Maternal death due to COVID-19

• Published in: American journal of obstetrics and gynecology Vol. 223; no. 1; pp. 109.e1 - 109.e16
• Main Authors: Hantoushzadeh, Sedigheh, Shamshirsaz, Alireza A., Aleyasin, Ashraf, Seferovic, Maxim D., Aski, Soudabeh Kazemi, Arian, Sara E., Pooransari, Parichehr, Ghotbizadeh, Fahimeh, Aalipour, Soroush, Soleimani, Zahra, Naemi, Mahsa, Molaei, Behnaz, Ahangari, Roghaye, Salehi, Mohammadreza, Oskoei, Atousa Dabiri, Pirozan, Parisa, Darkhaneh, Roya Faraji, Laki, Mahboobeh Gharib, Farani, Ali Karimi, Atrak, Shahla, Miri, Mir Mohammad, Kouchek, Mehran, Shojaei, Seyedpouzhia, Hadavand, Fahimeh, Keikha, Fatemeh, Hosseini, Maryam Sadat, Borna, Sedigheh, Ariana, Shideh, Shariat, Mamak, Fatemi, Alireza, Nouri, Behnaz, Nekooghadam, Seyed Mojtaba, Aagaard, Kjersti
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2020
• Subjects: Adult; Betacoronavirus; coronavirus disease in pregnancy; Coronavirus Infections - mortality; COVID-19; Female; Humans; Infant, Newborn; Iran - epidemiology; lower respiratory infections in pregnancy; maternal death; Maternal Mortality; maternal respiratory morbidity; Middle Aged; Original Research; Pandemics; Pneumonia, Viral - mortality; Pregnancy; Pregnancy Complications, Infectious - mortality; Pregnancy Complications, Infectious - virology; respiratory failure with COVID-19; Retrospective Studies; SARS CoV-2 virus; SARS-CoV-2; Iran; COVID-19; maternal respiratory morbidity; respiratory failure with COVID-19; pregnancy; lower respiratory infections in pregnancy; maternal death; SARS CoV-2 virus; coronavirus disease in pregnancy; maternal mortality
• ISSN: 0002-9378; 1097-6868; 1097-6868
• DOI: 10.1016/j.ajog.2020.04.030

Despite 2.5 million infections and 169,000 deaths worldwide (as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity have been reported to be related to COVID-19 disease. Given the disproportionate burden of severe and fatal respiratory disease previously documented among pregnant women following other coronavirus-related outbreaks (SARS-CoV in 2003 and MERS-CoV in 2012) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected. To describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease. We describe here a multiinstitution adjudicated case series from Iran that includes 9 pregnant women diagnosed with severe COVID-19 disease in their second or third trimester. All 9 pregnant women received a diagnosis of SARS-CoV-2 infection by reverse transcription polymerase chain reaction nucleic acid testing. Outcomes of these women were compared with their familial/household members with contact to the affected patient on or after their symptom onset. All data were reported at death or after a minimum of 14 days from date of admission with COVID-19 disease. Among 9 pregnant women with severe COVID-19 disease, at the time of reporting, 7 of 9 died, 1 of 9 remains critically ill and ventilator dependent, and 1 of 9 recovered after prolonged hospitalization. We obtained self-verified familial/household cohort data in all 9 cases, and in each and every instance, maternal outcomes were more severe compared with outcomes of other high- and low-risk familial/household members (n=33 members for comparison). We report herein maternal deaths owing to COVID-19 disease. Until rigorously collected surveillance data emerge, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed as having COVID-19 disease in their second or third trimester.