Profile and outcomes of COVID-19 positive patients requiring a caesarean section at an academic hospital in Johannesburg: A retrospective cross-sectional study.

Palesa Mogane; Monwabisi Pumlomo; Kenalemodisa Mogotsi; Sithandiwe Dingezweni

doi:10.51168/sjhrafrica.v7i2.2606

Authors

Dr PN Mogane University of the Witwatersrand
Dr MP Pumlomo University of the Witwatersrand
Dr KL Mogotsi University of the Witwatersrand
Dr S Dingezweni University of the Witwatersrand

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2606

Keywords:

Coronavirus disease-2019 (COVID-19), Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), Obstetrics, Outcomes

Abstract

Background

The obstetrics population represents a significant proportion of patients who present to our hospital, Chris Hani Baragwanath Academic Hospital (CHBAH). This study aims to determine the profile and outcomes of obstetric patients who are COVID-19 positive, requiring caesarean section.

Methods

A retrospective cross-sectional observational research study design was performed. The study population consisted of COVID-19 PCR-positive parturients undergoing caesarean section (CS) at CHBAH. A convenience contextual sampling method was used. Anaesthetic and maternal clinical records of 326 patients were reviewed during the period 1^stMarch 2020 to 31^st March 2021.

Results

One hundred and seventy-four patients with a median (interquartile range) age of 30 (IQR 26-37) years, a BMI of 26.6 (23.9-30.5) kg/m^2, and a median gestational age of 38 (37-39.5) weeks, were included in the study. Most of the patients were classified as ASA-PS 2 (81.6%) and underwent emergency procedures (86.8%). Human immunodeficiency virus (HIV) prevalence was 28.7%, with hypertension (5.7%) being the next most common comorbidity. Pregnancy-related complications were predominantly related to pre-eclampsia (24.1%). Preterm delivery occurred in 40.2% of cases. Thrombocytopenia was uncommon (2.8%), with cases attributable to HELLP syndrome or isolated findings. COVID-19 severity was predominantly mild, with no significant association found between HIV status and disease severity. The patient outcome showed 94% ward admission, 5% HCU/ICU admission, minimal need for inotropic support (0.6%), and overall length of stay (LOS) of 10 days. Mortality was low at 0.6%.

Conclusion

COVID-19 in the pregnant population did not result in poorer outcomes, which is in keeping with other studies in this field.

Recommendation

Maintain standard COVID-19 risk stratification irrespective of HIV status. Prioritise early detection and management of hypertensive disorders, strengthen antenatal care to reduce prematurity, and ensure preparedness for emergency caesarean sections with continued access to critical care and multidisciplinary support.

References

Dr Monwabisi Pumlomo was a registrar in Anaesthesiology at CHBAH. He now practises as a specialist anaesthesiologist in the Johannesburg area with a keen interest in teaching and training, particularly in obstetrics, major abdominal surgery, and orthopaedics.

Dr Kena Mogotsi is a specialist anaesthesiologist and intensivist in training. Her interests include obstetrics anaesthesia, critical care, and perioperative risk assessment. She is actively involved in postgraduate teaching and research supervision.

Dr Sithandiwe Dingezweni is a specialist anaesthesiologist and intensivist. He is actively involved in undergraduate and postgraduate teaching, examination, and research supervision. His interests include major surgery, critical care, geriatrics, and perioperative risk assessment.

Dr Palesa Mogane is a specialist anaesthesiologist. She is actively involved in undergraduate and postgraduate teaching, examination, and research supervision. Her interests include major abdominal surgery, critical care, global surgery, paediatrics, and perioperative risk assessment.

