COVID‐19 Coagulopathy in Pregnancy: Critical Review, Preliminary Recommendations and ISTH Registry ‐ Communication from the ISTH SSC for Women’s Health

Kadir, Rezan Abdul; Kobayashi, Takao; Iba, Toshiaki; Erez, Offer; Thachil, Jecko; Kazi, Sajida; Malinowski, Ann Kinga; Othman, Maha

BACKGROUND: Novel coronavirus (SARS‐CoV‐2), which causes COVID‐19, has thus far affected over 15 million individuals, resulting in over 600,000 deaths worldwide, and the number continues to rise. In a large systematic review and meta‐analysis of the literature including 2,567 pregnant women, 7% required intensive care admission, with a maternal mortality ~1% and perinatal mortality below 1%. There has been a rapid increase in publications on COVID‐19 associated coagulopathy, including disseminated intravascular coagulopathy (DIC) and VTE, in the non‐pregnant population, but very few reports of COVID‐19 coagulopathy during pregnancy; leaving us with no guidance for care of this specific population. METHODS: This is a collaborative effort conducted by a group of experts which was reviewed, critiqued and approved by the ISTH Subcommittee for Women’s Health Issues in Thrombosis and Hemostasis. A structured literature search was conducted, and the quality of current and emerging evidence was evaluated. Based on the published studies in the non‐pregnant and pregnant population with a moderate to high risk of bias as assessed by Newcastle‐Ottawa scale and acknowledging the absence of data from randomized clinical trials for management of pregnant women infected with SARS‐CoV‐2, a consensus in support of a guidance document for COVID‐19 coagulopathy in pregnancy was identified. RESULTS AND CONCLUSIONS: Specific haemostatic issues during pregnancy were highlighted, preliminary recommendations to assist in the care of COVID‐19‐affected pregnant women with coagulopathy or thrombotic complications were developed. An international registry to gather data to support the management of COVID‐19 and associated coagulopathy in pregnancy was established.