Maternal Death Due to COVID-19 Disease

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

Abstract Background Despite 2.5 million infections and 169,000 deaths worldwide (current as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity had been reported to be related to COVID-19 disease. Given the disproportionate burden of severe and mortal respiratory disease previously documented among pregnant women following other related coronavirus outbreaks (SARS-CoV in 2003 and MERS-CoV) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected. Objectives To describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease. Study design We describe here a multi-institution adjudicated case series from Iran which includes 9 pregnant women diagnosed with severe COVID-19 disease during their latter 2nd or 3rd trimester. All 9 pregnant women were diagnosed with SARS-CoV-2 infection by rRT-PCR nucleic acid testing (NAT). Outcomes of these women were compared to their familial/household members with exposure 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. Results 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 the maternal outcomes were more severe when compared to other high and low-risk familial/household members (n=33 members for comparison). Conclusion We report herein maternal deaths due to COVID-19 disease. Until rigorously collected surveillance data emerges, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed with COVID-19 disease in their latter trimester(s).