COVID-19 and Pregnancy Outcome: An Experience in ‘COVID-19 Management Designated’ Tertiary Care Hospital, Rawalpindi, Pakistan

Abstract

Background: The current COVID-19 pandemic has affected almost 17.3 million victims worldwide with mortality of almost 674K. Pregnancy is one of the most susceptible conditions for COVID-19 infection, but limited data is currently available about the clinical characteristics of pregnant women with the disease. Objective; to describe the clinical characteristics, co-morbidities, management, feto-maternal, and neonatal outcome in COVID-19 positive pregnant women.
 Methodology: A descriptive case series study was conducted in Obs/Gynae dept of Benazir Bhutto Tertiary Care Hospital, Rawalpindi, including all asymptomatic/symptomatic COVID-19 positive pregnant women and clinical suspects (COVID-19 PCR negative women) delivered in our hospital from 01st April 2020 to 31st July 2020. Their medical records were reviewed for clinical characteristics, management, feto-maternal and neonatal outcomes. Continuous variables were expressed in Mean & Range and Categorical variables as number & Percentage. Results: During the study period a total of 17 cases were reviewed. The mean maternal age was 28.94 yrs. Primigravida (07), Multipara (10). Mean gestational age was 37 wks (range; 30-41wks). Presenting symptomatology was varied. Asymptomatic; (29%), COVID-19 specific symptoms; fever & flu (12%), fever&cough (6%), shortness of breath(SOB) alone (6%), fever & SOB(6%) and pregnancy-related manifestations were labour pains (17%), eclampsia(6%), hydrocephalous fetus (6%) and hepatic encephalopathy(6%). The commonest co-morbidity was Hypertensive disorders of pregnancy (24%). Five women (29%) required ICU care. Lower segment caesarean sections(LSCS) (59%), vaginal delivery (41%). Eleven babies delivered with good Apgar score and birth weight. Two were early neonatal deaths (ENND) and 04 were received intra-uterine fetal deaths (IUDs). Fetal demise was associated with strong obstetric risk factors. Out of 13 live-born babies, RT-PCR Covid-19 testing was done in 10 (77%) cases and was negative. One mother was expired due to complications of hepatic encephalopathy, sepsis, and burst abdomen.
 Conclusion; The clinical course of COVID-19 disease in pregnancy seems to be no different from non-pregnant women. Clinical manifestations are diverse and infection contracted in the third trimester of pregnancy is associated with good feto-maternal and neonatal outcomes.

Maternal and Fetal Outcomes in Pregnant Women with COVID-19 Infection; A Case Series of 16 Patients at a Tertiary Care Hospital

“…2 patients had PROM butno evidence of perinatal transmission noted. In another local study conducted at Rawalpindi by Syed S. et al, 11 showed good maternal and fetal outcomes in pregnant patients with COVID disease in third trimester. PCR COVID-19 testing was done in 10 neonates and was negative that was similar to the results of our study.…”

“…3 Its association with altered immune status like lymphopenia and increase in certain inflammatory markers is similar to that of COVID-19 infection. 11 This, alongside the physiological cardiopulmonary adaptations in pregnancy that is reduced functional residual capacity in lungs and increased oxygen consumption renders pregnant women more susceptible to severe COVID disease.…”

Thrombocytopenia in Pregnancy: Identification and Management at a Reference Center in Pakistan

“…Since then, the pandemic has continued to wreak havoc on the country's already overburdened healthcare system [ 25 ]. Many studies suggest that clinical manifestation of COVID-19 in pregnancy is not different from non-pregnant adults, yet, according to a few studies pregnancy can complicate the clinical course of COVID-19 [ 26 ]. Since our study does not report any COVID-19 case, therefore, no such complication was observed in these patients.…”

Awareness, Practice, Knowledge and Attitude toward the COVID-19 among Antenatal Patients at Tertiary Care Hospital

“…[3] The ongoing COVID-19 outbreak has afflicted nearly 17.3 million individuals globally, with about 674000 deaths. [4] Although pregnancy is among the most vulnerable times for individuals suspected/detected with COVID-19 infection, there is currently little information regarding the clinical features of expectant mothers who suffer from COVID-19. [4] Although higher maternal age, presence of comorbidities, and high body mass index have been considered to be the risk factors of severe COVID-19 development among expectant mothers.…”

“…[4] Although pregnancy is among the most vulnerable times for individuals suspected/detected with COVID-19 infection, there is currently little information regarding the clinical features of expectant mothers who suffer from COVID-19. [4] Although higher maternal age, presence of comorbidities, and high body mass index have been considered to be the risk factors of severe COVID-19 development among expectant mothers. [5] Because of the physiological modifications in the cardiopulmonary and immunological systems that occur during pregnancy, women are predisposed to respiratory viral infection.…”