BACKGROUND: The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited. OBJECTIVE: This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2. STUDY DESIGN: This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation 93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24e48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported. RESULTS: Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m 2. Gestational age was at a mean of 29AE6 weeks at symptom onset and a mean of 30AE6 weeks at hospital admission, with a median disease day 7 since first symptoms. Most women (81%) were treated with hydroxychloroquine; 7% of women with severe disease and 65% of women with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation during their admission. The median duration of hospital stay was 6 days (6 days [severe group] and 10.5 days [critical group]; P¼.01). Intubation was usually performed around day 9 on patients who required it, and peak respiratory support for women with severe disease was performed on day 8. In women with critical disease, prone positioning was required in 20% of cases, the rate of acute respiratory distress syndrome was 70%, and reintubation was necessary in 20%. There was 1 case of maternal cardiac arrest, but there were no cases of cardiomyopathy or maternal death. Thirty-two of 64 (50%) women with coronavirus disease 2019 in this cohort delivered during their hospitalization (34% [severe group] and 85% [critical group]). Furthermore, 15 of ...

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Strengths of this study included the timely nature of our findings as the COVID-19 pandemic ensues, death tolls reach record highs, and communities adopt methods of social distancing to flatten the disease curve. Our findings are applicable to the obstetrical population who, regardless of the COVID-19 pandemic, cannot safely avoid or delay contact with hospitals compared with other patient populations because pregnancy is finite. The limited number of patients in our study was a potential weakness. In addition, given that we only investigated obstetrical patients, our findings may not be generalizable to other populations within the medical community. In addition, our study is preliminary and ongoing; hence we do not have any data on pregnancy outcomes. Our results were similar to those reported in a Letter to the Editor in the New England Journal of Medicine published on April 13, 2020, reporting that 13.5% of patients during a 2-week time period in 1 institution were asymptomatic and positive for SARS-CoV-2 7 ; this finding was very similar to the asymptomatic SARS-CoV-2epositive rate in our population of 13% (21/161).Our results can be used as a guide to other L&D units in deciding whether all admitted obstetrical patients should be routinely tested for SARS-CoV-2, the virus responsible for COVID-19.

(Am J Obstet Gynecol. 2018;219:390.e1–15) Over the past decade, the rate of births to women aged 30 years and older has risen. This trend will likely continue with the widespread availability of newer reproductive technologies. As women age, they are more likely to have comorbid conditions and women of advanced maternal age have increased complications in pregnancy. The objective of this study was to characterize the risk for severe maternal morbidity and other pregnancy complications by maternal age during delivery hospitalizations.

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