References

Hanaei, S., Rezaei, N. COVID-19: Developing from an Outbreak to A Pandemic. Arch Med Res. 2020;51(6):582-4. https://doi.org/10.1016/j.arcmed.2020.04.021 PMid:32405122 PMCid:PMC7219390

Ashokka, B., Loh, M. H., Tan, C. H., Su, L. L., Young, B. E., Lye, D. C., et al. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am J Obstet Gynecol. 2020;223(1):66-74.e3. https://doi.org/10.1016/j.ajog.2020.04.005 PMid:32283073 PMCid:PMC7151436

Salzberger, B., Buder, F., Lampl, B., Ehrenstein, B., Hitzenbichler, F., Hanses, F. [Epidemiology of SARS-CoV-2 infection and COVID-19]. Internist (Berl). 2020;61(8):782-8. https://doi.org/10.1007/s00108-020-00834-9 PMid:32548652 PMCid:PMC7296906

Brandt, J. S., Hill, J., Reddy, A., Schuster, M., Patrick, H. S., Rosen, T., et al. Epidemiology of coronavirus disease 2019 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes. Am J Obstet Gynecol. 2021;224(4):389.e1-.e9. https://doi.org/10.1016/j.ajog.2020.09.043 PMid:32986989 PMCid:PMC7518835

Keita, H., James, A., Bouvet, L., Herrmann, E., Le Gouez, A., Mazoit, J. X., et al. Clinical, obstetrical and anaesthesia outcomes in pregnant women during the first COVID-19 surge in France: A prospective multicentre observational cohort study. Anaesth Crit Care Pain Med. 2021;40(5):100937. https://doi.org/10.1016/j.accpm.2021.100937 PMid:34391984 PMCid:PMC8359490

Bajwa, S. J. S., Sharma, R., Kurdi, M. S., Katikar, M., Bajwa, S. K., Choudhary, R. Anesthesia management in a post-COVID-19 obstetric patient-What we need to know. J Anaesthesiol Clin Pharmacol. 2022;38(Suppl 1):S13-s21. https://doi.org/10.4103/joacp.joacp_550_21 PMid:36060195 PMCid:PMC9438824

Tang, P., Wang, J., Song, Y. Characteristics and pregnancy outcomes of patients with severe pneumonia complicating pregnancy: a retrospective study of 12 cases and a literature review. BMC Pregnancy and Childbirth. 2018;18(1):434.

https://doi.org/10.1186/s12884-018-2070-0 PMid:30390683 PMCid:PMC6215647

Juan, J., Gil, M. M., Rong, Z., Zhang, Y., Yang, H., Poon, L. C. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal, and neonatal outcome: systematic review. Ultrasound Obstet Gynecol. 2020;56(1):15-27. https://doi.org/10.1002/uog.22088 PMid:32430957 PMCid:PMC7276742

Ellington, S., Strid, P., Tong, V. T., Woodworth, K., Galang, R. R., Zambrano, L. D., 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(25):769-75. https://doi.org/10.15585/mmwr.mm6925a1

PMid:32584795 PMCid: PMC7316319

McClymont, E., Albert, A. Y., Alton, G. D., Boucoiran, I., Castillo, E., Fell, D. B., et al. Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes. Jama. 2022;327(20):1983-91. https://doi.org/10.1001/jama.2022.5906 PMid:35499852 PMCid:PMC9062768

Budhram, S., Vannevel, V., Botha, T., Chauke, L., Bhoora, S., Balie, G. M., et al. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study. Int J Gynaecol Obstet. 2021;155(3):455-65. https://doi.org/10.1002/ijgo.13917 PMid:34499750 PMCid:PMC9087659

Landau, R., Bernstein, K., Ring, L. E. Anesthesia Considerations for Pregnant People With COVID-19 Infection. Clin Obstet Gynecol. 2022;65(1):179-88. https://doi.org/10.1097/GRF.0000000000000669 PMid:35045039 PMCid:PMC8767918

Kumar, S., Choudhary, A., Shukla, R., Singh, V., Ranjan, R. Moderate to Severe Thrombocytopenia in Four Pregnant Women With Asymptomatic COVID-19 Infection. Cureus. 2021;13(10):e18531. https://doi.org/10.7759/cureus.18531

Le Gouez, A., Vivanti, A. J., Benhamou, D., Desconclois, C., Mercier, F. J. Thrombocytopenia in pregnant patients with mild COVID-19. Int J Obstet Anesth. 2020;44:13-5. https://doi.org/10.1016/j.ijoa.2020.05.010 PMid:32673964 PMCid:PMC7260571

