Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study.
Identifieur interne : 001743 ( Main/Corpus ); précédent : 001742; suivant : 001744Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study.
Auteurs : Rebecca A M. Pierce-Williams ; Julia Burd ; Laura Felder ; Rasha Khoury ; Peter S. Bernstein ; Karina Avila ; Christina A. Penfield ; Ashley S. Roman ; Chelsea A. Debolt ; Joanne L. Stone ; Angela Bianco ; Adina R. Kern-Goldberger ; Adi Hirshberg ; Sindhu K. Srinivas ; Jenani S. Jayakumaran ; Justin S. Brandt ; Hannah Anastasio ; Meredith Birsner ; Devon S. O'Brien ; Harish M. Sedev ; Cara D. Dolin ; William T. Schnettler ; Anju Suhag ; Shabani Ahluwalia ; Reshama S. Navathe ; Adeeb Khalifeh ; Kathryn Anderson ; Vincenzo BerghellaSource :
- American journal of obstetrics & gynecology MFM [ 2589-9333 ] ; 2020.
English descriptors
- KwdEn :
- Adult (MeSH), COVID-19 (diagnosis), COVID-19 (epidemiology), COVID-19 (physiopathology), COVID-19 (therapy), Cesarean Section (methods), Cesarean Section (statistics & numerical data), Cohort Studies (MeSH), Critical Illness (epidemiology), Critical Illness (therapy), Female (MeSH), Hospitalization (statistics & numerical data), Humans (MeSH), Infant, Newborn (MeSH), Infectious Disease Transmission, Vertical (prevention & control), Infectious Disease Transmission, Vertical (statistics & numerical data), Maternal Mortality (MeSH), Pregnancy (MeSH), Pregnancy Complications, Infectious (epidemiology), Pregnancy Complications, Infectious (physiopathology), Pregnancy Complications, Infectious (therapy), Pregnancy Complications, Infectious (virology), Pregnancy Outcome (epidemiology), Premature Birth (epidemiology), SARS-CoV-2 (isolation & purification), Severity of Illness Index (MeSH), United States (epidemiology).
- MESH :
- geographic , epidemiology : United States.
- diagnosis : COVID-19.
- epidemiology : COVID-19, Critical Illness, Pregnancy Complications, Infectious, Pregnancy Outcome, Premature Birth.
- isolation & purification : SARS-CoV-2.
- methods : Cesarean Section.
- physiopathology : COVID-19, Pregnancy Complications, Infectious.
- prevention & control : Infectious Disease Transmission, Vertical.
- statistics & numerical data : Cesarean Section, Hospitalization, Infectious Disease Transmission, Vertical.
- therapy : COVID-19, Critical Illness, Pregnancy Complications, Infectious.
- virology : Pregnancy Complications, Infectious.
- Adult, Cohort Studies, Female, Humans, Infant, Newborn, Maternal Mortality, Pregnancy, Severity of Illness Index.
Abstract
Background
The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited.
Objective
This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2.
Study Design
This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation ≤93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24-48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported.
Results
Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m
Conclusion
In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.
DOI: 10.1016/j.ajogmf.2020.100134
PubMed: 32391519
PubMed Central: PMC7205698
Links to Exploration step
pubmed:32391519Le document en format XML
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Pierce-Williams</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Burd, Julia" sort="Burd, Julia" uniqKey="Burd J" first="Julia" last="Burd">Julia Burd</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Felder, Laura" sort="Felder, Laura" uniqKey="Felder L" first="Laura" last="Felder">Laura Felder</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Khoury, Rasha" sort="Khoury, Rasha" uniqKey="Khoury R" first="Rasha" last="Khoury">Rasha Khoury</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Bernstein, Peter S" sort="Bernstein, Peter S" uniqKey="Bernstein P" first="Peter S" last="Bernstein">Peter S. Bernstein</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Avila, Karina" sort="Avila, Karina" uniqKey="Avila K" first="Karina" last="Avila">Karina Avila</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Penfield, Christina A" sort="Penfield, Christina A" uniqKey="Penfield C" first="Christina A" last="Penfield">Christina A. Penfield</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Roman, Ashley S" sort="Roman, Ashley S" uniqKey="Roman A" first="Ashley S" last="Roman">Ashley S. Roman</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Debolt, Chelsea A" sort="Debolt, Chelsea A" uniqKey="Debolt C" first="Chelsea A" last="Debolt">Chelsea A. Debolt</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Stone, Joanne L" sort="Stone, Joanne L" uniqKey="Stone J" first="Joanne L" last="Stone">Joanne L. Stone</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Bianco, Angela" sort="Bianco, Angela" uniqKey="Bianco A" first="Angela" last="Bianco">Angela Bianco</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Kern Goldberger, Adina R" sort="Kern Goldberger, Adina R" uniqKey="Kern Goldberger A" first="Adina R" last="Kern-Goldberger">Adina R. Kern-Goldberger</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Hirshberg, Adi" sort="Hirshberg, Adi" uniqKey="Hirshberg A" first="Adi" last="Hirshberg">Adi Hirshberg</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Srinivas, Sindhu K" sort="Srinivas, Sindhu K" uniqKey="Srinivas S" first="Sindhu K" last="Srinivas">Sindhu K. Srinivas</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Jayakumaran, Jenani S" sort="Jayakumaran, Jenani S" uniqKey="Jayakumaran J" first="Jenani S" last="Jayakumaran">Jenani S. Jayakumaran</name><affiliation><nlm:affiliation>Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.