Maternal Death Caused by Severe-Critical COVID-19 in Jakarta: Case Series

Abstract

BACKGROUND: As of January 2021, Indonesia had the 21st highest number of total COVID-19 cases and the 17th highest total deaths among all countries. COVID-19 infection in pregnant women seems to negatively affect both maternal and neonatal outcomes. CASE REPORT: We describe four cases of pregnant women confirmed with severe and critical COVID-19 that resulted in maternal death from November until December 2020. The first case was complicated with thrombocytopenia, her condition quickly deteriorated post-delivery. Pulmonary embolism was suspected as the cause of death. Second and third cases were complicated with preeclampsia, obesity, and advanced maternal age. Second case came in sepsis condition. Her SARS CoV-2 RTPCR swab test came out after her death. Third patient did not have COVID-19 symptoms at admission. She starts having symptoms on second day and was confirmed positive a day after. She falls in septic shock. Fourth patient has history of fever, cough, and dyspnea. She was confirmed positive on first day and her condition worsened, diagnosed with bacterial co-infection sepsis on day eight. All patients underwent cesarean section. CONCLUSION: Limited information and studies for COVID-19 management in pregnant women are challenging for obstetricians. Management should be individualized weighing the benefit and risks in presence of comorbidities or accompanying disease.

Clinical Factors Associated with Maternal Death in Pregnant Women Infected by COVID-19 in Indonesia: A Multicenter Prospective Study

“…The maternal death group had a higher comorbidities and pregnancy complications compared to the survived group (Cardiac disease, acute kidney injury, co-infection, and anemia). Contrary to many reports, our study did not found an increased prevalence of hypertension/preeclampsia, obesity, and diabetes in maternal death groups [28][29][30][31][32][33][34]. Acute kidney injury is the comorbidities with the highest risk to maternal death (OR: 19.14), followed by cardiac disease, co-infection, and anemia.…”

A Literature Review of Advanced Maternal Age in Pregnant Women with COVID-19

“…There was one article that mentioned the increased risk of intubation and severe pneumonia (D'Antonio et al, 2021) Three studies mentioned the comorbidities found in patients. Almost all of the pregnant women aged >35 years had comorbidity (Djusad et al, 2021;Kurniawati et al, 2022;Shams et al, 2022). The most common comorbidity found was obesity.…”

“…There was an increase in mortality in the AMA group compared with the non-AMA group. Two studies found that almost all maternal death in advanced-age mothers were complicated by preeclampsia (Djusad et al, 2021;Kurniawati et al, 2022).…”

“…From all the four maternal death cases caused by COVID-19, they were all planned to undergo an emergency cesarean section. These happened due to many reasons such as fetal distress, preeclampsia, and dystocia (Djusad et al, 2021). It is said that AMA was an independent risk factor for prelabor cesarean section in private and public services (Martinelli et al, 2021).…”

“…According to a study, CFR was 0.2% in the 20-29 age group, 1.3% in the 50-59 age group, and 15.6% in the 80 and above age group (Kurniawati et al, 2022). Two studies found that almost all maternal death in advanced-age mothers were complicated by preeclampsia (Djusad et al, 2021;Kurniawati et al, 2022). Hypertension is known to be more likely in people who are older since endothelial damage gets worse with age.…”