Lippi, G., Plebani, M., Henry, B. M. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;506:145-8. https://doi.org/10.1016/j.cca.2020.03.022 PMid:32178975 PMCid:PMC7102663

Ganesh, V., Bhatia, R., Trikha, A. COVID-19: Considerations for Obstetric Anesthesia and Analgesia. Journal of Obstetric Anaesthesia and Critical Care. 2020;10(2):69-74. https://doi.org/10.4103/joacc.JOACC_51_20

Guan, W. J., Ni, Z. Y., Hu, Y., Liang, W. H., Ou, C. Q., He, J. X., et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. https://doi.org/10.1056/NEJMoa2002032 PMid:32109013 PMCid:PMC7092819

Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5

PMid:31986264 PMCid: PMC7159299

Adam, Y. An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital. South African Journal of Obstetrics and Gynaecology. 2018;24:11. https://doi.org/10.7196/sajog.1226

Henry, B. M., de Oliveira, M. H. S., Benoit, S., Plebani, M., Lippi, G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021-8. https://doi.org/10.1515/cclm-2020-0369 PMid:32286245 PMCid:PMC8482317

Lambden, S., Laterre, P. F., Levy, M. M., Francois, B. The SOFA score-development, utility, and challenges of accurate assessment in clinical trials. Crit Care. 2019;23(1):374. https://doi.org/10.1186/s13054-019-2663-7 PMid:31775846 PMCid:PMC6880479

Raith, E. P., Udy, A. A., Bailey, M., McGloughlin, S., MacIsaac, C., Bellomo, R., et al. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. Jama. 2017;317(3):290-300. https://doi.org/10.1001/jama.2016.20328 PMid:28114553 PMCid:PMC10624277

Khumalo M, Leonard T, Scribante J, Perrie H. A Retrospective Review of the Decision to Deliver Time Interval for Foetal Distress at a Central Hospital. Int J Womens Health. 2022 Dec 14;14:1723-1732. https://doi.org/10.2147/IJWH.S382518 PMid:36540848 PMCid:PMC9760065

Walaza, S., Tempia, S., von Gottberg, A., Wolter, N., Bhiman, J. N., Buys, A., et al. Risk Factors for Severe Coronavirus Disease 2019 Among Human Immunodeficiency Virus-Infected and -Uninfected Individuals in South Africa, April 2020-March 2022: Data From Sentinel Surveillance. Open Forum Infect Dis. 2022;9(12):ofac578 https://doi.org/10.1093/ofid/ofac578 PMid:36570970 PMCid:PMC9772867

Gao, Y.-d., Ding, M., Dong, X., Zhang, J.-j., Kursat Azkur, A., Azkur, D., et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428-55. https://doi.org/10.1111/all.14657 PMid:33185910

Tan, E. K., Tan, E. L. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):791-802. https://doi.org/10.1016/j.bpobgyn.2013.08.001 PMid:24012425

Kim, C. N. H., Hutcheon, J., van Schalkwyk, J., Marquette, G. Maternal outcome of pregnant women admitted to intensive care units for coronavirus disease 2019. Am J Obstet Gynecol. 2020;223(5):773-4. https://doi.org/10.1016/j.ajog.2020.08.002 PMid:32771379 PMCid:PMC7410819

Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection in pregnancy. London: RCOG; 2022. Accessed 13 January 2023. https://www.rcog.org.uk/media/0qune0d3/covid-19-infection-in-pregnancy-v161-final.pdf

Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S et al.; for PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020 Sep 1;370:m3320. doi: 10.1136/bmj.m3320. Update in: BMJ. 2022 May 30;377:o1205. https://doi.org/10.1136/bmj.o1205 PMid:35636775

Virk, S., Gangu, K., Nasrullah, A., Shah, A., Faiz, Z., Khan, U., et al. Impact of COVID-19 on Pregnancy Outcomes across Trimesters in the United States. Biomedicines. 2023;11(11). https://doi.org/10.3390/biomedicines11112886 PMid:38001887 PMCid:PMC10669814

Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr. 2021 Aug 1;175(8):817-826. doi: 10.1001/jamapediatrics.2021.4953. PMID: 33885740; PMCID: PMC8063132