Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study.
Publication/Presentation Date
8-1-2020
Abstract
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 24-48 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
CONCLUSION: In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.
Volume
2
Issue
3
First Page
100134
Last Page
100134
ISSN
2589-9333
Published In/Presented At
Pierce-Williams, R. A. M., Burd, J., Felder, L., Khoury, R., Bernstein, P. S., Avila, K., Penfield, C. A., Roman, A. S., DeBolt, C. A., Stone, J. L., Bianco, A., Kern-Goldberger, A. R., Hirshberg, A., Srinivas, S. K., Jayakumaran, J. S., Brandt, J. S., Anastasio, H., Birsner, M., O'Brien, D. S., Sedev, H. M., … Berghella, V. (2020). Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. American journal of obstetrics & gynecology MFM, 2(3), 100134. https://doi.org/10.1016/j.ajogmf.2020.100134
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
32391519
Department(s)
Administration and Leadership
Document Type
Article