High rates of stillbirth and preterm delivery in women with covid-19 and the efficacy of ECMO in pregnancy
Published Date: 27th July 2020
Publication Authors: Kingston E
The initial data reported by the UK Obstetric Surveillance System study were of great interest, and the findings have been discussed in our multidisciplinary maternity team.
The rates of pregnancy loss, stillbirth, and preterm delivery seem considerably higher than those reported elsewhere. As noted by Magee and colleagues, the stillbirth rate among women with covid-19 admitted to hospital, 11.5 per 1000 maternities, is much higher than the most recently reported rate of 4.1 per 1000 completed maternities in England and Wales. Preterm delivery (248 per 1000 maternities) was almost triple that reported in Office for National Statistics data (82 per 1000 maternities). It should be noted, however, that many patients in the study remain pregnant, so the results will be negatively skewed towards those who have already completed their maternities owing to preterm deliveries or stillbirth.
We are particularly interested in the patients who received respiratory support and would like to know the outcomes of those who were intubated or who received extracorporeal membrane oxygenation (ECMO). Initial reports of the use of ECMO for covid-19 have been relatively conservative about the potential benefit and emphasise the resource intensive nature and cost of treatment. Reported mortality varies between 10% and 42%, although mortality in patients critically ill with covid-19 might be as high as 61.5%. Relatively few papers describe the use of ECMO in the context of pregnancy, owing to concerns over the risk of maternal and fetal haemorrhage, and few data on its efficacy in covid-19. Ong and colleagues identified 97 patients who received ECMO in pregnancy or the postpartum period up to 2018. Of these, 41 required ECMO for respiratory indications, with a mortality of 12%. These patients typically had a longer duration of treatment and more complications than those receiving ECMO for cardiovascular indications. We hope the UK Obstetric Surveillance System study can provide additional information about the efficacy of ECMO for covid-19 in pregnancy and the peripartum period.
Kingston, EV. (2020). High rates of stillbirth and preterm delivery in women with covid-19 and the efficacy of ECMO in pregnancy. BMJ. 370, 2921