Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19) : Obstetrics & Gynecology

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Contents: Original Research

Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19)

Savasi, Valeria M. MD, PhD; Parisi, Francesca MD, PhD; Patanè, Luisa MD; Ferrazzi, Enrico MD; Frigerio, Luigi MD, PhD; Pellegrino, Antonio MD; Spinillo, Arsenio MD; Tateo, Saverio MD; Ottoboni, Mariacristina MD; Veronese, Paola MD, PhD; Petraglia, Felice MD; Vergani, Patrizia MD; Facchinetti, Fabio MD; Spazzini, Donata MD; Cetin, Irene MD, PhD

Author Information

Department of Woman, Mother and Neonate, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, the Department of Clinical and Biological Sciences, University of Milan, Milan, the Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, the Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, the Department of Clinical Sciences and Community Health, University of Milan, Milan, the Department of Obstetrics and Gynecology, A. Manzoni Hospital, ASST Lecco, Lecco, the Department of Obstetrics and Gynecology, University of Pavia, IRCCS Foundation Policlinico San Matteo, Pavia, the Department of Obstetrics and Gynecology, Santa Chiara Hospital, Trento, the Department of Obstetrics and Gynecology, AUSL Piacenza, Piacenza, the Obstetrics and Gynecology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, the Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Obstetrics and Gynecology, University of Florence, Florence, the Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, the Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, and the Obstetrics and Gynecology Unit, Azienda Ospedaliera Bolognini, Seriate, Italy.

Corresponding author: Francesca Parisi, MD, PhD, Department of Woman, Mother and Neonate, ASST Fatebenefratelli Sacco, Milan, Italy; email: [email protected].

Financial Disclosure Fabio Facchinetti disclosed receiving funds from Lo Li Pharma and Zambongroup. The other authors did not report any potential conflicts of interest.

The authors thank Manuela Cardellicchio and Maria di Giminiani (Milan, Sacco), Enrico Iurlaro and Beatrice Tassis (Milan, Mangiagalli), Elena Ciriello, Giulia Fierro, and Santa Mariangela Barresi (Bergamo), Roberta Tironi and Giulia Pavone (Lecco), Pierpaolo Zorzato and Maria Teresa Gervasi (Padua), Francesca Perotti (Pavia), Marzia Maini and Clelia Callegari (Monza), Federico Mecacci and Caterina Serena (Florence), Renza Bonini and Monica Minopoli (Piacenza), Paola Algeri and Valentina Stagnati (Seriate), Liliana Mereu and Anna Boschetti (Trento), for their essential contribution to recruitment, data collection, and cleaning.

Each author has confirmed compliance with the journal's requirements for authorship.

Published online ahead-of-print May 19, 2020.

Peer reviews and author correspondence are available at https://links.lww.com/AOG/B915.

Obstetrics & Gynecology 136(2):p 252-258, August 2020. | DOI: 10.1097/AOG.0000000000003979

OBJECTIVE: 

To investigate the clinical evolution of coronavirus disease 2019 (COVID-19) in hospitalized pregnant women and potential factors associated with severe maternal outcomes.

METHODS: 

We designed a prospective multicenter cohort study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to 12 Italian maternity hospitals between February 23 and March 28, 2020. Clinical records, laboratory and radiologic examinations, and pregnancy outcomes were collected. A subgroup of patients with severe disease was identified based on intensive care unit (ICU) admission, delivery for respiratory compromise, or both.

RESULTS: 

Seventy-seven patients were included, 14 of whom had severe disease (18%). Two thirds of the patients in the cohort were admitted during the third trimester, and 84% were symptomatic on admission. Eleven patients underwent urgent delivery for respiratory compromise (16%), and six were admitted to the ICU (8%). One woman received extracorporeal membrane oxygenation; no deaths occurred. Preterm delivery occurred in 12% of patients, and nine newborns were admitted to the neonatal intensive care unit. Patients in the severe subgroup had significantly higher pregestational body mass indexes (BMIs) and heart and respiratory rates and a greater frequency of fever or dyspnea on admission compared with women with a nonsevere disease evolution.

CONCLUSION: 

In our cohort, one in five women hospitalized with COVID-19 infection delivered urgently for respiratory compromise or were admitted to the ICU. None, however, died. Increased pregestational BMI and abnormal heart and respiratory rates on admission were associated with severe disease.

© 2020 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

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