Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis.
BJOG
; 127(13): 1618-1626, 2020 12.
Article
in English
| MEDLINE | ID: covidwho-913443
ABSTRACT
OBJECTIVE:
To describe clinical characteristics of pregnant and postpartum women with severe COVID-19 in Brazil and to examine risk factors for mortality.DESIGN:
Cross-sectional study based on secondary surveillance database analysis.SETTING:
Nationwide Brazil. POPULATION OR SAMPLE 978 Brazilian pregnant and postpartum women notified as COVID-19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020.METHODS:
Data was abstracted from the Brazilian ARDS Surveillance System (ARDS-SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. MAIN OUTCOMEMEASURES:
Case fatality rate.RESULTS:
We identified 124 maternal deaths, corresponding to a case fatality rate among COVID-19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID-19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect.CONCLUSIONS:
Negative outcomes of COVID-19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period. TWEETABLE ABSTRACT A total of 124 COVID-19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Pregnancy Complications, Cardiovascular
/
Pregnancy Complications, Infectious
/
Puerperal Disorders
/
Respiratory Distress Syndrome
/
Coronavirus Infections
/
Diabetes Mellitus
/
Obesity, Maternal
Type of study:
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Adult
/
Female
/
Humans
/
Pregnancy
/
Young adult
Country/Region as subject:
South America
/
Brazil
Language:
English
Journal:
BJOG
Journal subject:
Gynecology
/
Obstetrics
Year:
2020
Document Type:
Article
Affiliation country:
1471-0528.16470
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