Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Jan 10;23(1):18.
doi: 10.1186/s12884-022-05310-w.

Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score

Zilma Silveira Nogueira Reis  1 , Magda Carvalho Pires  2 , Lucas Emanuel Ferreira Ramos  2 , Thaís Lorenna Souza Sales  3 , Polianna Delfino-Pereira  4   5 , Karina Paula Medeiros Prado Martins  6 , Andresa Fontoura Garbini  7 , Angélica Gomides Dos Reis Gomes  8 , Bruno Porto Pessoa  9 , Carolina Cunha Matos  10 , Christiane Corrêa Rodrigues Cimini  11   12 , Claudete Rempel  13 , Daniela Ponce  14 , Felipe Ferraz Martins Graça Aranha  15 , Fernando Anschau  7 , Gabriela Petry Crestani  16 , Genna Maira Santos Grizende  17 , Gisele Alsina Nader Bastos  18 , Giulia Maria Dos Santos Goedert  19 , Luanna Silva Monteiro Menezes  20 , Marcelo Carneiro  21 , Marcia Ffner Tolfo  22 , Maria Augusta Matos Corrêa  12 , Mariani Maciel de Amorim  23 , Milton Henriques Guimarães Júnior  24 , Pamela Andrea Alves Durães  25 , Patryk Marques da Silva Rosa  26 , Petrônio José de Lima Martelli  27 , Rafaela Santos Charão de Almeida  7 , Raphael Castro Martins  28 , Samuel Penchel Alvarenga  29 , Eric Boersma  30 , Regina Amélia Lopes Pessoa de Aguiar  1 , Milena Soriano Marcolino  4   5   6   31
Affiliations
Multicenter Study

Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score

Zilma Silveira Nogueira Reis et al. BMC Pregnancy Childbirth. .

Abstract

Background: The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died.

Methods: This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score.

Results: From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641-0.944) and 0.704 (95% IC: 0.617-0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001).

Conclusions: The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

Keywords: Artificial respiration; COVID-19; Clinical decision rules; Mortality; Pregnant women; Prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of COVID-19 pregnant patients included in the study. *General hospitalized adults (men and women)
Fig. 2
Fig. 2
Cities of the hospital of pregnant patients included in this study. *R Core Team (R version 4.0.2). https://www.R-project.org/
Fig. 3
Fig. 3
Discrimination of ABC2-SPH Score in the sample of pregnant patients to predict in-hospital mortality (A), and composite of mechanical ventilation support and in-hospital mortality (B)
Fig. 4
Fig. 4
Calibration plot of ABC2-SPH Score for in-hospital mortality (A), and composite of mechanical ventilation and in-hospital mortality (B), for each quartile of pregnant women risk. *It plots the observed and expected death, and the diagonal line represents a perfect agreement between observed and expected probability of the outcome
See this image and copyright information in PMC

References

    1. Carta MG, Scano A, Lindert J, Bonanno S, Rinaldi L, Fais S, et al. Association between the spread of COVID-19 and weather-climatic parameters. Eur Rev Med Pharmacol Sci. 2020;24(15):8226–8231. doi: 10.26355/eurrev_202008_22512. - DOI - PubMed
    1. Breitling LP. Global epidemiology and socio-economic development correlates of the reproductive ratio of COVID-19. Int Health. 2021;13(6):514–519. doi: 10.1093/inthealth/ihab006. - DOI - PMC - PubMed
    1. Ribeiro KB, Ribeiro AF, Veras MASM, de Castro MC. Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil. Int J Epidemiol. 2021;50(3):732–742. doi: 10.1093/ije/dyab022. - DOI - PMC - PubMed
    1. Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, et al. Pregnancy and COVID-19. Physiol Rev. 2021;101(1):303–318. doi: 10.1152/physrev.00024.2020. - DOI - PMC - PubMed
    1. Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health. 2021;18(1):1–39. doi: 10.1186/s12978-021-01070-6. - DOI - PMC - PubMed

Publication types