Experience in managing severe and extremely severe COVID-19 in pregnant women
- Authors: Gareyeva A.I.1, Mozgovaya E.V.2,3, Belopolskaya M.A.1,4, Kovalchuk A.S.1, Kucheryavenko A.N.1
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Affiliations:
- S.P. Botkin Clinical Infectious Diseases Hospital
- The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott
- Saint Petersburg State University
- Institute of Experimental Medicine
- Issue: Vol 71, No 1 (2022)
- Pages: 11-22
- Section: Original Research
- URL: https://journals.rcsi.science/jowd/article/view/72169
- DOI: https://doi.org/10.17816/JOWD72169
- ID: 72169
Cite item
Abstract
BACKGROUND: In the context of the COVID-19 pandemic caused by the SARS-CoV-2 virus, viral pneumonia is the leading clinical form of coronavirus infection and a significant cause of maternal mortality.
AIM: The aim of this study was to assess the course of severe and extremely severe forms of COVID-19, its impact on pregnancy and fetus, as well as on maternal mortality.
MATERIALS AND METHODS: In this retrospective study, we evaluated 39 case histories of patients with severe and extremely severe COVID-19, which were divided into two groups. Group 1 included 22 pregnant women with a severe course of coronavirus infection and a favorable outcome. Group 2 comprised 17 pregnant women in whom complications caused by SARS-CoV-2 were fatal.
RESULTS: More than 80% of patients with severe disease course had anaemia in pregnancy. The most significant clinical and anamnestic factors of adverse outcome were gestational diabetes mellitus (p = 0.02), preeclampsia (p = 0.05), and oligoamnios (p = 0.01). Obesity in group 2 was twice more common. The clinical manifestations of the disease in the both study groups were dominated by fever, shortness of breath, weakness and dry cough. In patients with a fatal outcome at the height of the disease, the levels of leukocytosis, urea and lactate dehydrogenase were higher than in those who recovered (p = 0.05). Besides, the levels of alanine transferase and aspartate transaminase were twice as high as in pregnant women who recovered later. Patients in the both study groups required oxygen support as respiratory failure progressed. The vast majority of patients with severe and extremely severe forms of coronavirus infection were in the third trimester of pregnancy.
CONCLUSIONS: Women in the third trimester of pregnancy are more susceptible to severe and extremely severe COVID-19 with an unfavorable outcome. Gestational diabetes mellitus, preeclampsia and oligoamnios are significant comorbidities that predispose to severe course and poor outcome in pregnant women and puerperas with COVID-19. The characteristic clinical manifestations of the severe course of coronavirus infection are shortness of breath and fever against a backdrop of significant damage to the lung tissue. A pronounced increase in hepatic enzymes and placental insufficiency is a harbinger of an unfavorable outcome as a manifestation of multiple organ failure.
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##article.viewOnOriginalSite##About the authors
Aygul I. Gareyeva
S.P. Botkin Clinical Infectious Diseases Hospital
Email: aygul.gareeva.90@mail.ru
ORCID iD: 0000-0001-7403-4594
MD
Russian Federation, Saint PetersburgElena V. Mozgovaya
The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; Saint Petersburg State University
Email: elmozg@mail.ru
ORCID iD: 0000-0002-6460-6816
SPIN-code: 5622-5674
MD, Dr. Sci. (Med.)
Russian Federation, 3, Mendeleevskaya Line, Saint Petersburg, 199034; Saint PetersburgMaria A. Belopolskaya
S.P. Botkin Clinical Infectious Diseases Hospital; Institute of Experimental Medicine
Email: belopolskaya.maria@yahoo.com
ORCID iD: 0000-0002-5107-8831
MD, Cand. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgAlexey S. Kovalchuk
S.P. Botkin Clinical Infectious Diseases Hospital
Email: babai_jo@bk.ru
ORCID iD: 0000-0001-8206-6561
MD
Russian Federation, Saint PetersburgAlexandr N. Kucheryavenko
S.P. Botkin Clinical Infectious Diseases Hospital
Author for correspondence.
