Objectives
To describe characteristics of pregnant or postpartum women who died due to COVID‐19 complications in Brazil and the mortality rate in the obstetric population.
Methods
We adopted a case finding approach combining data from Brazilian Ministry of Health Acute Respiratory Distress Syndrome Surveillance System (ARDS‐SS) and systematic review of academic and grey literature using terms for COVID‐19, SARS‐CoV‐2, maternal deaths and Brazil. Maternal deaths during pregnancy or the postpartum period were analysed to remove potential duplicates. Demographic and clinical characteristics and mortality rate were described.
Results
491 pregnant or postpartum women with COVID‐19 were identified and 62 women died (12.6%). Average age of fatal cases was 31.4 ± 6.1 years and the average gestational age of symptoms onset was 26.5 ± 5.8 weeks. Symptoms onset occurred in pregnancy
OC04.04: Table 1. Demographic and clinical characteristics of COVID‐19‐related death cases in Brazil
|
Age Mean ⟨DP⟩ |
31.4 ⟨6.1⟩ 15 – 47 |
|
Symptoms onset n % Pregnancy Postpartum Missing data |
41 ⟨66.1⟩ 15 ⟨24.2⟩ 6 ⟨9.7⟩ |
|
Gestational age of symptoms onset Mean ⟨SD⟩ Min – Max |
26.5 ⟨5.8⟩ 13 – 34 |
|
Trimester of symptoms onset) n % 1st 2nd 3rd Missing data |
2 ⟨4.9⟩ 11 ⟨26.8⟩ 23 ⟨56.1⟩ 5 ⟨12.2⟩ |
|
Comorbidities or risk factors n % None At least 1 comorbidity Missing data |
16 ⟨25.8⟩ 29 ⟨46.8⟩ 17 ⟨27.4⟩ |
|
Prevalence of comorbidities n % Cardiovascular disease Asthma Diabetes Obesity Hypothyroidism Systemic Erythematous Lupus Others× |
14⟨31.1⟩ 7 ⟨15.6⟩ 6 ⟨13.3⟩ 4⟨8.9⟩ 3 ⟨6.7⟩ 2⟨4.4⟩ 5 ⟨11.1⟩ |
|
Delivery‐related time of death n % Postpartum Pregnancy |
43 ⟨69.4⟩ 19 ⟨30.6⟩ |
| Pancreatitis, lung disease, HIV, chronic kidney disease, pyelonephritis (one occurrence each)× | — |
in 66.1%; at least 1 comorbidity was present in 46.8% of obstetric patients; 16 out of 62 had no reported comorbidities. Cardiovascular disease (including hypertensive disorders of pregnancy) and asthma were the most frequent comorbidities in the sample. 69.4% of deaths occurred in the postpartum period.
Conclusions
Mortality rate among pregnant and postpartum women seems higher than previous reports available in the international literature. The absolute number of maternal deaths disproportionally exceeded reports from elsewhere in the world.