</nlm:affiliation></affiliation></author><author><name sortKey="Brandt, Justin S" sort="Brandt, Justin S" uniqKey="Brandt J" first="Justin S" last="Brandt">Justin S. Brandt</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.</nlm:affiliation></affiliation></author><author><name sortKey="Anastasio, Hannah" sort="Anastasio, Hannah" uniqKey="Anastasio H" first="Hannah" last="Anastasio">Hannah Anastasio</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Birsner, Meredith" sort="Birsner, Meredith" uniqKey="Birsner M" first="Meredith" last="Birsner">Meredith Birsner</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA.</nlm:affiliation></affiliation></author><author><name sortKey="O Brien, Devon S" sort="O Brien, Devon S" uniqKey="O Brien D" first="Devon S" last="O'Brien">Devon S. O'Brien</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, NJ.</nlm:affiliation></affiliation></author><author><name sortKey="Sedev, Harish M" sort="Sedev, Harish M" uniqKey="Sedev H" first="Harish M" last="Sedev">Harish M. Sedev</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Dolin, Cara D" sort="Dolin, Cara D" uniqKey="Dolin C" first="Cara D" last="Dolin">Cara D. Dolin</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Schnettler, William T" sort="Schnettler, William T" uniqKey="Schnettler W" first="William T" last="Schnettler">William T. Schnettler</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH.</nlm:affiliation></affiliation></author><author><name sortKey="Suhag, Anju" sort="Suhag, Anju" uniqKey="Suhag A" first="Anju" last="Suhag">Anju Suhag</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH.</nlm:affiliation></affiliation></author><author><name sortKey="Ahluwalia, Shabani" sort="Ahluwalia, Shabani" uniqKey="Ahluwalia S" first="Shabani" last="Ahluwalia">Shabani Ahluwalia</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Navathe, Reshama S" sort="Navathe, Reshama S" uniqKey="Navathe R" first="Reshama S" last="Navathe">Reshama S. Navathe</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Khalifeh, Adeeb" sort="Khalifeh, Adeeb" uniqKey="Khalifeh A" first="Adeeb" last="Khalifeh">Adeeb Khalifeh</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Einstein Healthcare Network, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Anderson, Kathryn" sort="Anderson, Kathryn" uniqKey="Anderson K" first="Kathryn" last="Anderson">Kathryn Anderson</name><affiliation><nlm:affiliation>Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Berghella, Vincenzo" sort="Berghella, Vincenzo" uniqKey="Berghella V" first="Vincenzo" last="Berghella">Vincenzo Berghella</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32391519</idno><idno type="pmid">32391519</idno><idno type="doi">10.1016/j.ajogmf.2020.100134</idno><idno type="pmc">PMC7205698</idno><idno type="wicri:Area/Main/Corpus">001743</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001743</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study.</title><author><name sortKey="Pierce Williams, Rebecca A M" sort="Pierce Williams, Rebecca A M" uniqKey="Pierce Williams R" first="Rebecca A M" last="Pierce-Williams">Rebecca A M. Pierce-Williams</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Burd, Julia" sort="Burd, Julia" uniqKey="Burd J" first="Julia" last="Burd">Julia Burd</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Felder, Laura" sort="Felder, Laura" uniqKey="Felder L" first="Laura" last="Felder">Laura Felder</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Khoury, Rasha" sort="Khoury, Rasha" uniqKey="Khoury R" first="Rasha" last="Khoury">Rasha Khoury</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Bernstein, Peter S" sort="Bernstein, Peter S" uniqKey="Bernstein P" first="Peter S" last="Bernstein">Peter S. Bernstein</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Avila, Karina" sort="Avila, Karina" uniqKey="Avila K" first="Karina" last="Avila">Karina Avila</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Penfield, Christina A" sort="Penfield, Christina A" uniqKey="Penfield C" first="Christina A" last="Penfield">Christina A. Penfield</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Roman, Ashley S" sort="Roman, Ashley S" uniqKey="Roman A" first="Ashley S" last="Roman">Ashley S. Roman</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Debolt, Chelsea A" sort="Debolt, Chelsea A" uniqKey="Debolt C" first="Chelsea A" last="Debolt">Chelsea