COVID-19, infection during pregnancy is very uncommon [1]. Earliest cases, reported were in Wuhan, China, December 2019 (The Virus SARS-CoV-2) [2]. It is Betacoronavirus. The Host cell receptor is a structural analysis that suggests angiotensin-converting enzyme, receptor. The animal hosts are bats; animals might represent an intermediate host. The incubation period, the Mean 5.2 days (95% confidence interval [CI], 4.1-7.0); and the 95 % of the distribution was 12.5 days. It ranges, from 2-14 days. Time from illness onset until hospitalization with a mean of 12.5 days. (95% CI, 10.3-14.8), onset before Jan. 1 with a mean 9.1 days (95% CI, 8.6 9.7). Basic reproduction number OR 2.2 (95% CI, 1.4-3.9) [2]. Patient characteristics; nearly all reported patients are adults. Children have been infrequently reported (< 1% of cases). Age range; (10-89 years) the average age in years was 59 years. Male to female ration 56% - 44%. The mortality as a Case fatality rate overall Initial estimate is about 1%. Clinical manifestations were described from hospitalized patients, and the most common symptoms were Fever (83-100%) then Cough (59-82%), Myalgia (11-35%), Headache and Sore throat (7-8%) and finally Diarrhea (2-10%). Laboratory findings were Leukopenia (9-25%), Lymphopenia (35-70%) and Thrombocytopenia (5-12%). Radiographic abnormalities on chest imaging were (100%) [3].

In general, pregnant women have many anatomical and physiological variations of pregnancy that affect the respiratory system and that increase liability to infections COVID-19, and the clinical progression of the disease in infected pregnant women delayed diagnosis of COVID-19, this is in due to pregnancy-associated rhinitis and physiologic dyspnea, which is common in pregnancy [4]. The immunosuppression of pregnant women impacts the severity of symptoms, particularly towards the end of pregnancy, pregnant women cannot clear respiratory secretion and decreased lung functional residual capacity [4]. During normal pregnancy, hormone such as estrogen and progesterone increase levels of angiotensinogen and renin, leading to an increase in ACE-2 levels [5] and increased expression of ACE2 may facilitate infection with COVID-19 [6]. What is the effect of coronavirus (COVID-19) infection on pregnancy, and what are the common symptoms [7]? Very minimal knowledge is known until today; this lack of reliable data makes the answer to many questions very difficult [8]. Early few studies showed that clinical features of pneumonia-related COVID-19 in pregnancy were similar to those in non-pregnant [9]. Little evidence exists to permit any reliable conclusions about the nature of COVID-19 infection in pregnancy [10, 11].

The objective of this study is systematic review and meta-analysis of the commonly reported symptoms of COVID-19 in pregnancy and to compare it to symptoms of non-pregnant.

(Systematic review and meta-analysis) of published retrospective studies.

Pregnant women included in the list of people who are at moderate chance to get Covid 19 infection, and no evidence is more likely to get seriously ill from the infection. The main symptoms of coronavirus are fever, cough, myalgia and sore throat and a loss of smell or taste (anosmia) in non-pregnant. In pregnancy, a different study showed different symptoms compare to non-pregnant.

In our study, we analyze four retrospective case series, a number of pregnant women in each were (43, 15, 9 and 116 pregnant women) diagnosed as positive for COVID-19 clinically showed similar symptoms to non-pregnant more than 86% had mild illness, 9.3% were severely ill, and 4.7% were critically ill [12-16].

In pregnant women, the majority of patients were presented with fever and cough, myalgia and sore throat while laboratory tests yielded lymphocytopenia. C.T. findings of these patients were consistent with previous reports of non-pregnant patients, (Ground-glass opacities) at the early stage. These patients need follow-up images after delivery.

We compare a total of 183 pregnant women considering each symptom fever, cough, myalgia and sore throat separately in each study to the symptom of control from a study which has a total of 262 non-pregnant. It was found that the only symptoms that are more common in pregnant than non-pregnant are the sore throat. That concluded that when pregnant women start to have sore throat care should be taken to exclude COVID-19 infection.

