Eighty-nine per cent of COVID-19 related maternal mortality was more in women of age group 20-30 years, revealed a single-centre prospective observational study conducted by the Lokmanya Tilak Municipal medical college and general Sion hospital on Covid-19 and pregnancy.
In the study, a total of 390 patients were included who were found COVID-19 positive during the study period and 17 patients who died during their hospital admission.
The study also revealed that the majority of the Covid-19 positive mothers were discharged without major complications, severe maternal mortality was reported as a result of Covid-19. The study was published in the International Journal of Reproduction, Contraception, Obstetrics and Gynaecology on January 11.
Dr Niranjan Chavan, one of the main authors of the study and professor and unit chief, gynaecology department, Sion Hospital said the Objective of the current study was to study demographic and associated factors in a maternal mortality patient with COVID-19 infection.
The study period was from 1 April 2020, to July 30 July 2021. Moreover, the study selection criteria were based on pregnant women with quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR- confirmed SARS-CoV-2 infection visiting the hospital in the out-patient department undergoing admission and visiting the emergency department met the eligibility requirements.
“Most women presented to our centre with complaints of fever, cough, cold or breathlessness (55.5%). Patients who succumbed to COVID-19 were mostly primiparous (52.9%) and died within 5 days of delivery (46%). 64% of patients died following 5 days of diagnosis of COVID-19. The co-morbidity present in most patients with COVID-19 associated maternal mortality was pre-eclampsia (31.5%). Most patients were referred with only 17% patients registered at our centre and the type of delay involved in management was mostly Type 1 and 2 (82.2%),” said Dr Chavan.
The study, which included 17 deaths, said the most significant association of co-morbidities in maternal mortality patients with COVID-19 was pre-eclampsia- a condition in pregnancy characterised by high blood pressure, sometimes with fluid retention and presence of protein in the urine.
Dr Chavan added that during the study, they saw two kinds of delays in the patients who lost their lives. "We saw there was a delay in the patient seeking medical help and there was a delay in the referral of the patient to the tertiary care centre. 83% of the delays were combinations of these two," he said.
In the present study, we see how COVID-19 has accelerated maternal death in a tertiary care centre. The maximum number of COVID-19 related maternal death coincides with the peak COVID-19 cases demographically seen at that time.
There were fewer cases seen in 2021 which may denote effective vaccination drives and low exposure to mothers due to increased knowledge of the disease. The uncertainty regarding the treatment of COVID-19 infection during 2020 was also eliminated in 2021 leading to proper guidelines especially in pregnant females leading to better treatment of patients and thus lower maternal mortality resulting from it.
“Although the majority of COVID-19 positive mothers were discharged without major complications, severe maternal mortality was reported as a result of COVID-19. The mortality rates of COVID-19 are comparable with that of non-COVID-19 patients. Furthermore, based on the above findings, the mortality rate in this study appeared to be higher in COVID-19 infection with pre-eclampsia. Multi-centre retrospective analysis with larger population size is required in order for this to be statistically significant,” concluded Dr Chavan.
