Maternal mortality among women with coronavirus disease 2019 admitted to the intensive care unit OBJECTIVE:Limited data are available on critically ill pregnant women hospitalized with coronavirus disease 2019 (COVID-19). Although maternal mortality has been reported, 1e3 the frequency with which this devastating outcome occurs is unknown. The objective of this study was to determine the rate of maternal death among pregnant and postpartum women with COVID-19 admitted to the intensive care units (ICUs) in a large integrated health system in the New York metropolitan area. In this study, we described patient demographics, baseline comorbidities, clinical presentation, hospital course, and maternal outcomes. STUDY DESIGN:This case series evaluated all consecutively hospitalized pregnant and immediately postpartum women with laboratory-confirmed diagnosis of COVID-19 who were admitted to the ICUs at 10 hospitals within Northwell Health, the largest academic health system in New York, and Maimonides Medical Center, an affiliate of Northwell Health in Brooklyn, NY, from March 1, 2020, to May 6, 2020. Collectively, these hospitals perform approximately 40,000 deliveries per year, representing about 1 in 6 births in the state of New York and 1% of all births in the United States. Respiratory specimens were collected using nasopharyngeal swabs. Symptomatic patients who received positive test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction (PCR) assay were included. Admission to the ICU was at the discretion of the consulted critical care attending physician at each site. Patients who had a critical care consultation but were not directly managed by an intensivist were not included.

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Objective Coronavirus disease 2019 (COVID-19) is associated with cardiac injury 1-3 and bradycardia 4 in the non-pregnant population. The incidence of these complications in pregnancy is unknown. The objective of this study was to determine the rate of abnormal serum cardiac biomarkers or bradycardia among pregnant and immediately postpartum women admitted for treatment of severe or critical COVID-19 in a large integrated health system in New York. Study Design This is a retrospective review of all pregnant and immediately postpartum women hospitalized for COVID-19 at 7 hospitals within Northwell Health, the largest academic health system in New York state, from March 1 to April 30, 2020. Women who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction (PCR) assay and who met the National Institute of Health (NIH) criteria for severe or critical illness 5 were included. Women with a positive PCR test who were admitted for a reason other than treatment of COVID-19 (eg, labor) were excluded. The Northwell Health Institutional Review Board approved the study as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. Clinical records were manually reviewed. Data collected included demographics, medical comorbidities, pregnancy characteristics, laboratory and imaging results, medications administered, and clinical outcomes. Laboratory and imaging studies were ordered at the discretion of the attending physician. The primary outcomes evaluated were elevated cardiac troponins (I, T, or high sensitivity), elevated brain natriuretic peptide (BNP), bradycardia (defined as < 60 beats per minute, bpm), and maternal heart rate (HR) nadir. Descriptive statistics were used to characterize the data. Results A total of 31 women met inclusion criteria; 20 (65%) had cardiac biomarkers measured during hospitalization (Table). Cardiac troponins and BNP were elevated in 22% (n=4/18) and 30% (n=3/10) of these patients, respectively. Four patients had transthoracic echocardiograms performed and all were reported as normal. No patients had preexisting cardiovascular disease or hypertension. Two maternal mortalities in this cohort were previously reported; 6 both patients had elevated cardiac troponins and one also had an elevated BNP. The nadir HR ranged from 30-92 bpm and bradycardia occurred in one-third of patients (n=10/31). Half of women with elevated troponin and three-fourths of women with elevated BNP had an episode of bradycardia recorded during their hospital course. Conclusion Myocardial injury as demonstrated by abnormal cardiac biomarkers and bradycardia may be common among pregnant women with severe or critical COVID-19. In this study, one-fifth of patients who had tropo...