Citation Information :
Umashankar K, Kanakannavar S, Devoor A, Tejashree B. Analysis of Maternal Mortality in COVID-positive Pregnant Mothers at Tertiary Care Hospital. J South Asian Feder Obs Gynae 2022; 14 (5):534-540.
Introduction: COVID-19 infection is a pandemic health emergency with significant mortality in human population. The course of infection in pregnancy is not well-known. The understanding is fogged by the changes in the pulmonary and immunological systems during pregnancy. Initially, the COVID-19 infections among pregnant mothers were assumed to be having benign course. Recent investigations from Sweden have indicated that pregnant and postpartum women are at increased risk of severe complications associated with COVID-19 infections.
Methodology: This prospective study was conducted at Department of Obstetrics and Gynecology BMCRI and Bowring Lady Curzon Medical College. All pregnant women diagnosed to have COVID-19 infection who died during treatment were included in the study. The details of clinical evaluation are entered in structured format. Cases were studied in detail to fulfill the study objectives.
Aims and objective: To analyze the maternal mortality cases due to COVID-19 infection. To estimate the prevalence of maternal mortality due to COVID-19 infection.
Results: Among 1070 COVID-19 cases diagnosed during pregnancy, 37 (3.45%) patients had maternal mortality due to COVID infection. The prevalence of maternal mortality was 0.6 (3.45%). Maternal mortality were mostly in 3rd trimester (51.4%). Saturation was below 90% in all cases, 90.8% of patients are antepartum, maximum gestational age 37 weeks, and minimum gestational age 12 weeks.
Conclusions: COVID-19 pneumonia is an additional toll for maternal mortality. Obstetric patients in the 2nd and 3rd trimester having COVID-19 infection with late presentation to hospital, moderate-to-severe disease (RR >30 minutes), with raised inflammatory markers, and having bilateral lung affection are indicative of poor maternal outcome.
Shahnaz S, Sharmin R, Sattar MA. Pregnancy with COVID-19: Weal and Woe. J South Asian Feder Obs Gynae 2020;12(4):258–260. DOI: 10.5005/jp-journals-10006-1798.
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel Coronavirus-infected pneumonia. N Engl J Med 2020; 382(13):1199–1207. DOI: 10.1056/NEJMoa2001316.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel Coronavirus in Wuhan, China. Lancet 2020;395(10223): 497–506. DOI: 10.1016/S0140-6736(20)30183-5.
Nambiar SS, Ajith S, Reshmi VP. Assessing disease outcome in COVID-19 pregnancies in a Tertiary Referral Center in South India: A single-center retrospective cohort study. J South Asian Feder Obs Gynae 2020;12(5):335–339. DOI: 10.5005/jp-journals-10006-1822.
Chen L, Li Q, Zheng D, et al. Clinical characteristics of pregnant women with COVID-19 in Wuhan, China. N Eng J Med 2020;382(25):e100. DOI: 10.1056/NEJMc2009226.
Collin J, Byström E, Carnahan A, et al. Pregnant and postpartum women with SARS-CoV-2 infection in intensive care in Sweden. Acta Obstet Gynecol Scand 2020;99(7):819–822. DOI: 10.1111/aogs.13901.
Ellington S, Strid P, Tong VT, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status—United States. MMWR Morb Mortal Wkly Rep 2020;69(25):769–775. DOI: 10.15585/mmwr.mm6925a1.
Ahmed I, Azhar A, Eltaweel N, et al. First COVID-19 maternal mortality in the UK associated with thrombotic complications. Br J Haematol 2020;190(1):e37–e38. DOI: 10.1111/bjh.16849.
dos Reis HLB, Boldrini NAT, Caldas JVJ, et al. Severe coronavirus infection in pregnancy: Challenging cases report. Rev Inst Med Trop Sao Paulo 2020;62:e49. DOI: 10.1590/S1678-9946202062049.
Afshar Y, Gaw SL, Flaherman VJ, et al. Clinical presentation of Coronavirus disease 2019 (COVID-19) in pregnant and recently pregnant people. Obstet Gynecol 2020;136(6):1117–1125. DOI: 10.1097/AOG.0000000000004178.
Villar J, Ariff S, Gunier RB, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID multinational cohort study. JAMA Pediatr 2021;175(8):1–10. DOI: 10.1001/jamapediatrics.2021.1050.12.
Vousden N, Bunch K, Morris E, et al. The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infections in the UK from March to September 2020: A national cohort study using the UK Obstetric Surveillance System (UKOSS). PLoS One 2021;16(5):e0251123. DOI: 10.1371/journal.pone.0251123.
Asalkar M, Thakkarwad S, Rumani I. Prevalence of maternal mortality and clinical course of maternal deaths in COVID-19 Pneumonia – A cross-sectional study. J Obstet Gynecol India 2021;72(13):1–10. DOI: 10.1007/s13224-021-01545-3.
Takemoto M, Menezes MO, Andreucci CB, et al. Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis. BJOG 2020;127(13): 1618–1626. DOI: 10.1111/1471-0528.16470.
Tjendra Y, Al Mana AF, Espejo AP, et al. Predicting disease severity and outcome in COVID-19 patients: a review of multiple biomarkers. Arch Pathol Lab Med 2020;144(12):1465–1474. DOI: 10.5858/arpa.2020-0471-SA.
World Health Organization. Clinical management of severe acute respiratory infection when novel Coronavirus (nCoV) infection is suspected 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected [Accessed 12 February, 2021].
Hazari KS, Paulose L, Kurien N, et al. Clinical characteristics, management, maternal and neonatal outcome among seven severe and critically ill pregnant women with COVID-19 pneumonia. Clin J Obstet Gynecol 2020;3:158–166. DOI: 10.29328/journal.cjog.1001071.
Lederman MM. Cell-mediated immunity and pregnancy. Chest 1984;86(Suppl 3):6S–9S. DOI: 10.1378/chest.86.3.6S.
Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, et al. Maternal death due to COVID-19. Am J Obstet Gynecol 2020;223(1):109.e1–109.e16. DOI: 10.1016/j.ajog.2020.04.030.
WAPM. Maternal and perinatal outcomes of pregnant women with SARS-COV-2 infection. Ultrasound Obstet Gynecol 2020;57(2): 232–241. DOI: 10.1002/uog.23107.
Nayak AH, Kapote DS, Fonseca M, et al. Impact of the Coronavirus infection in pregnancy: a preliminary study of 141 patients. J Obstet Gynaecol India 2020;70(4):256–261. DOI: 10.1007/s13224-020-01335-3.
Nakamura-Pereira M, Betina Andreucci C, de Oliveira MM, et al. Worldwide maternal deaths due to COVID-19: A brief review. Int J Gynaecol Obstet 2020;151(1):148–150. DOI: 10.1002/ijgo.13328.
Kayem G, Lecarpentier E, Deruelle P, et al. A snapshot of the COVID-19 pandemic among pregnant women in France. J Gynecol Obstet Hum Reprod 2020;49(7):101826. DOI: 10.1016/j.jogoh.2020.101826.
Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women hospitalized with confirmed SARS-CoV-2 infection in the UK: National population based cohort study. BMJ 2020;369:m2107. DOI: 10.1136/bmj.m2107.
Lumbreras-Marquez MI, Campos-Zamora M, Lizaola-Diaz de Leon H, et al. Maternal mortality from COVID-19 in Mexico. Int J Gynecol Obstet 2020;150:266–267. DOI: 10.1002/ijgo.13250.