Maternal death related to COVID‐19: A systematic review and meta‐analysis focused on maternal co‐morbidities and clinical characteristics

Verde, Marco La; Riemma, Gaetano; Torella, Marco; Cianci, Stefano; Savoia, Fabiana; Licciardi, Federico; Scida, S.; Morlando, Maddalena; Colacurci, Nicola; Franciscis, Pasquale De

doi:10.1002/ijgo.13726

Cited by 52 publications

(53 citation statements)

References 35 publications

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“…The present study supports the conclusion of a recent meta-analyses where the authors proved that COVID-19 with at least one co-morbidity increases risk of intensive care and mortality [ 25 ]. However, new insights are showing the promising role of different therapies such as modulators of endocannabinoids receptor and alpha-lipoic acid in the management of COVID-19 related inflammation [ 26 , 27 ].…”

Section: Discussionsupporting

confidence: 92%

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?—A Case Report

et al. 2021

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We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.

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Section: Discussionsupporting

confidence: 92%

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?—A Case Report

et al. 2021

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“…A recent systematic review has indicated that comorbidities such as obesity (OR 2.48), diabetes (OR 5.7) and asthma (OR 2.02) are significantly associated with maternal mortality 6 . In the present study, comorbidities such as anaemia, tuberculosis and diabetes mellitus were associated with an increased risk of maternal death in pregnant and post-partum women with COVID-19.…”

Section: Resultsmentioning

confidence: 99%

“…Previous respiratory virus outbreaks, including severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome, are associated with increased risk of stillbirth, pre-term birth and foetal growth restriction 2 . In the context of SARS-CoV-2, although initial reports had suggested no detrimental effects of the infection on pregnant women 3 4 5 , large-scale studies and systematic reviews have shown that pregnant women with COVID-19 are at a higher risk for severe disease, abortions and maternal deaths 6 7 8 . A systematic review of available systematic reviews suggests that the risk of maternal death, stillbirth and neonatal death is around one per cent of pregnancies complicated with SARS-CoV-2 infection 9 .…”

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confidence: 99%

Clinical characteristics, outcomes, & mortality in pregnant women with COVID-19 in Maharashtra, India: Results from PregCovid registry

et al. 2021

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Background & objectives : The PregCovid registry was established to document the clinical presentations, pregnancy outcomes and mortality of pregnant and post-partum women with COVID-19. Methods : The PregCovid registry prospectively collects information in near-real time on pregnant and post-partum women with a laboratory-confirmed diagnosis of SARS-CoV-2 from 19 medical colleges across the State of Maharashtra, India. Data of 4203 pregnant women collected during the first wave of the COVID-19 pandemic (March 2020-January 2021) was analyzed. Results : There were 3213 live births, 77 miscarriages and 834 undelivered pregnancies. The proportion of pregnancy/foetal loss including stillbirths was six per cent. Five hundred and thirty-four women (13%) were symptomatic, of which 382 (72%) had mild, 112 (21%) had moderate, and 40 (7.5%) had severe disease. The most common complication was preterm delivery (528, 16.3%) and hypertensive disorders in pregnancy (328, 10.1%). A total of 158 (3.8%) pregnant and post-partum women required intensive care, of which 152 (96%) were due to COVID-19 related complications. The overall case fatality rate (CFR) in pregnant and post-partum women with COVID-19 was 0.8 per cent (34/4203). Higher CFR was observed in Pune (9/853, 1.1%), Marathwada (4/351, 1.1%) regions as compared to Vidarbha (9/1155, 0.8%), Mumbai Metropolitan (11/1684, 0.7%), and Khandesh (1/160, 0.6%) regions. Comorbidities of anaemia, tuberculosis and diabetes mellitus were associated with maternal deaths. Interpretation & conclusions : The study demonstrates the adverse outcomes including severe COVID-19 disease, pregnancy loss and maternal death in women with COVID-19 in Maharashtra, India.

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“…Co-morbidities increased the risk of intensive care admission and mortality significantly ( 80 ). In retrospective studies of pregnant women with confirmed or suspected COVID-19, the risk for pneumonia increased with maternal age above 35 years and lymphopenia, whereas it decreased with gestational age ( 76 , 81 ). Surprisingly, high serum liver enzymes and D-dimers did not modify the risk of developing pneumonia ( 59 , 74 , 75 ).…”

Section: Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-cov-2)...mentioning

confidence: 98%

“…A significant increase in stillbirth, ruptured ectopic pregnancies, maternal depression, and maternal deaths was also reported during the COVID-19 pandemic, but these findings came from studies with “critically low” overall quality due to lack or inconsistency in the selection of healthy controls, unreported or unclear definition of diseases, lack of clarity in reporting of outcomes, study design (e.g., retrospective analysis), and substantial statistical heterogeneity. Additionally, as an indirect consequence of the COVID-19 pandemic, changes in healthcare-seeking behavior and in the access to prenatal services have been reported as impacting negatively on the maternal outcomes ( 81 ).…”

Section: Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-cov-2)...mentioning

confidence: 99%

Effects of Vertical Transmission of Respiratory Viruses to the Offspring

et al. 2022

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Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.

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Maternal death related to COVID‐19: A systematic review and meta‐analysis focused on maternal co‐morbidities and clinical characteristics

Cited by 52 publications

References 35 publications

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?—A Case Report

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?—A Case Report

Clinical characteristics, outcomes, & mortality in pregnant women with COVID-19 in Maharashtra, India: Results from PregCovid registry

Effects of Vertical Transmission of Respiratory Viruses to the Offspring

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