Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study

Abstract

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 ...

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

“…Serum biochemistry results were reported in 37 studies encompassing 381 women respectively 4,5,9–11,13–15,17,18,20,21,25,29,30,33–36,39,41,44–50,53,56,57–60,63,66 . In this group, raised serum C‐reactive protein was reported among 275 (72.2%) women, lymphopenia among 179 (47.0%) women, and transaminitis among 93 (24.4%) women.…”

“…Seven (1.9%) women were aged 40 years or older. Presenting symptoms were reported in 55 studies, comprising 515 pregnant women 4,5,7,11–19,21–30,32–57 . Of these, the most common symptoms at presentation were fever (n=273, 53.0%), cough (n=224, 43.5%), myalgia/malaise (n=79, 15.3%), dyspnea (n=64, 12.4%), diarrhea (n=18, 3.5%), and sore throat (n=18, 3.5%), regardless of gestational age.…”

Obstetrical and intensive care strategies in a high-risk pregnancy with critical respiratory failure due to COVID-19: a case report

“…Ethnicity has been implicated due to a general higher prevalence of medical problems such as cardiovascular disease, diabetes and higher deprivation in such societies. In a cohort of hospitalised cases in the United States, peak respiratory support for severe COVID-19 in pregnancy has been reported to occur on day 8 and intubation on day 9 [7]. Co-morbidities like previous pulmonary/cardiac disease and high BMI were again associated with severe disease.…”

“…We report a case of critical COVID-19 in a high-risk pregnancy, with acute respiratory failure requiring mechanical ventilation and premature termination of the pregnancy. Although pregnant women are not recognised as a vulnerable group for COVID-19, there is a growing body of evidence linking late pregnancy and prior maternal risk factors such as high BMI, diabetes and hypertension to adverse pregnancy outcomes including maternal and neonatal deaths [1,2,5,6,7].…”

“…The patient presented with several risk factors that have been linked to an increased likelihood for severe COVID-19 course including morbid obesity (BMI 57 kg/m 2 ), diabetes mellitus [7] and Asian origin [8]. Ethnicity has been implicated due to a general higher prevalence of medical problems such as cardiovascular disease, diabetes and higher deprivation in such societies.…”