Maternal Mortality in COVID Pandemic Era

Background: COVID 19 pandemic is a crisis of global proportions which has transformed the perspective of the entire world. The pandemic has affected maternal and neonatal health adversely. COVID 19 infection has an effect on various organs of the body increasing the risk of morbidity and mortality and it needs research to know the effect of the virus and also to ascertain the cause of the death. This study aims to evaluate maternal mortality in COVID pandemic era. Method: This is a prospective study which was carried out in the department of obstetrics and gynecology, Civil Hospital, Ahmedabad. The maternal patients coming to CHA with the clinical picture highly suggestive of COVID irrespective of RTPCR status were taken in this study. From these patients, few patients with alternate diagnosis were not included in this study. The study population was followed during their course of treatment to know the maternal and neonatal outcome. A proforma will be used for patients' details. Data will be compiled and analyzed. Result: Overall incidence of mortality amongst COVID positive patients in the given study population of 89 patients was found to be 12.3% (N=11). Out of 89 patients taken in this study 85 patients were RTPCR positive and 4 patients were found to be negative on RTPCR report but clinical and radiological pictures were strongly suggestive of COVID pneumonitis. The most common presenting complaint is fever seen in 53.9% patients. Other complaints were cough (25.8%), sore throat (13.4%), breathlessness (8.9%), diarrhoea (2.2%).19% of the patients in this study had presented without any complaints. Approximately 26.9% patients in this study developed complications. Most common complication found in patients infected with COVID was ARDS/pneumonitis (63%) in this study. Other compilations were DIC (14.8%), AKI (11.1%), hepatic failure (7.4%) and cardiac disease (3.7%) in this study. Conclusion: In the beginning of the COVID-19 pandemic, there was a perception that COVID-19 infection involves lungs primarily but later it was seen that multiple system involvement was attributable to the cytokine storm. AKI and other complications were attributable to past/ present/ subclinical COVID-19 infection and were also observed in RTPCR negative patients, indicating that RTPCR was not the basis of treatment during the pandemic but the clinical symptoms were found to be more reliable. The diagnosis of pneumonitis was delayed in antenatal patients as radiological investigations were avoided and hence these patients presented in the later stages of the disease leading to increased mortality in COVID-19 pandemic era. Thus it is best to take appropriate measures to prevent COVID-19 infection. This study observed absence of vertical transmission from mother to fetus and hence neonates were allowed to breastfeed from their mothers. There was no need for isolation of the neonate from the mother with COVID-19 infection.