Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
Department of Obstetrics and Gynecology, Strasbourg University Hospitals, Strasbourg, France.
Am J Obstet Gynecol. 2020 Dec;223(6):914.e1-914.e15. doi: 10.1016/j.ajog.2020.06.022. Epub 2020 Jun 15.
Despite the mainly reassuring outcomes for pregnant women with coronavirus disease 2019 reported by previous case series with small sample sizes, some recent reports of severe maternal morbidity requiring intubation and of maternal deaths show the need for additional data about the impact of coronavirus disease 2019 on pregnancy outcomes.
This study aimed to report the maternal characteristics and clinical outcomes of pregnant women with coronavirus disease 2019.
This retrospective, single-center study includes all consecutive pregnant women with confirmed (laboratory-confirmed) or suspected (according to the Chinese management guideline [version 7.0]) coronavirus disease 2019, regardless of gestational age at diagnosis, admitted to the Strasbourg University Hospital (France) from March 1, 2020, to April 3, 2020. Maternal characteristics, laboratory and imaging findings, and maternal and neonatal outcomes were extracted from medical records.
The study includes 54 pregnant women with confirmed (n=38) and suspected (n=16) coronavirus disease 2019. Of these, 32 had an ongoing pregnancy, 1 had a miscarriage, and 21 had live births: 12 vaginal and 9 cesarean deliveries. Among the women who gave birth, preterm deliveries were medically indicated for their coronavirus disease 2019-related condition for 5 of 21 women (23.8%): 3 (14.3%) before 32 weeks' gestation and 2 (9.5%) before 28 weeks' gestation. Oxygen support was required for 13 of 54 women (24.1%), including high-flow oxygen (n=2), noninvasive (n=1) and invasive (n=3) mechanical ventilation, and extracorporeal membrane oxygenation (n=1). Of these, 3, aged 35 years or older with positive test result for severe acute respiratory syndrome coronavirus 2 using reverse transcription polymerase chain reaction, had respiratory failure requiring indicated delivery before 29 weeks' gestation. All 3 women were overweight or obese, and 2 had an additional comorbidity.
Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth. Its association with other well-known risk factors for severe maternal morbidity in pregnant women with no infection, including maternal age above 35 years, overweight, and obesity, suggests further studies are required to determine whether these risk factors are also associated with poorer maternal outcome in these women.
尽管此前的病例系列研究报告了 COVID-19 对孕妇的结果基本令人安心，但一些最近关于需要插管的严重产妇发病率和产妇死亡的报告表明，需要更多关于 COVID-19 对妊娠结局影响的数据。
本研究旨在报告 COVID-19 孕妇的母体特征和临床结局。
本回顾性单中心研究纳入了所有 2020 年 3 月 1 日至 4 月 3 日期间因确诊（实验室确诊）或疑似（根据中国管理指南[第 7.0 版]） COVID-19 而入住斯特拉斯堡大学医院（法国）的连续妊娠孕妇，无论诊断时的孕龄如何。从病历中提取了母体特征、实验室和影像学检查结果以及母婴结局。
研究纳入了 54 例确诊（n=38）和疑似（n=16）COVID-19 的孕妇。其中，32 例孕妇继续妊娠，1 例流产，21 例分娩：12 例阴道分娩和 9 例剖宫产。在分娩的孕妇中，5 例（23.8%）因 COVID-19 相关疾病而需要医学上的早产分娩：3 例（14.3%）在 32 周之前，2 例（9.5%）在 28 周之前。54 例孕妇中有 13 例（24.1%）需要吸氧支持，包括高流量吸氧（n=2）、无创（n=1）和有创（n=3）机械通气和体外膜氧合（n=1）。其中，3 例年龄在 35 岁或以上且 SARS-CoV-2 逆转录聚合酶链反应检测呈阳性的孕妇因呼吸衰竭需要在 29 周之前进行有指征的分娩。这 3 例孕妇均超重或肥胖，且 2 例合并其他合并症。
COVID-19 孕妇的发病率和早产与母体发病率相关。它与孕妇无感染时已知的其他严重产妇发病率的危险因素（如年龄在 35 岁以上、超重和肥胖）相关，表明需要进一步研究以确定这些危险因素是否也与这些孕妇的不良母体结局相关。
