Haemostatic and thrombo-embolic complications in pregnant women with
COVID-19: a systematic review and critical analysis
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.