COVID-19 and Pregnancy Outcome: An Experience in ‘COVID-19 Management Designated’ Tertiary Care Hospital, Rawalpindi, Pakistan
Background: The current COVID-19 pandemic has affected almost 17.3 million victims worldwide with mortality of almost 674K. Pregnancy is one of the most susceptible conditions for COVID-19 infection, but limited data is currently available about the clinical characteristics of pregnant women with the disease. Objective; to describe the clinical characteristics, co-morbidities, management, feto-maternal, and neonatal outcome in COVID-19 positive pregnant women.
Methodology: A descriptive case series study was conducted in Obs/Gynae dept of Benazir Bhutto Tertiary Care Hospital, Rawalpindi, including all asymptomatic/symptomatic COVID-19 positive pregnant women and clinical suspects (COVID-19 PCR negative women) delivered in our hospital from 01st April 2020 to 31st July 2020. Their medical records were reviewed for clinical characteristics, management, feto-maternal and neonatal outcomes. Continuous variables were expressed in Mean & Range and Categorical variables as number & Percentage. Results: During the study period a total of 17 cases were reviewed. The mean maternal age was 28.94 yrs. Primigravida (07), Multipara (10). Mean gestational age was 37 wks (range; 30-41wks). Presenting symptomatology was varied. Asymptomatic; (29%), COVID-19 specific symptoms; fever & flu (12%), fever&cough (6%), shortness of breath(SOB) alone (6%), fever & SOB(6%) and pregnancy-related manifestations were labour pains (17%), eclampsia(6%), hydrocephalous fetus (6%) and hepatic encephalopathy(6%). The commonest co-morbidity was Hypertensive disorders of pregnancy (24%). Five women (29%) required ICU care. Lower segment caesarean sections(LSCS) (59%), vaginal delivery (41%). Eleven babies delivered with good Apgar score and birth weight. Two were early neonatal deaths (ENND) and 04 were received intra-uterine fetal deaths (IUDs). Fetal demise was associated with strong obstetric risk factors. Out of 13 live-born babies, RT-PCR Covid-19 testing was done in 10 (77%) cases and was negative. One mother was expired due to complications of hepatic encephalopathy, sepsis, and burst abdomen.
Conclusion; The clinical course of COVID-19 disease in pregnancy seems to be no different from non-pregnant women. Clinical manifestations are diverse and infection contracted in the third trimester of pregnancy is associated with good feto-maternal and neonatal outcomes.
1. Organization WH. Corona virus disease 2019 (COVID-19): situation report 2020;vol.72.
2. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-openingremarks-
3. Leung K, Wu JT, Liu D, Leung GM. First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment. Lancet 2020;935 (10233):1382–93.
4. Available on; (https://www.worldometers.info/coronavirus/country/pakistan/, accessed on: July 31, 2020.
5. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020; 20 (5): 559-64.
6. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. New England Journal ofMedicine.2020.
7. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel corona virus in Wuhan, China.The Lancet. 2020;395(10223):497-506.
8. W-j Guan, Ni Z-y, Hu Y, Liang W-h, C-q Ou, He J-x, et al. Clinical characteristics of corona virus disease 2019 in China. N Engl J Med 2020;382(April (18)):1708–20.
9. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;102433.
10. W.N. Phoswa, O.P. Khaliq. Is pregnancy a risk factor of COVID-19?. Eur J Obstet Gynecol (2020), https://doi.org/10.1016/j.ejogrb.2020.06.058
11. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by the novel corona virus from Wuhan: an analysis based on decade-long structural studies of SARS corona virus. J Virol 2020;94(7).
12. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;24:91–8.
13. Tracking data on covid-19 during pregnancy can protect pregnanat women and their babies. Available on; http://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-opulations/pregnancy-data-on-covid-19.html
14. Sohail S, Dar LR. Pandemic of COVID-19 and pregnancy. Biomedica. 2020; 36 (COVID19-S2): 206-12.
15. RCOG. Corona virus (COVID-19) infection and pregnancy. Information for healthcare professionals. Available online at: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-09-coronavirus -COVID-19-infection-in-pregnancy.pdf
16. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9 (1): 51-60.
17. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395: 809–15
18. Stumpfe FM, Titzmann A, Schneider MO, Stelzl P, Kehl S, Fasching PA, et al. SARS-CoV-2 infection in pregnancy – a review of the current literature and possible impact on maternal and neonatal outcome. Geburtshilfe Frauenheilkd. 2020; 80 (4): 380-90.
19. Chan JF-W, Yuan S, Kok K-H, To KK-W, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to person transmission: a study of a family cluster. Lancet 2020;395(10223):514–23.
20. 20.Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clinical infectious diseases: an official publication of the infectious Diseases Society of America.2020.
21. Ellington S, Strid P, Tong VT, et al. Characteristics Of Women Of Reproductive Age With Laboratory-Confirmed Sars-Cov-2 Infecstion By Pregnancy status-United States, January22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769-75. DOI:http://dx.doi.org/10.15585/mmwr.mm6925a1
22. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020; 222 (5): 415-26.
23. Dekel N, Gnainsky Y, Granot I, Mor G. Inflammation and implantation. Am J Reprod Immunol 2010;63(1):17–21.
24. Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol 2010;63(6):425–33.
25. Wu Y, Liu C, Dong L, Zhang C, Chen Y, Liu J, et al. Coronavirus disease 2019 among pregnant Chinese women: case series data on the safety of vaginal birth and breastfeeding. BJOG. 2020;10.1111/1471-0528.16276. [Epub ahead of print].
26. Bauer M, Bernstein K, Dinges E, Delgado C, El-Sharawi N, Sultan P, et al. Obstetric anesthesia during the COVID-19 pandemic. Anesth Analg. 2020. [Epub ahead of print].
27. Collin J, Byström E, Carnahan A, Ahrne M. Public Health Agency of Sweden’s brief report: pregnant and postpartum women with SARS‐CoV‐2 infection in intensive care in Sweden. Acta Obstet Gynecol Scand 2020. Epub May 9, 2020.
28. Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS One 2020;15(4)e0230295.
29. Liu W, Wang Q, Zhang Q, Chen L, Chen J, Zhang B, et al. Coronavirus Disease 2019 (COVID-19) During Pregnancy: A Case Series. 2020.
30. Lu Q, Shi Y. Coronavirus disease (COVID-19) and neonate: What neonatologist need to know. Journal of Medical Virology. 2020.
31. Chua MSQ, Lee JCS, Sulaiman S, Tan HK. From the frontlines of COVID-19–Howprepared are we as obstetricians: a commentary. BJOG: An International Journal of Obstetrics & Gynaecology. 2020.
32. Mardani M, Pourkaveh B. A Controversial Debate: Vertical Transmission of COVID-19 in Pregnancy. Neoscriber Demo Publisher.
33. Coronavirus Disease (COVID-19) and Breastfeeding. Center for Disease Control and prevention Available on: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html (Page last reviewed: June 4, 2020)
34. Breast Feeding and Covid-19.WHO Scientific Brief, 23 JUNE 2020. WHO reference number: WHO/2019-nCoV/Sci_Brief/Breastfeeding/2020.1
Copyright (c) 2020 Shazia Syed, Humera Noreen, Humaira Masood, Ismat Batool, Hina Gul, Nighat Naheed
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.