When we analyze publication, that deals with COVID-19 in pregnancy. None of the findings indicates that COVID-19 infections induce labour to pregnant women. (18.2). Until now, there are no suggestive data that supports the serious threat of early pregnancy loss with COVID-19, or miscarriage [19, 20]. (Fetal compromise and preterm rupture of membranes were reported in few cases to cause preterm birth, but the exact relation between preterm birth and covid-19 is still unclear [21].

Transmission in Early studies, there was no reported evidence for vertical transmission of COVID-19 from mother to child in late pregnancy [22]. In few recent reports indicate that vertical transmission can occur. An early study reported two neonates to be infected with COVID 19 transmission likely to occur in the postnatal period [23].

It is unclear yet whether comorbidity arising during pregnancy, such as cardiac failure diabetes, hypertension, diabetes, and hypercoagulability might be additional risk factors for pregnant women as they do for non-pregnant people. Vertical transmission from mother to fetus does not occur during the last trimester, and no data were collected in the first and second trimester.

Pregnant women should be admitted to the maternity suite once they are in spontaneous or induced labor, proper care has been given to them during the pandemic of covid-19 [24].

Every health care provider staff: the obstetric consultant, anaesthetists, the midwife-in-charge, the neonatologist consultant, the charge nurse, and the infection control team should be informed. As for emergency scenarios a local policy should state to reduce the number of staff members entering the room. The team should continue maternal observations and assessment as per standard practice, with oxygen saturations. If a woman develops a fever, which is one of the most typical symptoms, further investigation should be done. For all patients in labour, continuous electronic fetal monitoring is recommended [25].

In the Case of acute changes and worsening of the woman's symptoms, an assessment regarding the benefits and risks of continuing the labour versus preceding to emergency caesarean birth. The neonatal team should be given enough time to allow them to attend entering the room/theatre. If there are no contraindications, then Cord clamping is advised after birth, until today there is currently no clear evidence to favour the delivery mode. It should be discussed with the woman, taking into consideration any obstetric indications and patients' preferences. The presence of COVID-19 should not influence the mode of birth unless the woman's respiratory condition urge an intervention for delivery if vaginal secretions are negative for COVID-19 [26].

The time of the second stage of labour shall be shortened with elective instrumental delivery.

An individualized informed discussion and decision should be made for an asymptomatic woman who is getting hypoxia or being exhausted.

Regarding analgesia: the presence of coronaviruses is not contraindicated to (epidural or spinal analgesia), and this is to minimize the use of general anaesthesia. As for patient with a single- microbiological filter, Entonox can be used [27].

Risk of venous thromboembolism should be assessed, and patients should have prophylactic LMWH and have a longer course of prophylactic LMWH [28].

A covid-19 suspected woman should have an individual assessment for an elective (planned) caesarean section. There should be an individualized evaluation with consideration of urgency of delivery, and risk of transmission. Obstetric management of elective caesarean delivery should be according to usual practice [28]

Planned induction of labours or elective caesarean section, an individual assessment should be made regarding the urgency of planned induction of labour for women currently in self-isolation because of suspected COVID-19 affecting either themselves or household contact. If delaying the induction of labour is not safe, the general advice for services providing care to suspected/confirmed COVID-19 admitted women should be followed [28].

The only symptoms that are more common in pregnant than non-pregnant are the sore throat. That concluded that when pregnant women start to have sore throat care should be taken to exclude COVID-19 infection.

A.J., H.H. designed the study protocol and search, data extraction. Aj and H.H. critical, independent review with contributed to statistical analysis and interpretation of data. A.J. drafted the manuscript with H.H. critically revising the manuscript.

The authors would like to express their gratitude to all those who helped me during the writing of this manuscript (Mrs. Loreli Rayes, Miss Ghaliah AJ. and Miss Nouf Jarada). Thanks to all the peer reviewers and editors for their opinions and suggestions.

The authors declare having no conflict of interest related to this work.