Department of Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
BMC Pregnancy Childbirth. 2021 Feb 5;21(1):108. doi: 10.1186/s12884-021-03568-0.
As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19.
Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed.
One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two.
Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.
由于妊娠是一种生理性的促凝状态，孕妇可能面临与 COVID-19 相关的凝血病和/或血栓栓塞并发症的风险增加。
在 2019 年 9 月至 2020 年 6 月期间，我们在两个生物医学数据库中搜索了基于阳性拭子或高度临床怀疑但未进行拭子检查而诊断为 COVID-19 的孕妇的病例报告和系列病例。还包括作者所知道的其他登记案例。采取了措施来尽量减少重复的患者。使用标准表格提取基于异常凝血试验结果或弥漫性血管内凝血（DIC）的临床证据以及动脉或静脉血栓形成的凝血障碍信息。如果有详细的实验室结果和母婴结局信息，也进行了分析。
有 1063 名女性符合纳入标准，其中 3 名（0.28，95%CI0.0 至 0.6）有动脉和/或静脉血栓形成，7 名（0.66，95%CI0.17 至 1.1）有 DIC，另有 3 名（0.28，95%CI0.0 至 0.6）有凝血障碍但不符合 DIC 的定义。537 名女性（56%）已报告分娩，426 名（40%）处于妊娠中。有 17 名（1.6，95%CI0.85 至 2.3）孕产妇死亡，其中有 2 名报告 DIC 是死亡的一个因素。
我们的数据表明，COVID-19 感染的妊娠中凝血障碍和血栓栓塞均增加。前者的检测可能有助于识别有恶化风险的女性。
