BACKGROUND: The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited. OBJECTIVE: This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2. STUDY DESIGN: This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation 93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24e48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported. RESULTS: Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m 2. Gestational age was at a mean of 29AE6 weeks at symptom onset and a mean of 30AE6 weeks at hospital admission, with a median disease day 7 since first symptoms. Most women (81%) were treated with hydroxychloroquine; 7% of women with severe disease and 65% of women with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation during their admission. The median duration of hospital stay was 6 days (6 days [severe group] and 10.5 days [critical group]; P¼.01). Intubation was usually performed around day 9 on patients who required it, and peak respiratory support for women with severe disease was performed on day 8. In women with critical disease, prone positioning was required in 20% of cases, the rate of acute respiratory distress syndrome was 70%, and reintubation was necessary in 20%. There was 1 case of maternal cardiac arrest, but there were no cases of cardiomyopathy or maternal death. Thirty-two of 64 (50%) women with coronavirus disease 2019 in this cohort delivered during their hospitalization (34% [severe group] and 85% [critical group]). Furthermore, 15 of ...

NCT03185455, Remote Surveillance of Postpartum Hypertension (TextBP), https://clinicaltrials.gov.

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Background Remdesivir is efficacious for severe COVID-19 in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. Methods Reported data span March 21 to June 16, 2020 for hospitalized pregnant women with PCR-confirmed SARS-CoV-2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200mg on Day 1, followed by 100mg for Days 2-10, given intravenously). Results Nineteen of 86 women delivered before their first dose and were reclassified as immediate “postpartum” (median postpartum day=1; range 0-3). At baseline, 40% of pregnant women (median gestational age 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By Day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (16%). Most adverse events were related to pregnancy and underlying disease; most laboratory abnormalities were Grades 1 or 2. There was one maternal death attributed to underlying disease and no neonatal deaths. Conclusions Among 86 pregnant and postpartum women with severe COVID-19 who received compassionate use remdesivir, recovery rates were high, with a low rate of serious adverse events.

Objective The effect of a cesarean in different stages of labor on spontaneous preterm birth (sPTB) in a subsequent pregnancy has not been extensively studied. The objective of the study was to evaluate the risk of subsequent sPTB after a first stage cesarean or second stage cesarean compared to a vaginal delivery. Study Design This was a planned secondary analysis of a large retrospective cohort study of women with 2 consecutive deliveries from 2005–2010. Women with prior sPTB were excluded. First stage (<10cm) and second stage cesareans (≥10cm) were compared to those with a vaginal delivery. Data were obtained through chart abstraction. The primary outcome was sPTB (<37wks) in a subsequent pregnancy. Categorical variables were compared with χ2 analyses and logistic regression was used to calculate odds and control for confounders. Results 887 women were included (721 vaginal, 129 first stage, 37 second stage cesareans). The sPTB rate varied between groups (7.8%, 2.3%, 13.5%, p=0.03), respectively. When compared to a vaginal delivery, women with a first stage cesarean had a decreased risk of sPTB which remained after adjusting for confounders (aOR 0.30 [0.09–0.99], p=0.049). There was a non-significant increase in odds of sPTB after a second stage cesarean compared to a vaginal delivery (aOR 2.4 [0.77–7.43], p=0.13). Women with a second stage cesarean had a 6 fold higher odds of sPTB as compared to women with a first stage cesarean which remained after adjusting for confounders (aOR 5.8 [1.08–30.8], p=0.04). Conclusion Women with a full term second stage cesarean have a significantly higher than expected rate of subsequent sPTB (13.5%) compared to both the overall national sPTB rate (7–8%) and to a first stage cesarean (2.3%). As the cesarean rate continues to rise, this potential impact on pregnancy outcomes cannot be ignored.