Do chest CT findings predict the outcome in pregnant patients with COVID-19 pneumonia? A cross-sectional study

Abstract

Background: COVID-19 is a novel infectious disease that poses significant challenges for the management of pregnant patients, especially regarding the use and interpretation of chest CT scans. This study aimed to evaluate the clinical significance and radiological features of chest CT scans in pregnant women with COVID-19. Methods: The authors conducted a cross-sectional, multi-center study of 53 pregnant women with confirmed COVID-19 by RT-PCR testing who underwent chest CT scans in three hospitals in Iran. They collected and analyzed data on demographic, clinical, laboratory, and radiological variables, as well as maternal and neonatal outcomes. They used low-dose chest CT protocol and abdominal shields to minimize radiation exposure and assessed the interobserver reliability of the chest CT diagnosis using Cohen’s kappa coefficient. Results: The study included 41 pregnant women with COVID-19 and available chest CT scans. The mean maternal age was 34.6±7.60 years and the mean gestational age was 28.73±5.66 weeks. Dyspnea was the most common symptom (85.4%), followed by fever (68.3%) and cough (51.2%). Asthma (p=0.001) and diabetes (p=0.001) were significantly associated with worse outcomes and abnormal chest CT scans. Myalgia (p=0.001), respiratory distress (p=0.001), admission O2 saturation (p=0.001), leukopenia (p=0.001), lymphocytosis (p=0.001), and high CRP levels (p=0.001) were also correlated with adverse outcomes and abnormal chest CT scans. Normal chest scans were observed in 25 patients (61%), while 16 patients (39%) had abnormal CT scan findings. Ground glass opacity (81.3%) and consolidation (68.8%) were the most common radiological features on chest CT scans. Four maternal deaths occurred due to delayed referral and underlying comorbidities such as heart failure or renal failure. Conclusion: The percentage of lung involvement and the presence of consolidation on chest CT scans could predict the prognosis of pregnant women with COVID-19. Chest CT scans could be a useful tool for the diagnosis and management of COVID-19 in pregnancy, especially in cases of severe symptoms or comorbidities.