A. Debolt</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Stone, Joanne L" sort="Stone, Joanne L" uniqKey="Stone J" first="Joanne L" last="Stone">Joanne L. Stone</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Bianco, Angela" sort="Bianco, Angela" uniqKey="Bianco A" first="Angela" last="Bianco">Angela Bianco</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Kern Goldberger, Adina R" sort="Kern Goldberger, Adina R" uniqKey="Kern Goldberger A" first="Adina R" last="Kern-Goldberger">Adina R. Kern-Goldberger</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Hirshberg, Adi" sort="Hirshberg, Adi" uniqKey="Hirshberg A" first="Adi" last="Hirshberg">Adi Hirshberg</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Srinivas, Sindhu K" sort="Srinivas, Sindhu K" uniqKey="Srinivas S" first="Sindhu K" last="Srinivas">Sindhu K. Srinivas</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Jayakumaran, Jenani S" sort="Jayakumaran, Jenani S" uniqKey="Jayakumaran J" first="Jenani S" last="Jayakumaran">Jenani S. Jayakumaran</name><affiliation><nlm:affiliation>Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.</nlm:affiliation></affiliation></author><author><name sortKey="Brandt, Justin S" sort="Brandt, Justin S" uniqKey="Brandt J" first="Justin S" last="Brandt">Justin S. Brandt</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.</nlm:affiliation></affiliation></author><author><name sortKey="Anastasio, Hannah" sort="Anastasio, Hannah" uniqKey="Anastasio H" first="Hannah" last="Anastasio">Hannah Anastasio</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Birsner, Meredith" sort="Birsner, Meredith" uniqKey="Birsner M" first="Meredith" last="Birsner">Meredith Birsner</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA.</nlm:affiliation></affiliation></author><author><name sortKey="O Brien, Devon S" sort="O Brien, Devon S" uniqKey="O Brien D" first="Devon S" last="O'Brien">Devon S. O'Brien</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, NJ.</nlm:affiliation></affiliation></author><author><name sortKey="Sedev, Harish M" sort="Sedev, Harish M" uniqKey="Sedev H" first="Harish M" last="Sedev">Harish M. Sedev</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Dolin, Cara D" sort="Dolin, Cara D" uniqKey="Dolin C" first="Cara D" last="Dolin">Cara D. Dolin</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Schnettler, William T" sort="Schnettler, William T" uniqKey="Schnettler W" first="William T" last="Schnettler">William T. Schnettler</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH.</nlm:affiliation></affiliation></author><author><name sortKey="Suhag, Anju" sort="Suhag, Anju" uniqKey="Suhag A" first="Anju" last="Suhag">Anju Suhag</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH.</nlm:affiliation></affiliation></author><author><name sortKey="Ahluwalia, Shabani" sort="Ahluwalia, Shabani" uniqKey="Ahluwalia S" first="Shabani" last="Ahluwalia">Shabani Ahluwalia</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Navathe, Reshama S" sort="Navathe, Reshama S" uniqKey="Navathe R" first="Reshama S" last="Navathe">Reshama S. Navathe</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Khalifeh, Adeeb" sort="Khalifeh, Adeeb" uniqKey="Khalifeh A" first="Adeeb" last="Khalifeh">Adeeb Khalifeh</name><affiliation><nlm:affiliation>Department of Obstetrics and Gynecology, Einstein Healthcare Network, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Anderson, Kathryn" sort="Anderson, Kathryn" uniqKey="Anderson K" first="Kathryn" last="Anderson">Kathryn Anderson</name><affiliation><nlm:affiliation>Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Berghella, Vincenzo" sort="Berghella, Vincenzo" uniqKey="Berghella V" first="Vincenzo" last="Berghella">Vincenzo Berghella</name><affiliation><nlm:affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</nlm:affiliation></affiliation></author></analytic><series><title level="j">American journal of obstetrics & gynecology MFM</title><idno type="eISSN">2589-9333</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>COVID-19 (diagnosis)</term><term>COVID-19 (epidemiology)</term><term>COVID-19 (physiopathology)</term><term>COVID-19 (therapy)</term><term>Cesarean Section (methods)</term><term>Cesarean Section (statistics & numerical data)</term><term>Cohort Studies (MeSH)</term><term>Critical Illness (epidemiology)</term><term>Critical Illness (therapy)</term><term>Female (MeSH)</term><term>Hospitalization (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Infant, Newborn (MeSH)</term><term>Infectious Disease Transmission, Vertical (prevention & control)</term><term>Infectious Disease Transmission, Vertical (statistics & numerical data)</term><term>Maternal Mortality (MeSH)</term><term>Pregnancy (MeSH)</term><term>Pregnancy Complications, Infectious (epidemiology)</term><term>Pregnancy Complications, Infectious (physiopathology)</term><term>Pregnancy Complications, Infectious (therapy)</term><term>Pregnancy Complications, Infectious (virology)</term><term>Pregnancy Outcome (epidemiology)</term><term>Premature Birth (epidemiology)</term><term>SARS-CoV-2 (isolation & purification)</term><term>Severity of Illness Index (MeSH)</term><term>United States (epidemiology)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>COVID-19</term><term>Critical Illness</term><term>Pregnancy Complications, Infectious</term><term>Pregnancy Outcome</term><term>Premature Birth</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Cesarean Section</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>COVID-19</term><term>Pregnancy Complications, Infectious</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Infectious Disease Transmission, Vertical</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Cesarean Section</term><term>Hospitalization</term><term>Infectious Disease Transmission, Vertical</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>COVID-19</term><term>Critical Illness</term><term>Pregnancy Complications, Infectious</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Pregnancy Complications, Infectious</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Cohort Studies</term><term>Female</term><term>Humans</term><term>Infant, Newborn</term><term>Maternal Mortality</term><term>Pregnancy</term><term>Severity of Illness Index</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background</b></p><p>The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited.</p></div><div type="abstract" xml:lang="en"><p><b>Objective</b></p><p>This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2.</p></div><div type="abstract" xml:lang="en"><p><b>Study Design</b></p><p>This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation ≤93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24-48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m</p></div><div type="abstract" xml:lang="en"><p><b>Conclusion</b></p><p>In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32391519</PMID><DateCompleted><Year>2021</Year><Month>01</Month><Day>26</Day></DateCompleted><DateRevised><Year>2021</Year><Month>01</Month><Day>26</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2589-9333</ISSN><JournalIssue CitedMedium="Internet"><Volume>2</Volume><Issue>3</Issue><PubDate><Year>2020</Year><Month>08</Month></PubDate></JournalIssue><Title>American journal of obstetrics & gynecology MFM</Title><ISOAbbreviation>Am J Obstet Gynecol MFM</ISOAbbreviation></Journal><ArticleTitle>Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study.</ArticleTitle><Pagination><MedlinePgn>100134</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ajogmf.2020.100134</ELocationID><Abstract><AbstractText Label="Background">The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited.</AbstractText><AbstractText Label="Objective">This study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2.</AbstractText><AbstractText Label="Study Design">This is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation ≤93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24-48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported.</AbstractText><AbstractText Label="Results">Of 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m<sup>2</sup>. Gestational age was at a mean of 29±6 weeks at symptom onset and a mean of 30±6 weeks at hospital admission, with a median disease day 7 since first symptoms. Most women (81%) were treated with hydroxychloroquine; 7% of women with severe disease and 65% of women with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation during their admission. The median duration of hospital stay was 6 days (6 days [severe group] and 10.5 days [critical group]; <i>P</i>=.01). Intubation was usually performed around day 9 on patients who required it, and peak respiratory support for women with severe disease was performed on day 8. In women with critical disease, prone positioning was required in 20% of cases, the rate of acute respiratory distress syndrome was 70%, and reintubation was necessary in 20%. There was 1 case of maternal cardiac arrest, but there were no cases of cardiomyopathy or maternal death. Thirty-two of 64 (50%) women with coronavirus disease 2019 in this cohort delivered during their hospitalization (34% [severe group] and 85% [critical group]). Furthermore, 15 of 17 (88%) pregnant women with critical coronavirus disease 2019 delivered preterm during their disease course, with 16 of 17 (94%) pregnant women giving birth through cesarean delivery; overall, 15 of 20 (75%) women with critical disease delivered preterm. There were no stillbirths or neonatal deaths or cases of vertical transmission.</AbstractText><AbstractText Label="Conclusion">In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.