Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100134. doi: 10.1016/j.ajogmf.2020.100134. Epub 2020 May 8.
The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited.
This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2.
This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation ≤93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24-48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported.
Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m. Gestational age was at a mean of 29±6 weeks at symptom onset and a mean of 30±6 weeks at hospital admission, with a median disease day 7 since first symptoms. Most women (81%) were treated with hydroxychloroquine; 7% of women with severe disease and 65% of women with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation during their admission. The median duration of hospital stay was 6 days (6 days [severe group] and 10.5 days [critical group]; =.01). Intubation was usually performed around day 9 on patients who required it, and peak respiratory support for women with severe disease was performed on day 8. In women with critical disease, prone positioning was required in 20% of cases, the rate of acute respiratory distress syndrome was 70%, and reintubation was necessary in 20%. There was 1 case of maternal cardiac arrest, but there were no cases of cardiomyopathy or maternal death. Thirty-two of 64 (50%) women with coronavirus disease 2019 in this cohort delivered during their hospitalization (34% [severe group] and 85% [critical group]). Furthermore, 15 of 17 (88%) pregnant women with critical coronavirus disease 2019 delivered preterm during their disease course, with 16 of 17 (94%) pregnant women giving birth through cesarean delivery; overall, 15 of 20 (75%) women with critical disease delivered preterm. There were no stillbirths or neonatal deaths or cases of vertical transmission.
In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.
2019 年冠状病毒病大流行对全球医疗体系造成了影响，截至本文撰写之时，已有 300 万人感染该病毒，20.8 万人因此病死亡。关于冠状病毒感染孕妇的信息仍然有限。
本研究旨在描述在 12 家美国机构住院的严重和危急 2019 年冠状病毒病孕妇的临床过程，这些孕妇的严重急性呼吸综合征冠状病毒 2 实验室检测结果为阳性。
这是一项对 2020 年 3 月 5 日至 4 月 20 日期间住院的 12 名患有严重或危急 2019 年冠状病毒病的孕妇进行的队列研究。根据已发表的标准，严重疾病定义为患者自述呼吸困难、呼吸频率＞30 次/分钟、在空气环境下血氧饱和度≤93%、动脉血氧分压与吸入氧分数比值＜300mmHg，或胸部影像学显示 24-48 小时内肺浸润＞50%。危急疾病定义为呼吸衰竭、脓毒症性休克或多器官功能或衰竭。如果孕妇被认为患有 2019 年冠状病毒病，但实验室检测结果为阴性，则将其排除在研究之外。主要结局是从入院到出院的中位时间。次要结局包括需要补充氧气、插管、心肌病、心脏骤停、死亡和分娩时间。描述这些症状出现后疾病发生的中位天数。还报告了治疗和新生儿结局。
在 64 名患有 2019 年冠状病毒病的住院孕妇中，44 名（69%）患有严重疾病，20 名（31%）患有危急疾病。观察到以下合并症：25%有肺部疾病，17%有心脏疾病，平均体重指数为 34kg/m。症状出现时的妊娠周数平均为 29±6 周，入院时的妊娠周数平均为 30±6 周，自首次出现症状起中位疾病日为 7 天。大多数妇女（81%）接受了羟氯喹治疗；7%的严重疾病患者和 65%的危急疾病患者接受了瑞德西韦治疗。所有危急疾病患者在住院期间均接受了预防性或治疗性抗凝治疗。中位住院时间为 6 天（严重组为 6 天，危急组为 10.5 天；=0.01）。需要插管的患者通常在第 9 天进行插管，而严重疾病患者的最高呼吸支持时间为第 8 天。在危急疾病患者中，有 20%的患者需要俯卧位，急性呼吸窘迫综合征的发生率为 70%，需要再次插管。有 1 例产妇心脏骤停，但无心肌病或产妇死亡病例。在本队列中，32 名（50%）2019 年冠状病毒病孕妇在住院期间分娩（严重组为 34%，危急组为 85%）。此外，17 名（88%）危急 2019 年冠状病毒病孕妇中有 15 名在疾病过程中早产，17 名（94%）孕妇均通过剖宫产分娩；总体而言，20 名（75%）危急疾病患者中有 15 名早产。无死胎、新生儿死亡或垂直传播病例。
在患有严重或危急 2019 年冠状病毒病的孕妇中，入院通常发生在症状出现后 7 天左右，住院时间为 6 天（严重组为 6 天，危急组为 12 天）。危急疾病患者急性呼吸窘迫综合征发生率较高，有 1 例心脏骤停，但无心肌病或产妇死亡。严重或危急 2019 年冠状病毒病孕妇的住院治疗导致本队列中有 50%的患者在疾病过程中分娩，通常在孕晚期。本队列中无围产期死亡病例。
