Maternal mortality among women with coronavirus disease 2019 admitted to the intensive care unit

Abstract

Maternal mortality among women with coronavirus disease 2019 admitted to the intensive care unit OBJECTIVE:Limited data are available on critically ill pregnant women hospitalized with coronavirus disease 2019 (COVID-19). Although maternal mortality has been reported, 1e3 the frequency with which this devastating outcome occurs is unknown. The objective of this study was to determine the rate of maternal death among pregnant and postpartum women with COVID-19 admitted to the intensive care units (ICUs) in a large integrated health system in the New York metropolitan area. In this study, we described patient demographics, baseline comorbidities, clinical presentation, hospital course, and maternal outcomes. STUDY DESIGN:This case series evaluated all consecutively hospitalized pregnant and immediately postpartum women with laboratory-confirmed diagnosis of COVID-19 who were admitted to the ICUs at 10 hospitals within Northwell Health, the largest academic health system in New York, and Maimonides Medical Center, an affiliate of Northwell Health in Brooklyn, NY, from March 1, 2020, to May 6, 2020. Collectively, these hospitals perform approximately 40,000 deliveries per year, representing about 1 in 6 births in the state of New York and 1% of all births in the United States. Respiratory specimens were collected using nasopharyngeal swabs. Symptomatic patients who received positive test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction (PCR) assay were included. Admission to the ICU was at the discretion of the consulted critical care attending physician at each site. Patients who had a critical care consultation but were not directly managed by an intensivist were not included.

Identifying and combating the impacts of COVID-19 on malaria

“…While COVID-19 is less often severe in children and pregnant women [13,14], these groups would bear a disproportionate burden of excess malaria mortality arising from COVID-19-related disruption of health systems and malaria control programmes, particularly in sub-Saharan Africa. Recently, the Malaria Atlas Project modelled these potential impacts in Africa for the World Health Organization's (WHO) Global Malaria Program [15].…”

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID‐19 in Brazil: a surveillance database analysis

“…Subsequent data emerging from Europe and North America also concluded that pregnant women were at no increased risk of severe COVID‐19 or death 3,7,8 . More recently, further studies reported higher risk of ICU admission and mechanical ventilation during pregnancy, 9,10 and the first cases of near miss and maternal deaths have emerged from Iran, US, UK, France, Mexico and Spain 7–9,11–16 …”

The Impact of the COVID-19 Pandemic on Maternal and Perinatal Health: A Scoping Review

“…[2][3][4][5][6] Laboratory ndings consistently included lymphopenia, leukopenia, thrombocytopenia, and elevated levels of C-reactive protein and transaminases. 2,[7][8][9] Others reported an increased D-dimer level and neutrophil/lymphocyte ratio and a decreased white blood cell count. 3,4 Chest CT scans revealed abnormal imaging features, namely ground-glass opacities, in the lungs of pregnant individuals with COVID-19, 2,5,10 but the clinical signi cance of these imaging ndings and the laboratory parameters is not clear.…”

“…Most cases of COVID-19 among pregnant individuals did not progress to severe disease, and ICU admission involving mechanical ventilation was seldom required. 1,2,11 The most commonly reported adverse outcome was preterm delivery; [6][7][8]12 and increased prevalence of low birthweight and Cesarean-section (C-section) delivery were also observed, 5,13 although these were not studies representative for well-de ned study bases. Other obstetric complications and outcomes including maternal death, stillbirth, miscarriage, preeclampsia, fetal growth restriction, coagulopathy, and premature rupture of membranes were rare, but apparent.…”