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Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience

  • Selcan Sinaci EMAIL logo , Atakan Tanacan , Berhan Besimoglu , Dilek Menekse Beser , Derya Uyan Hendem , Duygu Tugrul Ersak , Aysegul Atalay , Ecem Kaya , Eda Ozden Tokalioglu , Hayriye Cankar Dal , Doga Fatma Ocal , Deniz Erdem , Seval Izdes , Ozlem Moraloglu Tekin , İhsan Ates , Sema Turan and Dilek Sahin
Published/Copyright: May 3, 2023
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 51 Issue 7

Abstract

Objectives

This study aimed to present perinatal outcomes, clinical challenges, and basic ICU management in pregnant women with severe-critical COVID-19 at our tertiary referral center.

Methods

In this prospective cohort study, patients were divided into two groups, whether they survived or not. Clinical characteristics, obstetric and neonatal outcomes, initial laboratory test results and radiologic imaging findings, arterial blood gas parameters at ICU admission, and ICU complications and interventions were compared between groups.

Results

157 of the patients survived, and 34 of the patients died. Asthma was the leading health problem among the non-survivors. Fifty-eight patients were intubated, and 24 of them were weaned off and discharged healthfully. Of the 10 patients who underwent ECMO, only 1 survived (p<0.001). Preterm labor was the most common pregnancy complication. Maternal deterioration was the most common indication for a cesarean section. Higher neutrophil-to-lymphocyte-ratio (NLR) values, the need for prone positioning, and the occurrence of an ICU complication were important parameters that influenced maternal mortality (p<0.05).

Conclusions

Overweight pregnant women and pregnant women with comorbidities, especially asthma, may have a higher risk of mortality related to COVID-19. A worsening maternal health condition can lead to increased rates of cesarean delivery and iatrogenic prematurity.

Keywords: critical care; maternal mortality; newborn; pregnancy; preterm birth; severe-critical COVID-19
Corresponding author: Selcan Sinaci, Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, 1604th Street, No. 9, Cankaya, Ankara 06800, Türkiye, E-mail:

Acknowledgments

The authors would like to thank all perinatologists, neonatologists, infectious disease specialists, cardiovascular surgeons, and intensive care physicians and nurses, who have worked devotedly to provide optimal health care to patients during the pandemic period.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. SS: concept design, methodology, data collection, data analysis/interpretation and writing; AT: reviewing and editing, revising the draft critically; BB, DM, DUH, DTE, AA: data collection, data analysis/interpretation; EK, EOT, HCD: data curation, visualization; DFO: reviewing and editing; DE, Sİ: data analysis/interpretation; OMT: supervision; İA: data analysis/interpretation, reviewing; ST: concept design, reviewing and editing; DS: concept design, methodology, reviewing and editing, final approval.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

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Received: 2022-11-21
Accepted: 2023-01-19
Published Online: 2023-05-03
Published in Print: 2023-09-26

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes
  4. Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis
  5. Opinion Papers
  6. Anger: an underappreciated destructive force in healthcare
  7. Severe maternal thrombocytopenia and prenatal invasive procedures: still a grey zone
  8. Commentary
  9. The care of the magic of life before and after its beginning
  10. Original Articles – Obstetrics
  11. The impact of trimester of COVID-19 infection on pregnancy outcomes after recovery
  12. Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience
  13. Are bacteria, fungi, and archaea present in the midtrimester amniotic fluid?
  14. Bioavailability of the tumor necrosis factor alpha/regulated on activation, normal T cell expressed and secreted (RANTES) biosystem inside the gestational sac during the pre-immune stages of embryo development
  15. The role of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PIGF) – ratio in clinical practice in obstetrics: diagnostic and prognostic value
  16. Prenatal diagnosis of non-mosaic sex chromosome abnormalities: a 10-year experience from a tertiary referral center
  17. Prediction of lung maturity through quantitative ultrasound analysis of fetal lung texture in women with diabetes during pregnancy
  18. Evaluation of an artificial intelligent algorithm (Heartassist™) to automatically assess the quality of second trimester cardiac views: a prospective study
  19. Original Article – Fetus
  20. Fetal brain activity and the free energy principle
  21. Predictive value of ultrasound in prenatal diagnosis of hypospadias: hints for accurate diagnosis
  22. The effect of maternal diabetes on the expression of gamma-aminobutyric acid and metabotropic glutamate receptors in male newborn rats’ inferior colliculi
  23. Original Articles – Neonates
  24. Respiratory function monitoring during early resuscitation and prediction of outcomes in prematurely born infants
  25. Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU
  26. Short Communication
  27. Use of a pocket-device point-of-care ultrasound to assess cervical dilation in labor: correlation and patient experience
  28. Letters to the Editor
  29. Correspondence on “COVID-19 vaccination and pregnancy”
  30. Response to the letter to the editor regarding “Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes”
https://doi.org/10.1515/jpm-2022-0564
Keywords for this article
critical care; maternal mortality; newborn; pregnancy; preterm birth; severe-critical COVID-19

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes
  4. Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis
  5. Opinion Papers
  6. Anger: an underappreciated destructive force in healthcare
  7. Severe maternal thrombocytopenia and prenatal invasive procedures: still a grey zone
  8. Commentary
  9. The care of the magic of life before and after its beginning
  10. Original Articles – Obstetrics
  11. The impact of trimester of COVID-19 infection on pregnancy outcomes after recovery
  12. Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience
  13. Are bacteria, fungi, and archaea present in the midtrimester amniotic fluid?
  14. Bioavailability of the tumor necrosis factor alpha/regulated on activation, normal T cell expressed and secreted (RANTES) biosystem inside the gestational sac during the pre-immune stages of embryo development
  15. The role of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PIGF) – ratio in clinical practice in obstetrics: diagnostic and prognostic value
  16. Prenatal diagnosis of non-mosaic sex chromosome abnormalities: a 10-year experience from a tertiary referral center
  17. Prediction of lung maturity through quantitative ultrasound analysis of fetal lung texture in women with diabetes during pregnancy
  18. Evaluation of an artificial intelligent algorithm (Heartassist™) to automatically assess the quality of second trimester cardiac views: a prospective study
  19. Original Article – Fetus
  20. Fetal brain activity and the free energy principle
  21. Predictive value of ultrasound in prenatal diagnosis of hypospadias: hints for accurate diagnosis
  22. The effect of maternal diabetes on the expression of gamma-aminobutyric acid and metabotropic glutamate receptors in male newborn rats’ inferior colliculi
  23. Original Articles – Neonates
  24. Respiratory function monitoring during early resuscitation and prediction of outcomes in prematurely born infants
  25. Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU
  26. Short Communication
  27. Use of a pocket-device point-of-care ultrasound to assess cervical dilation in labor: correlation and patient experience
  28. Letters to the Editor
  29. Correspondence on “COVID-19 vaccination and pregnancy”
  30. Response to the letter to the editor regarding “Covid-19 vaccination and pregnancy: a systematic review of maternal and neonatal outcomes”
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