Coronavirus Disease 2019 During Pregnancy: A Systematic Review of Reported Cases

Gatta, Anna Nunzia Della; Rizzo, Roberta; Pilu, G.; Simonazzi, Giuliana

doi:10.1097/01.ogx.0000723856.99244.b0

Cited by 50 publications

(80 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Complications such as preterm birth and need for delivery are common for women with severe and critical cases of COVID-19. 34,35 Our study suggests that the known respiratory complications associated with severe and critical COVID-19 may lead to greater numbers of maternal ICU admissions, intubation, and mechanical ventilation and may likely result in an increased number of preterm births and cesarean deliveries in the setting of worsening maternal respiratory status. This information is important in counseling pregnant women diagnosed at the early stage of the disease on the potential for progression to a severe or critical stage.…”

Section: Discussionmentioning

confidence: 88%

Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls

DeBolt

Bianco

Limaye

et al. 2021

American Journal of Obstetrics and Gynecology

172

130

View full text Add to dashboard Cite

BACKGROUND: In March 2020, as community spread of severe acute respiratory syndrome coronavirus 2 became increasingly prevalent, pregnant women seemed to be equally susceptible to developing coronavirus disease 2019. Although the disease course usually appears mild, severe and critical cases of coronavirus disease 2019 seem to lead to substantial morbidity, including intensive care unit admission with prolonged hospital stay, intubation, mechanical ventilation, and even death. Although there are recent reports regarding the impact of coronavirus disease 2019 on pregnancy, there is a lack of information regarding the severity of coronavirus disease 2019 in pregnant vs nonpregnant women. OBJECTIVE: We aimed to describe the outcomes of severe and critical cases of coronavirus disease 2019 in pregnant vs nonpregnant, reproductive-aged women. STUDY DESIGN: This is a multicenter, retrospective, case-control study of women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection hospitalized with severe or critical coronavirus disease 2019 in 4 academic medical centers in New York City and 1 in Philadelphia between March 12, 2020, and May 5, 2020. The cases consisted of pregnant women admitted specifically for severe or critical coronavirus disease 2019 and not for obstetrical indications. The controls consisted of reproductive-aged, nonpregnant women admitted for severe or critical coronavirus disease 2019. The primary outcome was a composite morbidity that includes the following: death, a need for intubation, extracorporeal membrane oxygenation, noninvasive positive pressure ventilation, or a need for high-flow nasal cannula O 2 supplementation. The secondary outcomes included intensive care unit admission, length of stay, a need for discharge to long-term acute care facilities, and discharge with a home O 2 requirement. RESULTS: A total of 38 pregnant women with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction-confirmed infections were admitted to 5 institutions specifically for coronavirus disease 2019, 29 (76.3%) meeting the criteria for severe disease status and 9 (23.7%) meeting the criteria for critical disease status. The mean age and body mass index were markedly higher in the nonpregnant control group. The nonpregnant cohort also had an increased frequency of preexisting medical comorbidities, including diabetes, hypertension, and coronary artery disease. The pregnant women were more likely to experience the primary outcome when compared with the nonpregnant control group (34.2% vs 14.9%; P¼.03; adjusted odds ratio, 4.6; 95% confidence interval, 1.2e18.2). The pregnant patients experienced higher rates of intensive care unit admission (39.5% vs 17.0%; P<.01; adjusted odds ratio, 5.2; 95% confidence interval, 1.5e17.5). Among the pregnant women who underwent delivery, 72.7% occurred through cesarean delivery and the mean gestational age at delivery was 33.8AE5.5 weeks in patients with severe disease status and 35AE3.5 weeks in patients with critical coronav...

show abstract

Section: Discussionmentioning

confidence: 88%

Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls

DeBolt

Bianco

Limaye

et al. 2021

American Journal of Obstetrics and Gynecology

172

130

View full text Add to dashboard Cite

show abstract

“…13e19 There is therefore an increased potential for maternal deaths, 20e23 especially in low-to middleincome countries. 24 There are also disparate accounts of an increase in premature births, 23,25e27 premature cesarean deliveries, 28 and myocardial injuries 29,30 in addition to an increased risk for preeclampsia, cesarean delivery, and perinatal death in pregnant women with COVID-19 infections. 31 When compared with COVID-19 infected, nonpregnant peers, symptomatic pregnant patients may be at an increased risk for a more severe COVID-19 disease course.…”

