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. 2022 Aug:12:100269.
doi: 10.1016/j.lana.2022.100269. Epub 2022 May 6.

Maternal mortality linked to COVID-19 in Latin America: Results from a multi-country collaborative database of 447 deaths

Fabian Maza-Arnedo  1 , Angel Paternina-Caicedo  2 , Claudio G Sosa  3 , Bremen de Mucio  3 , José Rojas-Suarez  1   4 , Lale Say  5 , Jenny A Cresswell  5 , Luis Andrés de Francisco  6 , Suzanne Serruya  3 , Diana Carolina Franco Pulido Lic  7 , Luis Urbina  8 , Erika Saint Hilaire  9 , César V Munayco  10 , Fabiola Gil  10 , Erick Rousselin  11 , Leonardo Contreras  12 , Allan Stefan  13 , Alvinzy Velásquez Becerra  14 , Evelyn Degraff  12 , Franco Espada  15 , Victor Conde  16 , Gustavo Mery  17 , Víctor Hugo Álvarez Castaño  18 , Aura Liliana Torres Umbarila  18 , Ivy Lorena Talavera Romero  19 , Yeimy Catherine Rodríguez Alfonso  19 , Raquel Lovato Silva  20 , Jakeline Calle  21 , Cynthia Marlene Díaz-Viscensini  21 , Vicente Nicolas Bataglia Frutos  22 , Elodia Vysokolán Laguardia  23 , Haydee Padilla  23 , Alvaro Ciganda  24 , Mercedes Colomar  3   24
Affiliations

Maternal mortality linked to COVID-19 in Latin America: Results from a multi-country collaborative database of 447 deaths

Fabian Maza-Arnedo et al. Lancet Reg Health Am. 2022 Aug.

Abstract
in English, Spanish

Background: This study aimed to describe the clinical characteristics of maternal deaths associated with COVID-19 registered in a collaborative Latin-American multi-country database.

Methods: This was an observational study implemented from March 1st 2020 to November 29th 2021 in eight Latin American countries. Information was based on the Perinatal Information System from the Latin American Center for Perinatology, Women and Reproductive Health. We summarized categorical variables as frequencies and percentages and continuous variables into median with interquartile ranges.

Findings: We identified a total of 447 deaths. The median maternal age was 31 years. 86·4% of women were infected antepartum, with most of the cases (60·3%) detected in the third trimester of pregnancy. The most frequent symptoms at first consultation and admission were dyspnea (73·0%), fever (69·0%), and cough (59·0%). Organ dysfunction was reported in 90·4% of women during admission. A total of 64·8% women were admitted to critical care for a median length of eight days. In most cases, the death occurred during the puerperium, with a median of seven days between delivery and death. Preterm delivery was the most common perinatal complication (76·9%) and 59·9% were low birth weight.

Interpretation: This study describes the characteristics of maternal deaths in a comprehensive multi-country database in Latin America during the COVID-19 pandemic. Barriers faced by Latin American pregnant women to access intensive care services when required were also revealed. Decision-makers should strengthen severity awareness, and referral strategies to avoid potential delays.

Funding: Latin American Center for Perinatology, Women and Reproductive Health.

Antecedentes: Este estudio tuvo el objetivo de describir las características clínicas de las muertes maternas asociadas a COVID-19 registradas en una base de datos latinoamericana multipaís.

Métodos: Se implementó un estudio observacional descriptivo en el que participaron ochos países Latinoamericanos desde el 1ero de marzo 2020 al 29 de noviembre 2021. La información se obtuvo del Sistema Informático Perinatal del Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva. Presentamos las variables categóricas como frecuencias y porcentajes y las variables continuas en medianas con rangos inter cuartiles.

Resultados: Identificamos un total de 447 muertes. La mediana de edad materna fue de 31 años. 86·4% de las mujeres se infectaron ante del parto, siendo la mayoría de los casos detectados en el tercer trimestre del embarazo (60·3%). Los síntomas más frecuentes en la primera consulta y la admisión fueron disnea (73·0%), fiebre (69·0%), y tos (59·0%). Se reportaron disfunciones orgánicas en 90·4% de las mujeres durante la admisión. Un total de 64·8% de las mujeres fueron ingresadas a cuidados críticos por una mediana de ocho días de estadía. En la mayoría de los casos la muerte ocurrió durante el puerperio, con una media de siete días entre el parto y su ocurrencia. El parto prematuro fue la complicación perinatal más frecuente (76·9%) y 59·9% tuvo bajo peso al nacer.

Interpretación: Este estudio describe las características de las muertes maternas durante la pandemia por COVID-19 a partir de una base colaborativa multipaís. Se observaron barreras para el acceso a cuidados intensivos. Los tomadores de decisión deberían trabajar en el fortalecimiento de la conciencia de gravedad, y en estrategias de referencia para evitar potenciales demoras.

Financiamiento: Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva.

Keywords: COVID-19; Maternal death; Maternal mortality; Pregnancy; Puerperium; SARS-CoV-2.

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Conflict of interest statement

None.

Figures

Fig 1
Figure 1
The onset of symptoms at first consultation (Panel A) or hospital admission (Panel B) for maternal deaths with COVID-19.
Fig 2
Figure 2
Time from symptoms onset to first consultation, delivery and death in pregnant and postpartum women with COVID-19 in Latin America (n = 447).
Fig 3
Figure 3
Organ dysfunction for maternal deaths with COVID-19 in Latin America, according to the WHO classification.
See this image and copyright information in PMC

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