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Russian Journal of Human Reproduction ; 27(5):114-120, 2021.
Article in Russian | Scopus | ID: covidwho-1573839

ABSTRACT

Objective. To provide a comparative assessment of comorbid factors and the clinical course of the COVID-19 in pregnant women who died and survived a critical condition (near miss) in the Siberian and Far Eastern Federal Districts of Russia. Material and methods. Design was a retrospective study. The analysis of the primary medical documentation of pregnant women and postpartum women with a severe course of COVID-19 from April 1, 2020 to May 25, 2021 was carried out. Mathematical analysis included methods of descriptive statistics, analysis of contingency tables, where the value of χ2 was estimated, the achieved level of significance (p);calculation of the odds ratio (OR) at a 95% confidence interval (95% CI). Results. 10.842 cases of COVID-19 of pregnant women were registered in the Far Eastern Federal District and the Siberian Federal District. The incidence rate in pregnant women was 2.7 times higher than among the general population: 8833.5 vs. 3289.1 per 100 thousand population (8.8% vs. 3.2%;p<0.001). The proportion of deaths in pregnant women, women in labor and parturient women was 0.19%, among the population — 2.3% (p<0.001). The highest risk of maternal mortality (MM) is associated with obesity (OR=80.3;95% CI 9.34-690.19), slightly lower — with diabetes (OR=11.3;95% CI 2.0-63.27);chronic arterial hypertension (OR=17.2;95% CI 1.80-163.62);respiratory diseases (OR=12.2;95% CI 1.19-123.96);anemia (OR=4.5;95% CI 1.28-16.02). CT grade 3-4 lung damage on admission was associated with a 9-fold increase in the risk of death (OR=9.1;95% CI 3.03-27.14). The risk factors for MM were delay of antibacterial (OR=4.6;95% CI 11.24-16.87) and glucocorticoid (OR=3.4;95% CI 1.24-9.16) therapy. Anticoagulant therapy was prescribed statistically significantly later in the MM group (5.3±1.2 vs. 3.5±1.1;p=0.048). Conclusion. The risk of maternal mortality in COVID-19 is associated with co-morbid factors — obesity, diabetes, chronic arterial hypertension, respiratory diseases, and anemia, delay of antibacterial and glucocorticoid therapy. Timely anticoagulant therapy and delivery are key factors to preventing maternal mortality. Cesarean section for obstetric indications does not increase the risk of poor outcome, while operative delivery with intractable respiratory failure and refractory septic shock is associated with a high risk of maternal death. © 2021, Media Sphera Publishing Group. All rights reserved.

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