Section: Limited Evidence Basementioning

confidence: 99%

Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients

Chervenak

McCullough

Bornstein

et al. 2021

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

The development of COVID-19 vaccines in current and planned clinical trials is essential for the success of this public health response. This paper focuses on how physicians should implement the results of these clinical trials: counseling patients who are pregnant, planning to become pregnant, breastfeeding or planning to breastfeed about vaccines with government authorization for clinical use. Determining the most effective approach to counseling patients about COVID-19 vaccination is challenging. We address the professionally responsible counseling of three groups of patients – those who are pregnant, those planning to become pregnant, and those breastfeeding or planning to breastfeed. We begin with an evidence-based account of five major challenges: the limited evidence base; documented increased risk of severe disease among pregnant COVID-19-infected patients; conflicting guidance from government agencies and professional associations; false information about COVID-19 vaccines; and maternal mistrust and vaccine hesitancy. We then provide evidence-based, ethically justified, practical guidance for meeting these challenges in professionally responsible counseling of patients about COVID-19 vaccination. To guide professionally responsible counseling of patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed, we explain how obstetrician-gynecologists should evaluate current clinical information and why a recommendation of COVID-19 vaccination should be made and how this assessment should be presented to patients in the informed consent process with the goal of empowering them to make informed decisions. We also present a pro-active account of how to respond when patients refuse recommended vaccination, the elements of which are the legal obligation of informed refusal and the ethical obligation to ask patients to reconsider. During this process, the physician should be alert to vaccine hesitancy, ask patients to express their hesitation and reasons for it, and respectfully address them. In contrast to the conflicting guidance from government agencies and professional associations, evidence-based professional ethics in obstetrics and gynecology provides unequivocal and clear guidance: The physician should recommend COVID-19 vaccination to patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed. To prevent widening health inequities, to build trust in the health benefits of vaccination and to encourage COVID-19 vaccine and treatment uptake, in addition to recommending COVID-19 vaccinations, physicians should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, robust educational campaigns and novel approaches to immunization.

show abstract

“…11 In another study, Della Gatta reported one stillbirth in a series of 48 cases who delivered. 12 Ziyi Yang et al also reported a 1.2% stillbirth in the 18 studies, comprising of 114 patients, that they reviewed. 4 In our case, we planned to terminate our patient's pregnancy for maternal reason but she had an IUFD just before the start of the delivery induction to terminate the pregnancy.…”

Section: Discussionmentioning

confidence: 96%

“…[3][4][5] Mifepristone is synthetic steroid that has an anti-progestin effect by competitively blocking the progesterone receptors. [6][7][8][9][10][11][12][13][14][15][16] Normally mifepristone is administered orally, [14][15][16] thus making its use in an ICU ventilated, especially COVID-19,patient a challenge. Finding a way to administer this drug will be a valuable addition to successfully manage ventilated patient, especially in COVID-19 cases.…”

mentioning

confidence: 99%

Innovative mid-trimester termination of pregnancy in a COVID-19 critically Ill patient

Abuyaqoub¹

2021

IPCB

View full text Add to dashboard Cite

The current COVID-19 pandemic has introduced many challenges on the presentation of the disease, effects of the disease on co-morbidities of the patient and the management of these. This has necessitated innovative ways of managing these patients. This is particularly so in pregnant women with COVID-19. We present a case of a pregnant woman in her mid-trimester who presented with severe COVID-19 disease requiring ICU admission who required termination of pregnancy due to worsening condition while on ventilator. She presented with high fever, cough and difficulty in breathing. These rapidly deteriorated requiring ECMO. Her liver function, kidney function and inflammatory markers equally deteriorated very fast despite various treatments including using convalescence plasma. We decided to terminate the pregnancy to help in managing her condition. The baby died just when we were considering the termination of the pregnancy thus requiring Mid-trimester termination of the non-viable pregnancy. We initially tried to use vaginal misoprostol for the termination but failed thus we had to find a way of using mifepristone pre-treatment for the termination. An innovative used of mifepristone through the nasogastric tube was devised and we successfully terminated the pregnancy with mifepristone pre-treatment followed by a single dose of misoprostol with minimal blood loss. The patient’s condition improved rapidly after the termination of pregnancy and she recovered fully. We feel her pregnant status might have contributed to her severe symptoms and the disease may have contributed to the demised of the baby. We recommend the use of mifepristone through the nasogastric tube in the process of termination of pregnancy in a sick ventilated patient.

show abstract

Coronavirus Disease 2019 During Pregnancy: A Systematic Review of Reported Cases

Cited by 50 publications

References 2 publications

Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls

Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls

Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients

Innovative mid-trimester termination of pregnancy in a COVID-19 critically Ill patient

Contact Info

Product

Resources

About