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. 2021 Feb 5;21(1):108.
doi: 10.1186/s12884-021-03568-0.

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

Juliette Servante  1 , Gill Swallow  2 , Jim G Thornton  3 , Bethan Myers  4 , Sandhya Munireddy  4 , A Kinga Malinowski  5 , Maha Othman  6   7 , Wentao Li  8 , Keelin O'Donoghue  9 , Kate F Walker  3
Affiliations

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

Juliette Servante et al. BMC Pregnancy Childbirth. .

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.

Methods: Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. 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.

Results: One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) 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, 95% CI 0.85 to 2.3) 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.

Keywords: Arterial thrombosis; Birth; COVID-19; Coagulopathy; Disseminated intravascular coagulopathy; Haematological complications; Pregnancy; SARS-CoV-2; Venous thrombosis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flow chart of papers included in analysis. Papers were identified between 08/02/20 and 05/06/20 using methodology described by Walker et al. The original dataset is available at https://ripe-tomato.org/2020/05/15/covid-19-in-pregnancy-101-onwards/. Exclusion criteria were applied, and 69 papers were included in the final analysis
See this image and copyright information in PMC

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