Abstract
BackgroundIn contrast to the first wave, the second COVID-19 wave has taken a huge toll affecting maternal outcomes adversely. The aim of this study was to investigate the consequences of the severity of maternal disease on perinatal outcomes and the risk of vertical transmission and to find out the factors associated with adverse fetomaternal outcomes.Materials and methodsThis was an ambispective observational study including COVID-19 infected pregnant patients; 20-40 years of age irrespective of gestational age admitted at Government Institute of Medical Sciences, UP, India. The patients were divided into two groups: CW 1 (COVID-19 Wave 1): Patients admitted between April 1, 2020 and December 31, 2020 and CW 2 (COVID-19 Wave 2): Patients admitted between April 1, 2021 to May 31, 2021.Data in two groups were compared and analyzed with respect to the clinical profile, laboratory parameters, fetomaternal outcome and the risk of vertical transmission of COVID-19 infection.ResultsWe included 134 eligible patients in the CW1 group and 58 in the CW2 group. Significantly more patients were symptomatic in CW2 (23.1% versus 60.3%, p= <0.001). In CW2, maternal neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP) and D-Dimer were significantly raised along with abnormal chest x-rays. There was a significant increase in maternal mortality in CW2 (1.5% vs 13.7%; p≤0.001).A total of 76 patients delivered in CW1 and 26 in CW2 with increased incidence of cesarean section (43.4%; 42.3%), preterm deliveries (28.2%; 37%) and low birth weight (34.6%; 25.9%) in both waves, the difference among two groups being statistically insignificant. Compared to CW1, perinatal mortality was significantly increased in CW2 (2.2% vs 15.5%; p<0.001). Though nasopharyngeal swab tested positive in four neonates in CW1 and two neonates in CW2, no evidence of vertical transmission was observed even with increased severity of maternal illness. On regression analysis, D-Dimer and CRP were found to have a positive association with maternal and perinatal mortality. ConclusionThe severity of maternal illness proportionately affects the neonatal outcome with no impact on the risk of vertical transmission of infection. D-Dimer and CRP have emerged as independent predictors for maternal and perinatal mortality and hence can be utilized in obstetrics decision-making.
Highlights
COVID-19 infection has hit the whole world so hard that all have been left aghast
Compared to CW1, perinatal mortality was significantly increased in CW2 (2.2% vs 15.5%; p
D-Dimer and C-reactive protein (CRP) have emerged as independent predictors for maternal and perinatal mortality and can be utilized in obstetrics decision-making
Summary
COVID-19 infection has hit the whole world so hard that all have been left aghast. The pandemic has directly affected pregnant patients via COVID-19 infection as well as indirectly via disrupting maternal health services. Most of the studies reported asymptomatic or mild infection in pregnant patients with low mortality; contrary to this, second wave has taken a huge death toll in India and other countries probably owing to the high transmission rate and rapid emergence of new viral strains [1]. The disproportionate impact of pandemic on maternal and perinatal outcome has surfaced in two waves worldwide as well as between high-income countries and low-middle income countries [5]. With this trend observed there has emerged need to recognize the impact of maternal disease severity on perinatal outcome with respect to morbidity, mortality and vertical transmission which will aid in better management of obstetrical patients. The aim of this study was to investigate the consequences of the severity of maternal disease on perinatal outcomes and the risk of vertical transmission and to find out the factors associated with adverse fetomaternal outcomes
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