Symptomatic Covid-19 admissions in district general hospital: maternal and neonatal outcomes

Abstract

Design: A retrospective cohort study of 34 pregnant patients admitted with COVID-19 infection to a district general hospital in East of England. Outcomes included severe disease, failing organ system support, second-trimester miscarriage, stillbirth, iatrogenic prematurity, NICU admissions, neonatal SARS-Cov-2 infection and postnatal depression.

Methods: Thirty-four maternity admissions were identified reviewing the completed UKOSS COVID-19 notification forms submitted from 24th March 2020 to 29th December 2021. Admissions were grouped based on the place of care: maternity unit, medical wards or critical care (level 2 and 3) units. Demographics, antenatal risk factors, intrapartum and postnatal data were collected from electronic medical records and analysed using Microsoft Excel software.

Results: Of the 34 admitted patients, 2.9%, 17.6% and 79.4% were infected in the first, second and third trimesters, respectively. Among maternity COVID -19 admissions, 28 women (82.4%) were not vaccinated against SARS-CoV-2. Thirteen women (38.2%) required Critical Care with an average stay in the intensive care unit of 27.5 (1-106) days. Six patients (46.2%) required ventilation, of which 2 (15.4%) were transferred for extracorporeal membrane oxygenation. Fourteen maternity patients (41.17%) required expedited deliveries, including 8 (23.5%) due to deteriorating respiratory function and 6 (17.8%) because of fetal distress. Following early multidisciplinary team (MDT) discussions and delivery planning, 3 (21.4%) women had a single dose, and 9 (64.3%) had two doses of antenatal steroids prior to emergency caesarean section. The median gestational age at delivery in the aforementioned group was 32+5 (IQR - 34+3 - 29+4) weeks. Ten premature neonates required neonatal intensive care unit admissions. Two neonates (5.9%) were diagnosed with SARS-CoV-2, and one died because of acute respiratory distress syndrome. Regarding other adverse outcomes, we had one maternal death following severe COVID-19 infection, one case of late miscarriage at 19+4 weeks gestation, and two intrauterine deaths at 27+6 and 36+3 weeks. Histological examination of stillbirths’ placentas confirmed massive perivillous fibrin deposition and chronic histiocytic intervillositis. Three women (8.8%) were commenced on antidepressants postnatally following a traumatic experience, including neonatal loss and prolonged hospitalisation.

Conclusions: COVID-19 infection carries a significant risk to unvaccinated maternity patients. Our study identified various adverse pregnancy outcomes including maternal and neonatal deaths. Patients presenting with severe COVID-19 symptoms demonstrated rapid deterioration requiring invasive respiratory support and iatrogenic preterm delivery. Early MDT involvement in delivery planning can improve maternal and neonatal outcomes..