Maternal and Fetal Outcomes in Pregnancies with Covid-19: A Retrospective Analysis

Abstract

Objectives: To study the sociodemographic features, obstetric profile and clinical disease patterns in pregnancies with COVID-19, and to correlate with maternal and fetal outcomes.
Methods: A retrospective analysis,from1st April 2020 to 15th August 2020, on a cohort of pregnant/ postpartum (within 6weeks) subjects with COVID-19 infection confirmed either by RT‐PCR test for SARS‐CoV‐2 on nasopharyngeal and oropharyngeal swabs or by rapid antigen test kits. Information was collected from department data base and case record files. All women seen in the emergency either because they were showing clinical symptoms of COVID 19 or in labor or did not have home quarantine facility and were admitted. They were classified into – Asymptomatic/Mild category: minimal symptoms, no respiratory distress, RR 12-15/min, fever < 100 F, SPO2 > 95%; Moderate category: RR 15-30/min, Fever 100- 101.5 F, SPO2 90-94%, pneumonia on clinical/radiological examination; Severe category: Severe respiratory distress, shock, subnormal mentation, RR >30/min, fever >101.5 F, SPO2 <90%, ARDS, septic shock.
Results: 99 women with Covid-19 infection were included in the study-; 82 testing positive by RTPCR and remaining 17 had positive rapid antigen test. Three women underwent medical MTP, 2 underwent laparotomy for ectopic pregnancy,39 delivered vaginally and 36 by LSCS while 19 were still undelivered. The majority were young (median age 26.76 years), educated, urban and sedentary (not practicing yoga/exercise). Obstetric profile- Most of the patients were multiparous, presented in third trimester with no major associated medical or obstetric complications or complaints. Anaemia was commonest medical complication in 58 patients, pre-eclampsia in 11, preterm labor in 3, and transient liver dysfunction was observed in 3 subjects. Clinical profile- Asymptomatic/Mild disease: 92, moderate disease: 4, severe disease: 3. Majority (65) had no COVID symptoms, fever (21), breathlessness (8), atypical symptoms like diarrhoea (2) and headache (1) were present in these numbers. The mean SpO2 at admission was 98.17%. Most of the participants had no clinical findings in chest. Majority had normal TLC and platelet count and no covid changes on CXR. In treatment, more than 80% received Hydroxychloroquine & Azithromycin, 7.10% were put on Oxygen, 10.10% received steroids and LMWH was given to 75.75% patients. There were 3 maternal mortalities; all had associated pre-eclampsia and anaemia and underwent emergency caesarean section. No neonate had asphyxia/ mortality. Testing for SARS-CoV-2 was performed on all neonates, with only one testing positive by RTPCR.

Conclusion: The present data on Indian population do not suggest an increased risk of severe disease among pregnant women, as has been observed with earlier influenza infections. However certain factors like pre-eclampsia, anaemia and emergency caesarean section may predispose them to severe morbidity/mortality.