Asian Research Journal of Gynaecology and Obstetrics

Background: The novel Coronavirus has established itself as the challenging pandemic of the 21^st century.  Maternal-fetal medicine practice has had to evolve continuously to meet the demands of this pandemic.  Researchers all over the globe have been working on this novel viral infection to find effective preventive and treatment modalities, less progress has been achieved so far. The pathogen displays a wide range of severity, causing difficulty in determining infection outcome. It is of great importance to study the effects of this virus on pregnancy and its outcome. Unpredictable and exaggerated immune response with raised inflammatory markers are the cardinal laboratory features in COVID-19 infection which help in reflecting the disease severity.

Objectives: 1) To study the clinical manifestations and management of COVID-19 in pregnant women and 2) To study the maternal outcomes in confirmed cases of COVID-19 as compared to pregnant women who were COVID-19 negative during that time.

Methods: This is a retrospective longitudinal study to analyze the clinical manifestations and to study the maternal outcomes in confirmed cases of COVID-19 from June 1^st 2020 to May 31^st 2021. Data were collected from case records and patient details regarding obstetric history, preexisting comorbidities, clinical manifestations, investigations and interventions. Data were recorded and analyzed. 96 COVID-19 positive and 96 COVID-19 negative pregnant women were included in this study conducted at our tertiary care institution.

Results: In COVID-19 Positive group, mean Pulse rate was 98.0 ± 9.0 bpm, mean Temperature was 96.9 ± 1.2^OF, mean SpO2 was 96.7 ± 4.3. Mean Pulse Rate, Temperature was high in COVID-19 positive group compared to COVID-19 negative group. Mean SpO2 was significantly lower in COVID-19 positive group compared to COVID-19 negative group. Total count, Neutrophil count, Eosinophil count was low in COVID-19 positive group and basophilic count was high in COVID-19 positive group compared to negative group. In COVID-19 positive patients, mean Serum Ferritin was 82.6 ± 156.4, mean serum LDH was 313.6 ± 230.0, mean D dimer was 1.2 ± 0.8, mean CRP was 2.0 ± 0.9. In COVID-19 negative patients mean Serum Ferritin was 46.1 ± 88.8, mean serum LDH was 227.7 ± 74.8, mean D dimer was 0.5 ± 0.4, mean CRP was 5.2± 7.0. There was significant difference in Serum Ferritin, serum LDH, D dimer and Serum CRP between two groups.  In COVID-19 positive mothers, 11.4% had HTN comparable to 4.2% in COVID-19 negative group. Distribution of mode of delivery: 57.9% delivered by LSCS, 30.6% by vaginal delivery and 11.6% were not delivered. 16.9% had Low birth weight, 1.2% had macrosomia, and 2.4% had IUD and 1.1% of mothers died in COVID-19 positive group. The inflammatory markers were statistically significant. There was a higher rate for LSCS in view of the COVID-19 pandemic.

Conclusion: COVID-19 infection was noted to have an impact on the cytokine profile of pregnant women, which can be correlated with the disease severity. The mode of delivery does not have much impact on the disease severity of pregnant women. The severe form of COVID-19 disease was seen in 1% of COVID-19 positive pregnant women and proved to be fatal. LSCS was done in this case to reduce the respiratory burden on the mother. Hypertension was found more significant in the COVID-19 positive group. 2.1% of the cases had abruption, 6.25% were found to have PPROM when compared to 3.1% in control group.