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%