An Insight on the Maternal-Fetal Outcomes of Critically Ill Pregnant Women During the Second Wave of COVID-19

Abstract

Background: Coronavirus disease 2019 and other respiratory infections have been attributed to causing severe disease and pneumonia in pregnant women because of physiological stress and alterations in the immune system during pregnancy. Pregnant women are prone to develop serious outcomes for both mother and child when infected by previous coronaviruses, but there is a paucity of data regarding clinical characteristics and maternal-fetal outcomes in COVID-19. Moreover, various laboratory and radiological parameters are scarcely studied in pregnant women in the third trimester who develop severe COVID-19. Therefore, we conducted this study to assess and compare the maternal-fetal outcomes of critically ill pregnant women with COVID-19 pneumonia who required admission to the intensive care unit (ICU). Materials and methods:We conducted this retrospective observational study at a tertiary care hospital affiliated with an academic center in the United Arab Emirates. A total of 123 patients in their third trimester were included in the study from December 1, 2020, to March 31, 2021, comprising 30 cases of severe or critical COVID-19 and 93 mild to moderate COVID-19 patients. We collected and analyzed maternal demographic data and radiological and biochemical profiles. We also compared maternal-fetal outcomes.Results: Thirty patients (24.3%) were admitted to the ICU, and eight required invasive ventilation. Severe COVID-19 pneumonia was significantly associated with higher mortality (20% vs. 0%; p < 0.001), postpartum complications (50% vs. 9.67%; p < 0.001), and increased overall hospital stay than mild to moderate COVID-19 (p < 0.001). In addition, the primary indication for intervention in severe cases was worsening of COVID-19 pneumonia, and pregnant patients had significantly greater chances of undergoing delivery by Cesarean section (80% vs. 40.8%; p = 0.01). Neonates born to severe COVID-19 patients had significantly higher chances of being born preterm (76.6% vs. 35.7%; p < 0.001) and had low birth weight (46.6% vs. 13.9%; pvalue = 0.002). There were four stillbirth cases, two vertical transmission cases, and no neonatal deaths.Conclusions: This study assessed and compared maternal-fetal outcomes of critically ill pregnant women with COVID-19 pneumonia who required admission to the ICU because of the paucity of data in this patient demographic. Pregnant women with severe COVID-19 have high mortality, peripartum complications, increased hospital stay, and are more likely to undergo Cesarean section delivery because of COVID-19 progression than pregnant patients with less severe forms of COVID-19. The newborns born to such mothers may be premature and have low birth weights but have similar mortality to those born to mothers with mild to moderate COVID-19.

COVID-19-associated morbidity and mortality outcomes in pregnant patients admitted to intensive care unit

“…Moreover, low SpO 2 at admission to the intensive care unit was associated with increased mortality. The most common symptoms observed in pregnant women in our study were consistent with previous studies (Allotey J, et al,2020;Faraz S, et al,2022;Hantoushzadeh S, et al, 2020;Sitter M, et al, 2022;Zaigham M, Andersson O. 2020).…”

“…The neonatal mortality rate was reported to range from 0% to 11.7% (Vergara-Merino L, et al,2021;Litman EA, et al,2022;Epelboin S, et al,2021;Antoun L, et al,2020;Jafari M, et al,2021). In addition, severe cases are associated with longer hospital stays and intensive care unit admissions (Faraz S, et al,2022). The rate of cesarean section was higher in patients in our study, and severe COVID-19 infection was associated with an increased risk of cesarean section.…”

“…In another study, it was stated that among 385 pregnant women, 17 were admitted to the intensive care unit with one maternal death (Elshafeey F, et al,2020). Moreover, in a study on 123 COVID-19positive pregnant women, 30 patients (24.4%) had severe COVID-19 symptoms requiring intensive care unit admission, and 6 of these patients (20%) died (Faraz S, et al,2022). In two studies reporting higher mortality rates compared to these studies, it was stated that 10 out of 14 and 7 out of 9 patients admitted to ICUs died, respectively (Hantoushzadeh S, et al,2020;Ríos-Silva M, et al,2020).…”

“…They may also lead to the need for intensive care depending on the disease severity. In three studies, 35.2%, 40%, and, 83.6% of the pregnant women admitted to the intensive care units required IMV, respectively (Turan O, et al 2020;Faraz S, et al,2022;Elshafeey F, et al 2020).…”

Efeito protetor da vacina contra influenza para redução de mortalidade em gestantes e puérperas com formas graves de COVID-19

“…Considerando aspectos fisiológicos e inerentes à gestação, as adaptações mecânicas e nos sistemas imunológico e pulmonar tornam a gestante mais suscetível a infecções pulmonares, além de predisporem à evolução para quadros mais graves (43)(44)(45)(46)(47)(48).…”