• BJOG · Dec 2020

    Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis.

    • Mls Takemoto, M O Menezes, C B Andreucci, R Knobel, L Sousa, L Katz, E B Fonseca, M Nakamura-Pereira, C G Magalhães, Csg Diniz, Aso Melo, Mmr Amorim, and Brazilian Group for Studies of COVID-19 and Pregnancy.
    • Programa de Pós-graduação em Tocoginecologia, Medical School of Botucatu, São Paulo State University (UNESP), Botucatu, Brazil.
    • BJOG. 2020 Dec 1; 127 (13): 1618-1626.

    ObjectiveTo describe clinical characteristics of pregnant and postpartum women with severe COVID-19 in Brazil and to examine risk factors for mortality.DesignCross-sectional study based on secondary surveillance database analysis.SettingNationwide Brazil.Population Or Sample978 Brazilian pregnant and postpartum women notified as COVID-19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020.MethodsData was abstracted from the Brazilian ARDS Surveillance System (ARDS-SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression.Main Outcome MeasuresCase fatality rate.ResultsWe identified 124 maternal deaths, corresponding to a case fatality rate among COVID-19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID-19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect.ConclusionsNegative outcomes of COVID-19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period.Tweetable AbstractA total of 124 COVID-19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.© 2020 John Wiley & Sons Ltd.

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