Email: botkin.zamakush@zdrav.spb.ru
MD
Russian Federation, Saint PetersburgReferences
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497−506. doi: 10.1016/S0140-6736(20)30183-5
- World Health Organization [Internet]. Coronavirus disease (COVID-19) Weekly epidemiological update and weekly operational update. [cited 11 Dec 2021]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
- Moore KM, Suthar MS. Comprehensive analysis of COVID-19 during pregnancy. Biochem Biophys Res Commun. 2021;538:180−186. doi: 10.1016/j.bbrc.2020.12.064
- Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020;222(6):521−531. doi: 10.1016/j.ajog.2020.03.021
- Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with Coronavirus disease (COVID-19) pneumonia: A preliminary analysis. AJR Am J Roentgenol. 2020;215(1):127−132. Corrected and republished from: AJR Am J Roentgenol. 2020;215(1):262. doi: 10.2214/AJR.20.23072
- Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: Lessons from SARS, MERS, and other human coronavirus infections. Viruses. 2020;12(2):194. doi: 10.3390/v12020194
- Chen H, Guo J, Wang C, 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(10226):809−815. doi: 10.1016/S0140-6736(20)30360-3
- Iqbal SN, Overcash R, Mokhtari N, et al. An uncomplicated delivery in a patient with Covid-19 in the United States. N Engl J Med. 2020;382(16):e34. doi: 10.1056/NEJMc2007605
- Breslin N, Baptiste C, Miller R, et al. Coronavirus disease 2019 in pregnancy: early lessons. Am J Obstet Gynecol MFM. 2020;2(2):100111. doi: 10.1016/j.ajogmf.2020.100111
- LiuW, Wang Q, Zhang Q, et al. Coronavirus disease 2019 (COVID-19) during pregnancy: A case series. Preprints. 2020:2020020373. [cited 5 Dec 2021]. Available from: https://www.preprints.org/manuscript/202002.0373/v1
- Belokrinitskaya TE, Artymuk NV, Filippov OS, Frolova NI. Clinical course, maternal and neonatal outcomes of COVID-19 infection in pregnancy: an epidemiological study in Siberia and the Far East. Gynecology. 2021;23(1):43−47. (In Russ.). doi: 10.26442/20795696.2021.1.200639
- Kanash ZhA, Aubakir AK, Rahmanova UD, et al. Materinskaja smertnost’ sredi pacientov s COVID-19. Rozvitokosvіti, nauki ta bіznesu: rezul’tati 2020: tezi dop. mіzhnarodnoї naukovo-praktichnoїіnternet-konferencії, 3-4 grudnja 2020. Dnіpro. 2020;1:464. (In Russ.). [cited 11 Dec 21]. Available from: http://dspace.puet.edu.ua/bitstream/123456789/10007/1/(Part%201)%20Conference%20Results%202020.pdf#page=464
- Jafari M, Pormohammad A, Sheikh Neshin SA, et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Rev Med Virol. 2021;31(5):1−16. doi: 10.1002/rmv.2208
- Karimi L, Makvandi S, Vahedian-Azimi A, et al. Effect of COVID-19 on mortality of pregnant and postpartum women: A systematic review and meta-analysis. J Pregnancy. 2021;2021:8870129. doi: 10.1155/2021/8870129
- Ilchenko LYu, Nikitin IG, Fedorov IG. COVID-19 and liver damage. The Russian Archives of Internal Medicine. 2020;10(3):188−197. (In Russ.). doi: 10.20514/2226-6704-2020-10-3-188-197
- Belokrinitskaya TE, Frolova NI, Kolmakova KA, Shametova EA. Risk factors and features of COVID-19 course in pregnant women: a comparative analysis of epidemic outbreaks in 2020 and 2021. Gynecology. 2021;23(5):421−427. (In Russ.). doi: 10.26442/20795696.2021.5.201107
- Pierce-Williams RAM, Burd J, Felder L, et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM. 2020;2(3):100134. doi: 10.1016/j.ajogmf.2020.100134
- Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China. N Engl J Med. 2020;382:1708−1720. doi: 10.1056/NEJMoa2002032
- Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417−1418. doi: 10.1016/S0140-6736(20)30937-5
- Voevodin SM, Shemanaeva TV, Serova AV. Modern aspects of diagnosis and pathogenesis of oligohydramnios. Gynecology. 2017;19( 3):77−80.
- Xu L, Liu J, Lu M, et al. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998−1004. doi: 10.1111/liv.14435
- Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5(5):428−430. doi: 10.1016/S2468-1253(20)30057-1
- Xie H, Zhao J, Lian N, et al. Clinical characteristics of non-ICU hospitalized patients with coronavirus disease 2019 and liver injury: A retrospective study. Liver Int. 2020;40(6):1321−1326. doi: 10.1111/liv.14449
- Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. doi: 10.1136/bmj.m2107
- Breslin N, Baptiste C, Gyamfi-Bannerman C, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2(2):100118. doi: 10.1016/j.ajogmf.2020.100118
- Torosyan AO, Loginova EV, Gagaev ChG. Screening for gestational diabetes due to of the COVID-19 pandemic. Problemi Endocrinologii. 2020;66(3):56–61. (In Russ.). doi: 10.14341/probl12482