Haemostatic and thrombo-embolic
complications in pregnant women with COVID-19: a systematic review and
critical
analysis
Juliette Servante1, Gill Swallow2,
Jim G Thornton3, Bethan Myers4,
Sandhya Munireddy4, A. Kinga
Malinowski5, Maha Othman6,7, Wentao
Li8, Keelin O’Donoghue9, Kate F
Walker3
1Department of Obstetrics and Gynaecology, Nottingham
University Hospitals NHS Trust, Nottingham
2Department of Haematology, Nottingham University
Hospitals NHS Trust, Nottingham
3Division of Child Health, Obstetrics and Gynaecology,
School of Medicine, University of Nottingham
4 Department of Haematology, University Hospitals of
Leicester, Leicester
5Department of Obstetrics and Gynaecology, Division of
Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Mt.
Sinai Hospital, Canada; Department of Obstetrics & Gynaecology,
University of Toronto.
6Department of Biomedical and Molecular Sciences,
School of Medicine, Queen’s University Kingston, Ontario, Canada
7School of Baccalaureate Nursing, St Lawrence College,
Kingston, Ontario, Canada
8Department of Obstetrics and Gynaecology, Monash
University, Clayton, Australia
9The Irish Centre for Maternal and Child Health,
University College Cork, Cork University Maternity Hospital, Cork,
Ireland
Shortened running title: Haematological complications of COVID
in pregnancy
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.
Funding : no funding received
Keywords: COVID-19, SARS-CoV-2, pregnancy, birth, venous
thrombosis, arterial thrombosis, coagulopathy, disseminated
intravascular coagulopathy, haematological complications.
Tweetable Abstract: Disseminated intravascular coagulopathy in
0.66% of 1063 pregnant women with COVID-19; arterial +/ venous
thrombosis in 0.28%