Prevalence of Maternal Mortality and Clinical Course of Maternal Deaths in COVID-19 Pneumonia-A Cross-Sectional Study

Abstract

Introduction After initial studies suggested that pregnant women were not at a higher risk of complications due to COVID‐19 infection. Recent investigations from Sweden and the US have indicated that pregnant and postpartum women are at increased risk of severe complications associated with COVID‐19. This study aims to find out the prevalence of maternal mortality and the clinical course of maternal mortality cases due to COVID-19 pneumonia. Methodology A cross-sectional study was conducted from May 1st, 2020, to April 30th, 2021, at Postgraduate Institute and YCM Hospital Pimpri Pune (Maharashtra), a dedicated COVID hospital during COVID pandemic. During study period, all pregnant women who were diagnosed to have COVID-19 infection by RT PCR/Rapid Antigen Test were admitted and were enrolled for the study. Aim To audit the maternal mortality due to COVID-19 infection. Primary To estimate the prevalence of maternal mortality due to COVID-19 infection in obstetric patients. Secondary To systematically study and analyze the clinical course of infection in mothers who had mortality due to COVID-19 pneumonia. Data collected in standard format regarding Demography, clinical presentation, need for ICU/HDU, CXR findings, laboratory parameters and cases with maternal mortality were studied in detail to fulfill the study objectives. Results Among 871 COVID-19 cases diagnosed during pregnancy, nine patients had maternal mortality due to covid pneumonia. There was no obvious obstetric cause for mortality in these cases. The prevalence of maternal mortality was 0.01 (1.03%). Cases with maternal mortality were mostly in 3rd Trimester (5 of 9 cases) and presented with moderate to severe illness with breathlessness and myalgia in all 9 cases, cough and fever in 7 out of 9 cases, Tachypneoa was noted in all patients. Saturation below 90 in 6 cases and below 94 in 3 cases. Chest X-ray showed bilateral lung affection in all 9 cases. Leukocytosis with raised N:L ratio was predominantly seen, thrombocytopenia noted in 5 cases and elevated levels of acute phase reactants and inflammatory markers such as CRP, S. ferritin, ESR, LDH, D-dimer and S. fibrinogen was observed. None of the study participants received vaccine for COVID-19. Conclusions COVID-19 pneumonia is an additional toll for maternal mortality. Obstetric patients in 2nd and 3rd trimester having COVID-19 infection with late presentation to hospital, moderate to severe disease (RR > 30 min), with raised inflammatory markers (N:L ratio, CRP, Ferritin, d-Dimer, etc.) at presentation, having bilateral lung affection are at risk of poor maternal outcome.

COVID‐19 vaccination rates in an antenatal population: A survey of women's perceptions, factors influencing vaccine uptake and potential contributors to vaccine hesitancy

“…Pregnancy is an established risk factor for severe maternal COVID‐19, with studies demonstrating an increased risk of intensive care unit admission, requirement for mechanical ventilation, and death among pregnant women compared to their non‐pregnant counterparts. 1 , 2 , 3 Therefore, they are a priority group for COVID‐19 vaccination. 1 Pregnancy complications in particular with the Delta variant are also increased, including preterm birth, stillbirth, preeclampsia, and emergency caesarean section.…”

Impact of COVID-19 vaccination among pregnant women requiring hospital admission: prospective observational research

“…The main outcome of our study is that it allowed us to show the benefits of vaccination even during pregnancy. Even if the majority of pregnant women tested positive recovered within one week, the incidence of complications remains high and may lead to maternal morbidity and mortality [19,20] and poor fetal outcomes in form of early pregnancy loss, prematurity, oligohydramnios, intrapartum fetal distress, and sometimes fetal demise [21]. To improve maternal and fetal outcomes, COVID-19 vaccination in pregnancy has been endorsed by multiple professional societies, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine and the World Health Organization.…”

Perfil epidemiológico da mortalidade materna por COVID-19: revisão integrativa

“…Apenas quatro estudos analisados descreveram a faixa etária dos casos de mortalidade materna por COVID-19 (HANTOUSHZADEH et al, 2020;BELOKRINITSKAYA et al, 2021;ASALKAR et al, 2021;MOGHADAM et al, 2021). Houve variação das faixas etárias, um estudo destacou a faixa entre 25 e 35 anos, a qual é reconhecida como a idade reprodutiva feminina (ASALKAR et al, 2021), outros dois estudos descreveram a mesma tendência, com a média de idade com variação entre 30 a 32,3 anos (MOGHADAM et al, 2020;BELOKRINITSKAYA et al,2021). Apenas um estudo indicou a idade acima de 35 anos com maior risco de complicações e óbitos considerado a predisposição de comorbidades (HANTOUSHZ ADEH, et al, 2020).…”

“…Alguns estudos também destacaram exames laboratoriais e clínicos realizados nessa população, observada leucocitose, linfopenia, trombocitopenia, queda de saturação de O2. Ao realizar tomografia computadorizada as mulheres apresentaram características de vidro fosco, bem característico do vírus SARS-CoV (MOGHADA ,et al, 2020;ASALKAR, et al, 2021).…”

“…Quadro 3: Síntese da faixa etária, comorbidades e perfil clinico da população analisadas nos estudos relative aos óbitos materno e a COVID-19.Com relação aos óbitos maternos analisados nesta revisão, foram identificados os principais fatores correlacionados a este desfecho. A prevalência, o risco relacionado a morte materna, a letalidade e a razão de mortalidade materna foram analisados em sete artigos selecionados(ASALKAR, et al, 2021; BASU, CHAUKE, MAGORO., 2021CARVALHO-SAUER…”