</AbstractText><CopyrightInformation>© 2020 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Pierce-Williams</LastName><ForeName>Rebecca A M</ForeName><Initials>RAM</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Burd</LastName><ForeName>Julia</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Felder</LastName><ForeName>Laura</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Khoury</LastName><ForeName>Rasha</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bernstein</LastName><ForeName>Peter S</ForeName><Initials>PS</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Avila</LastName><ForeName>Karina</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Penfield</LastName><ForeName>Christina A</ForeName><Initials>CA</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Roman</LastName><ForeName>Ashley S</ForeName><Initials>AS</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Medical Center, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>DeBolt</LastName><ForeName>Chelsea A</ForeName><Initials>CA</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Stone</LastName><ForeName>Joanne L</ForeName><Initials>JL</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bianco</LastName><ForeName>Angela</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kern-Goldberger</LastName><ForeName>Adina R</ForeName><Initials>AR</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hirshberg</LastName><ForeName>Adi</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Srinivas</LastName><ForeName>Sindhu K</ForeName><Initials>SK</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jayakumaran</LastName><ForeName>Jenani S</ForeName><Initials>JS</Initials><AffiliationInfo><Affiliation>Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Brandt</LastName><ForeName>Justin S</ForeName><Initials>JS</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Anastasio</LastName><ForeName>Hannah</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Birsner</LastName><ForeName>Meredith</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>O'Brien</LastName><ForeName>Devon S</ForeName><Initials>DS</Initials><AffiliationInfo><Affiliation>Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, NJ.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sedev</LastName><ForeName>Harish M</ForeName><Initials>HM</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dolin</LastName><ForeName>Cara D</ForeName><Initials>CD</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schnettler</LastName><ForeName>William T</ForeName><Initials>WT</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Suhag</LastName><ForeName>Anju</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, TriHealth Good Samaritan Hospital, Cincinnati, OH.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ahluwalia</LastName><ForeName>Shabani</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Navathe</LastName><ForeName>Reshama S</ForeName><Initials>RS</Initials><AffiliationInfo><Affiliation>Department of Obstetrics and Gynecology, Crozer Chester Medical Center, Chester, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Khalifeh</LastName><ForeName>Adeeb</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Obstetrics and Gynecology, Einstein Healthcare Network, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Anderson</LastName><ForeName>Kathryn</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Berghella</LastName><ForeName>Vincenzo</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>05</Month><Day>08</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Obstet Gynecol MFM</MedlineTA><NlmUniqueID>101746609</NlmUniqueID><ISSNLinking>2589-9333</ISSNLinking></MedlineJournalInfo><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="Y">COVID-19</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002585" MajorTopicYN="N">Cesarean Section</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016638" MajorTopicYN="N">Critical Illness</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006760" MajorTopicYN="N">Hospitalization</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007231" MajorTopicYN="N">Infant, Newborn</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018445" MajorTopicYN="Y">Infectious Disease Transmission, Vertical</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008428" MajorTopicYN="N">Maternal Mortality</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011247" MajorTopicYN="N">Pregnancy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011251" MajorTopicYN="Y">Pregnancy Complications, Infectious</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011256" MajorTopicYN="N">Pregnancy Outcome</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D047928" MajorTopicYN="N">Premature Birth</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="Y">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">COVID-19</Keyword><Keyword MajorTopicYN="Y">SARS-CoV-2</Keyword><Keyword MajorTopicYN="Y">coronavirus</Keyword><Keyword MajorTopicYN="Y">pregnancy</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>04</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>05</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32391519</ArticleId><ArticleId IdType="doi">10.1016/j.ajogmf.2020.100134</ArticleId><ArticleId IdType="pii">S2589-9333(20)30077-X</ArticleId><ArticleId 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