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Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: a systematic review and critical analysis
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  • Juliette Servante,
  • Gill Swallow,
  • James Thornton,
  • Bethan Myers,
  • Sandhya Munireddy,
  • Kinga Malinowski,
  • Maha Othman,
  • Wentao Li,
  • Keelin ODonoghue,
  • Kate Walker
Juliette Servante
Queen's Medical Centre Nottingham University Hospital NHS Trust
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Gill Swallow
Queen's Medical Centre Nottingham University Hospital NHS Trust
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James Thornton
Nottingham City Hospital
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Bethan Myers
University Hospitals of Leicester NHS Trust
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Sandhya Munireddy
University Hospitals of Leicester NHS Trust
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Kinga Malinowski
Lunenfeld-Tanenbaum Research Institute
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Maha Othman
Queen's University
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Wentao Li
Monash University
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Keelin ODonoghue
University College Cork
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Kate Walker
University of Nottingham
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Abstract

Background: As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. Objectives: To investigate the occurrence of haemostatic and thrombo-embolic complications in pregnant women with COVID-19. Search Strategy: Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with COVID-19. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Selection criteria: Pregnant women with COVID-19 based either on a positive swab or high clinical suspicion e.g. symptoms and radiographic evidence. Data Collection and Analysis: Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. Main Results: 1063 women met the inclusion criteria, of which three (0.28%) had arterial and/or venous thrombosis, seven (0.66%) had DIC, and a further three (0.28%) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6%) maternal deaths in which DIC was reported as a factor in two. Conclusions: Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.