Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States

Abstract

Objective The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis. Study Design This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables. Results Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17–1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50–1.93) when compared with those without a diagnosis of COVID-19. Conclusion Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes. Key Points

Clinical, obstetrical and anaesthesia outcomes in pregnant women during the first COVID-19 surge in France: A prospective multicentre observational cohort study

“…Postpartum haemorrhage (PPH), as defined by a blood loss > 500 mL, was the leading postpartum complication with a rate of 14%. Several studies reported PPH have investigated such outcome in pregnant women with COVID-19 [30] , [31] . A rate of postpartum haemorrhage (> 1000 mL) of 9% was observed in a cohort of 64 pregnant women with COVID-19 [30] .…”

“…This rate reached 13% in the severe disease group (n = 44) and 6% in the critical disease group (n = 20) [30] . Nevertheless, in a retrospective cohort study which included 53 pregnant women with COVID-19 and 760 non-COVID-19 pregnant women, it was reported that deliveries associated with COVID-19 were not at increased risk for increased blood loss or obstetric haemorrhage compared with deliveries without COVID-19 [31] .…”

Incidence de la COVID-19 sur les issues de grossesse: examen systématique et méta-analyse

“…Les cas de COVID-19 ont été confirmés par un test de dépistage par PCR. Vingt-huit études portaient sur une infection par le SRAS-CoV-2 confirmée durant la grossesse comparativement à l'absence d'infection [11][12][13]15,22,[27][28][29][30][31][32]34,35,37,[39][40][41][42][43][44][45][47][48][49][50][51]53,54 . Douze études ont mis en parallèle la COVID-19 symptomatique et asymptomatique [7][8][9][10][11][12][13][14][15]46,48,52 .…”

“…Adhikari et al 48 Ahlberg et al 43 Brandt et al 22 Erol et al 50 Gulersen et al 29 Jering et al 53 Martínez-Perez et al 18 Patberg et al 41 Pirjani et al 37 Wang et al 39 Yang et al 42 Yazihan et al 47 Zhang et al 40 Total…”

“…Adhikari et al 48 Barbero et al 26 Brandt et al 22 Di Mascio et al 55 Kayem et al 17 Khoury et al 9 Maraschini et al 33 Martínez-Perez et al 18 Panagiotakopoulos et al 36 Savasi et al 21 Total Adhikari et al 48 Delahoy et al 7 Di Mascio et al 55 Jenabi et al 52 Khoury et al 9 London et al 10 Smithgall et al 13 Verma et al 14 Woodworth et al 46 Total 43 Cunarro-Lopez et al 44 Diaz-Corvillon et al 15 Edlow et al 49 Flaherman et al 27 Hcini et al 51 Jering et al 53 Li et al 31 Martínez-Perez et al 18 Nayak et al 35 Pineles et al 54 Prabhu et al 11 Smithgall et al 13 Wang et al 39 Woodworth et al 46 Yang et al 42 Yazihan et al 47 Zhang et al 40 Total comparatives arrive à une conclusion différente, et fournit des preuves tangibles que la COVID-19 symptomatique ou grave est associée à un risque considérable de prééclampsie, de naissance prématurée et de faible poids à la naissance.…”