); unpleasant birth experiences will affect the next delivery, while women who experience their first pregnancy will usually be haunted by myths about labor pain before delivery (14).

CONCLUSION AND RECOMMENDATION
There was adequate correlation between maternal age and the history of pregnancy in Bagas Waras Regional Public Hospital, Klaten, with P value = 0.0001 which indicates