Maternal and Perinatal Morbidity and Mortality in COVID-19 Positive Obstetrics Patients in Tertiary Care Centre

Abstract

Background: COVID-19 disease had been declared as a public health crisis by WHO by the end of 2019. SARS-CoV- 2, a strain of coronavirus is responsible for this pandemic. This virus has human-to-human transmission especially through close contact with an infected person or from fomites, and can be readily isolated from respiratory droplets or secretions, faeces. The effect of SARS-CoV-2 infection on pregnancy including symptoms, disease severity, risk of vertical transmission and perinatal and neonatal outcome have been the subject of research. Preliminary studies showed a fluctuating course of the disease ranging from asymptomatic or mild symptoms to even maternal death. However, recent evidences suggest that effect of COVID-19 infection during pregnancy may not lead to adverse maternal and neonatal outcome. The most common presentation, of pregnant women who were infected with SARS-CoV-2, was only mild or moderate cold/flu-like symptoms. The aim of this study is to describe the maternal and neonatal morbidity and mortality of pregnancies with SARS-CoV-2 infection.

Methods: In this cross sectional prospective observational study, we analysed 60 pregnant women infected with SARS- CoV-2 and their neonatal outcome, who tested positive for Covid-19 at district hospital, and were referred to Muzaffarnagar Medical College, were enrolled in this study. Maternal clinical manifestations, laboratory tests and treatments were studied along with the neonatal outcome. The outcomes of pregnancies included abortion, intrauterine fetal death (IUFD), preterm birth and live birth and they were assessed.

Results:

 The study comprised 60 pregnant women who tested positive for SARS-CoV-2. The median age of these women was 27 years old (interquartile range: 20–36), and the median gestational age at diagnosis was 37.64 weeks (IQR: 13.7–41.9). The majority of these women, 96.7% (58), had no symptoms at all, with coughing being the most common symptom, appearing in 3.3% (2) of the women. Out of the 60 pregnant women, 1 (1.6%) had an incomplete first trimester abortion at the time of the analysis, and 2 (4.34%) had IUFD. Pneumonitis was detected radiologically in 24 (75%) of the women, but since they showed no symptoms, they did not need intensive care. In addition, 76.08% (35) of the perinatal and neonatal outcomes were found to be normal. Neonatal deaths (2.17%) and preterm neonates (2.17%) were less common than NICU admissions (6.52%). Proportion of IUGR being at 8.09% (4) which was higher than IUDs observed 4.34% (2).

Conclusions: In this study we observed that most of the women with COVID-19 were asymptomatic or with mild symptoms. Even though they were asymptomatic, most of the patients showed pneumonitis changes radiologically but still they didn’t require any intensive care, had good recovery postpartum and were discharged under satisfactory condition. The neonatal outcome was highly favourable.

Abbreviations: IUFD: Intra Uterine Foetal Death, RT-PCR: Reverse Transcriptase – Polymerase Chain Reaction, IQR: Interquartile range