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).