Are Pregnant Women with COVID-19 More Likely to Experience Thrombosis or DIC?
BACKGROUND AND PURPOSE:
Servante et al. (BMC Pregnancy and Childbirth, 2021) sought to estimate the rate of arterial or venous thrombosis acquired coagulopathy in pregnant women with COVID-19
Systematic review and meta-analysis
Case reports and case series between September 2019 and June 2020
Studies that observed pregnant women with COVID-19 (diagnosis based either on a positive swab or high clinical suspicion)
Additional registry cases known to the authors were included
Duplicate patients were excluded to the extent possible
Laboratory results and information on maternal outcomes were analyzed (when available)
Coagulopathy: Abnormal coagulation test results or clinical evidence of DIC
Arterial or venous thrombosis
1063 pregnant women with positive or suspected COVID-19 | 69 papers
Given birth: 56%
Incidence rates for primary outcomes
Arterial and/or venous thrombosis: 0.28% (95% CI, 0.0 to 0.6%)
DIC: 0.66% (95% CI, 0.17 to 1.1)
Coagulopathy without meeting definition of DIC: 0.28% (95% CI, 0.0 to 0.6%)
17 total maternal deaths
Incidence rate: 1.6% (95% CI, 0.85 to 2.3%)
DIC reported as a factor in 2 deaths | PE reported in 2 deaths (different from those non-survivors with DIC)
Absolute risk of thromboembolic complications in pregnancy without COVID-19 is 0.1% and for DIC is between 0.03 to 0.35%
Coagulopathy and thromboses appears to be more common in pregnant women with COVID-19 vs pregnant women without a COVID-19 diagnosis
The authors conclude
Our findings suggest that haematological complications are more commonly observed in pregnant women with COVID-19 infection (1.26%) than in pregnant women without (0.45%) and support the current advice from the RCOG recommending that all pregnant women admitted with confirmed or suspected COVID-19 receive prophylactic low molecular weight heparin (LMWH), unless birth is expected within 12 h, and continue this for 10 days following discharge
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