Nine Maternal Mortalities in 2 Weeks of Second COVID-19 Surge in Indonesia: A Case Series from One Large Tertiary Center

Manggala Pasca Wardhana; Shabrina Avi Wulandari; Salsabila Nabilah Rifdah; Ifan Ali Wafa; Agus Sulistyono; Aditiawarman Aditiawarman; Hermanto Tri Joewono; Erry Gumilar

doi:10.3889/oamjms.2022.9415

Authors

Manggala Pasca Wardhana Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Obstetrics and Gynaecology, Academic dr. Soetomo General Hospital, Surabaya, Indonesia; Department of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Shabrina Avi Wulandari Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Salsabila Nabilah Rifdah Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Ifan Ali Wafa Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Agus Sulistyono Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Obstetrics and Gynaecology, Academic dr. Soetomo General Hospital, Surabaya, Indonesia
Aditiawarman Aditiawarman Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Obstetrics and Gynaecology, Academic dr. Soetomo General Hospital, Surabaya, Indonesia
Hermanto Tri Joewono Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Obstetrics and Gynaecology, Academic dr. Soetomo General Hospital, Surabaya, Indonesia
Erry Gumilar Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Obstetrics and Gynaecology, Academic dr. Soetomo General Hospital, Surabaya, Indonesia; Department of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9415

Keywords:

Case series, COVID-19, Obstetric, Maternal mortality, Health services

Abstract

BACKGROUND: The fluctuating COVID-19 cases among the pregnant women’s population encountered increased of cases and maternal mortality.

AIM: This research aimed to describe the case of maternal deaths caused by COVID-19.

CASE REPORT: We present nine serial cases of maternal death caused by COVID-19 who were admitted to Dr. Soetomo General Academic Hospital for 14 days in June. We found 32 positive COVID-19 obstetric cases and reported nine maternal deaths with a fatality rate of up to 28%. Seven of nine patients had reverse transcription-polymerase chain reaction–confirmed SARS-CoV-2 infection, while two had a positive antigen swab. Half of the patients ≥35 years old, and five of nine patients had Class I obesity as preexisting comorbidity. This study reported the death of pregnant woman at their 2nd trimester and 3rd trimester presenting infected by severe COVID-19. The usual symptoms are dyspnea, cough, fever, and decreased consciousness. The result of chest X-ray examination among eight patients showed bilateral pneumonia. Most of cases were referrals from a secondary hospital due to overload hospital capacity. Three patients were directly transferred to the tertiary hospital without receiving initial treatment. Eight of 9 patients (88.9%) were transferred to intensive care unit and intubated due to low oxygen saturation.

CONCLUSION: In conclusion, the limited hospital facility and lack of intensive care capacity for obstetric cases during the second wave of the COVID-19 pandemic may enhance the probability of mortality and morbidity in pregnant women infected by COVID-19.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Bong CL, Brasher C, Chikumba E, Mcdougall R, Mellin-Olsen J, Enright A. The COVID-19 pandemic: Effects on low- and middle-income countries. Anesth Analg. 2020;13(1):86-92. https://doi.org/10.1213/ANE.0000000000004846 PMid:32243287

Gamaliel N, Saminarsih D, Taher A. Indonesia’s second wave crisis: Medical doctors’ political role is needed more than ever. Lancet. 2021;398(10303):839-40. https://doi.org/10.1016/ S0140-6736(21)01807-9 PMid:3438453

Mahajan N, Polphakar M, Patil S, Yewale B, Chaaithanya I, Mahale S, et al. pregnancy outcomes and maternal complications during the second wave of coronavirus disease 2019 (COVID-19) in Indiae. Obstet Gynecol. 2021;138(4):660-2. https://doi.org/10.1097/AOG.0000000000004529 PMid:34233345

Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, Arian SE, et al. Maternal death due to COVID-19. Am J Obstet Gynecol. 2020;223(1):109.e1-109.e16. https://doi.org/10.1016/j.ajog.2020.04.030 PMid:32360108

Ministry of Health of the Republic of Indonesia. Covid-19 Treatment Protocol. 2nd ed. Indonesia: Pocket Book Directorate General of Health Services; 2021.

Gujski M, Humeniuk E, Bojar I. Current state of knowledge about SARS-CoV-2 and COVID-19 disease in pregnant women. Med Sci Monit. 2020;26:e924725. https://doi.org/10.12659/MSM.924725 PMid:32385225

Khalil A, Kalafat E, Benlioglu C, O’Brien P, Morris E, Draycott T, et al. SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes. EClinicalMedicine. 2020;25:100446. https://doi.org/10.1016/j.eclinm.2020.100446 PMid:32838230

Guan WJ, Liang WH, He JX, Zhong NS. Cardiovascular comorbidity and its impact on patients with COVID-19. Eur Respir J. 2020;55(6):2001227. https://doi.org/10.1183/13993003.01227-2020 PMid:32341104

Bello-Chavolla OY, Bahena-Lopez JP, Antonio-Villa NE, Vargas-Vazquez A, Gonzalez-Diaz A, Marquez-Salinas A, et al. Predicting mortality due to SARS-CoV-2: A mechanistic score relating obesity and diabetes to COVID-19 outcomes in Mexico. J Clin Endocrinol Metab. 2020;105(8):2752-61. https://doi.org/10.1210/clinem/dgaa346 PMid:32474598

Wenling Y, Junchao Q, Xiao Z, Ouyang S. Pregnancy and COVID-19: Management and challenges. Rev Inst Med Trop Sao Paulo. 2020;62:e62. https://doi.org/10.1590/s1678-9946202062062 PMid:32876296

Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: Living systematic review and meta-analysis. BMJ. 2020;370:m3320. https://doi.org/10.1136/bmj.m3320 PMid:35636775

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet. 2020;329(10226):809-15. https://doi.org/10.1016/S0140-6736(20)30360-3 PMid:32151335

Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2(2):100118. https://doi.org/10.1016/j.ajogmf.2020.100118 PMid:32292903

Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:769-75. https://doi.org/10.15585/mmwr.mm6925a1

Rasmussen SA, Jamieson DJ, Uyeki TM. Effects of influenza on pregnant women and infants. Am J Obstet Gynecol. 2012;207(Suppl 3):S3-8. https://doi.org/10.1016/j.ajog.2012.06.068 PMid:22920056

Mosby LG, Rasmussen SA, Jamieson DJ. 2009 Pandemic Influenza A (H1N1) in Pregnancy: A systematic review of the literature. Am J Obstet Gynecol. 2011;205(1):10-8. https://doi.org/10.1016/j.ajog.2010.12.033 PMid:21345415

Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7. https://doi.org/10.1016/j.ajog.2003.11.019 PMid:15295381

Nakamura-Pereira M, Andreucci CB, Menezes MD, Knobel R, Takemoto ML. Worldwide maternal deaths due to COVID-19: A brief review. Int J Gynaecol Obstet. 2020;151(1):148-50. https://doi.org/10.1002/ijgo.13328 PMid:32706925

Wardhana MP, Dachlan EG, Aditiawarman EM, Habibie PH, Umilar KE, Wicaksono B, et al. Maternal and perinatal outcome of COVID-19 in obstetric cases: 9 months experience from east java tertiary referral hospital. N Armenian Med J. 2021;15(3):39-46.