Results
From February 25 to April 22, 2020 15 Regions in Italy notified 65
pregnant women with confirmed COVID-19 infection receiving in or
outpatient hospital care. Of these, 55 (84.6%) were notified by 5
Regions and 2 Autonomous Provinces located in the North of the country
(Fig.1).
Italian Regions adopted different organisational models to face the
epidemic and the vast majority centralised the admissions of suspected
or positive COVID-19 women in dedicated hub hospitals. Overall, during
the study period 11 pregnant women have been transferred to a hub from a
different hospital.
This paper describes the first 65 cases admitted to hospital during
pregnancy, 33.8% receiving outpatient care and 66.2% inpatient care
either for antenatal complications of COVID-19 infection (n=38) or for
medical (n=3) or obstetric (n=2) conditions.
The COVID-19 infection diagnosis was confirmed by RT-PCR testing in 63
cases, in 1 case through antibody response from maternal peripheral
blood and in 1 case through chest RX.
During the 14 days prior to symptom onset, just over half of the women
reported having risk contacts. Specifically, 31 reported close contact
with a confirmed or probable case and 4 reported entrance in a health
care facility with confirmed SARS-CoV-2 cases.
Table 1 shows the women’s socio-demographic and obstetric
characteristics stratified by occurrence of COVID-19 pneumonia affecting
41.5% of the cohort. One case of Chlamydia pneumonia has been excluded
from the stratified analysis presented in the tables. Gestational age at
diagnosis ranges between 6 and 39 weeks, 15.6% of the women ≤14 weeks,
51.6% between 15 and 27 weeks and 32.8% ≥28 weeks of pregnancy.
Women’s mean age is 33.8 years (SD=5.5), and almost 70% of the women is
multipara. Pregnant women without Italian citizenship develop COVID-19
pneumonia in a higher proportion compared to Italian women. Having at
least one previous comorbidity is significantly associated to pneumonia
diagnosis (p-value 0.002), obesity being the most frequently reported
comorbidity (16.9%) followed by autoimmune diseases (6.2%).
Six per cent of the women had been administered the flu vaccine when
pregnant, and 2 only quit smoking during pregnancy. No fetal growth
restriction was diagnosed in any pregnancy.
At hospital admission, 10.8% of the women were asymptomatic. Table 2
describes the reported symptoms stratified by occurrence of pneumonia:
cough (70.8%), fever (63.1%) and general weakness (47.7%) being
overall the most common. Dyspnea was reported by 66.7% of the women
affected by pneumonia vs 18.9% of the unaffected (p-value 0.001).
Overall, 41.5% of the enrolled women developed COVID-19 pneumonia.
Tab 3 describes the adopted diagnostic imaging techniques, the principal
vital signs, laboratory reports and the therapeutic measures, stratified
by occurrence of pneumonia among hospitalised women. Around half of the
cases with confirmed pneumonia have been diagnosed through chest X-ray,
37% received lung ultrasound alone or in association with chest X-ray,
and 11% underwent chest TC. Among women without COVID-19 pneumonia,
46.7% has not undergone any diagnostic imaging techniques.
Body temperature over 37.5°C affected 40.7% of the women with pneumonia
and 26.7% of those without, respectively 63.0% and 33.3% presented
lymphopenia (<1500 mm3) and 44.4% and 6.7%
had C-reactive protein (CRP) values >10mg/100ml.
The percentage of hospitalised women receiving at least one
pharmacological treatment is 81.5% among women with pneumonia and
66.7% among the others. Overall, around half of the women were treated
with antiviral drugs, hydroxichloroquine and empirical antibiotic
therapy, with markedly higher percentages among women with confirmed
COVID-19 pneumonia compared to the unaffected, as described in table 3.
Oxygen saturation <95% was registered overall in 19% of the
cases and in 26% of the women affected by COVID-19 pneumonia. Sixteen
of the 30 blood gas analyses carried out were pathological, all but one
in the group with confirmed pneumonia. Overall, 55.8% of the
hospitalised women and 37% of those affected by COVID-19 pneumonia did
not require any respiratory support. Among women with COVID-19
pneumonia, respectively 63% and 29.6% received non-invasive and
invasive respiratory support; one underwent orotracheal intubation, none
required extracorporeal membrane oxygenation (Tab.3).
Overall 3 women were in critical conditions due to severe morbidity (1
renal failure and 2 acute respiratory distress syndrome) (Tab. 2) and 3
were admitted to intensive care unit (ICU) for 5, 8 and 22 days
respectively (Tab. 3). All unfavourable outcomes concerned women with
pneumonia and no maternal deaths were recorded. Ninety per cent of the
hospitalised women have been discharged, and the average hospital stay
is 9.8 days (range 1-30 days).