BACKGROUND: Despite 2.5 million infections and 169,000 deaths worldwide (as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity have been reported to be related to COVID-19 disease. Given the disproportionate burden of severe and fatal respiratory disease previously documented among pregnant women following other coronavirus-related outbreaks (SARS-CoV in 2003 and MERS-CoV in 2012) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected. OBJECTIVE: To describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease. STUDY DESIGN: We describe here a multiinstitution adjudicated case series from Iran that includes 9 pregnant women diagnosed with severe COVID-19 disease in their second or third trimester. All 9 pregnant women received a diagnosis of SARS-CoV-2 infection by reverse transcription polymerase chain reaction nucleic acid testing. Outcomes of these women were compared with their familial/household members with contact to the affected patient on or after their symptom onset. All data were reported at death or after a minimum of 14 days from date of admission with COVID-19 disease. RESULTS: Among 9 pregnant women with severe COVID-19 disease, at the time of reporting, 7 of 9 died, 1 of 9 remains critically ill and ventilator dependent, and 1 of 9 recovered after prolonged hospitalization. We obtained self-verified familial/household cohort data in all 9 cases, and in each and every instance, maternal outcomes were more severe compared with outcomes of other high-and low-risk familial/household members (n¼33 members for comparison). CONCLUSION: We report herein maternal deaths owing to COVID-19 disease. Until rigorously collected surveillance data emerge, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed as having COVID-19 disease in their second or third trimester.

Because of the recent frequent observations of major dust storms in southwestern cities in Iran such as Ahvaz, and the importance of the ionic composition of particulate matters regarding their health effects, source apportionment, etc., the present work was conducted aiming at characterizing the ionic composition of total suspended particles (TSP) and particles on the order of ∼10 μm or less (PM(10)) during dust storms in Ahvaz in April-September 2010. TSP and PM(10) samples were collected and their ionic compositions were determined using an ion chromatography. Mean concentrations of TSP and PM(10) were 1,481.5 and 1,072.9 μg/m(3), respectively. Particle concentrations during the Middle Eastern Dust (MED) days were up to four times higher than those in normal days. Ionic components contributed to only 9.5% and 11.3% of the total mass of TSP and PM(10), respectively. Crustal ions were most abundant during dust days, while secondary ions were dominant during non-dust days. Ca(2+)/Na(+) and Cl(-)/Na(+) ratios can be considered as the indicators for identification of the MED occurrence. It was found that possible chemical forms of NaCl, (NH(4))(2)SO(4), KCl, K(2)SO(4), CaCl(2), Ca(NO(3))(2), and CaSO(4) may exist in TSP. Correlation between the anionic and cationic components suggests slight anion and cation deficiencies in TSP and PM(10) samples, though the deficiencies were negligible.

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