COVID-19 and obstetric outcomes: a single-center retrospective experience in a predominantly Black population

Figures & data

Figure 1. Study Cohort. Details of he study cohort are described below. A total of 2080 deliveries were screened including 56 patients who were positive for SARS-CoV-2. Of these, 52 delivered at the study hospital including two sets of twins, one of which resulted in a previable demise. A total of 52 deliveries and 53 neonates were thus ultimately included in the analysis.

Table 1. Maternal Baseline Characteristics.

	Patients Positive for SARS-CoV-2 N = 56
Age, years	27 (23, 32)
Insurance Status
Public	41 (73.2)
Private	14 (25.0)
Unknown	1 (1.8)
Race
Black / African American	37 (66.1)
White	12 (21.4)
American Indian or Alaskan Native	1 (1.8)
Unknown / Not Reported	6 (10.7)
Hispanic or LatinX	4 (7.1)
Gravidity	3 (1, 4)
Nulliparous	19 (33.9)
BMI (kg/m^2)	31.61 (25.90, 35.52)
Smoking Status
Current Smoker/Vaper	1 (2.0)
Never Smoked	39 (76.5)
Quit Before Pregnancy	11 (21.6)
Substance Abuse
Alcohol	1 (1.8)
Marijuana	3 (5.4)
Pre-pregnancy Medical History
History of Preeclampsia	6 (10.7)
History of Chronic Hypertension	2 (3.6)
History of Diabetes	7 (12.5)
Type of Diabetes
Type II	3 (42.9)
Gestational	4 (57.1)
History of Hypothyroidism	1 (1.8)
History of Pulmonary Disease	2 (3.6)
History of Asthma	9 (16.1)
Autoimmune Disease	2 (3.6)
Mental Health Disorder	3 (5.4)
Other Chronic Disease	7 (12.5)

Data is presented as median (quartile 1, quartile 3) or n (%) depending on variable type. Five patients had a missing smoking status. One patient’s history of chronic hypertension was missing and one patient’s height was missing so the body mass index could not be calculated.

Table 2. COVID Signs, Symptoms and Treatment.

	Patients Positive for SARS-CoV-2 N = 56
COVID-19 Testing Prompted By
Symptoms	18 (32.1)
Universal Screening	38 (67.9)
Timing of Confirmation of COVID-19
Prior to Admission	15 (26.8)
During Admission, Prior to Delivery	21 (37.5)
During Admission, Postpartum	5 (8.9)
Unknown	15 (26.8)
Asymptomatic	26 (46.43)
COVID-19 Symptoms
Cough	15 (26.8)
Fever	8 (14.3)
Diarrhea	5 (8.9)
Shortness of Breath	10 (17.9)
Chest Pain	6 (10.7)
Headache	7 (12.5)
Myalgia	7 (12.5)
Malaise	6 (10.7)
Rigor	0 (0)
Absent sense of smell or taste	9 (16.1)
Gestational Age at First Positive Test, weeks	38.21 (30.93, 39.36)
Trimester at First Positive Test
First	1 (1.8)
Second	4 (7.1)
Third	51 (91.1)
COVID was Reason for Testing Encounter	12 (21.4)
Level of Care Required for Management of COVID-19
Outpatient	50 (89.3)
Inpatient (non-ICU)	4 (7.1)
ICU	2 (3.6)
Evidence of Pneumonia on Imaging	3 (6.25)
Highest Level of Oxygen Support due to COVID-19
None	54 (96.4)
Nasal Cannula/Face mask	1 (1.8)
Extracorporeal membrane oxygenation (ECMO)	1 (1.8)
Prone Ventilation	1 (1.8)
Pharmacologic Therapy for COVID-19
Antiviral Therapy	1 (1.8)
Antibiotic Therapy (Not for Chorioamnionitis, Endometritis, or Surgical Site Infection Prophylaxis)	7 (12.5)
Corticosteroids (Other than Betamethasone)	1 (1.8)

Data is presented as median (quartile 1, quartile 3) or n (%) depending on variable type. Imaging data to define pneumonia status was missing for eight patients.

Table 3. Labor and Delivery Characteristics.

	Delivered Patients Positive for SARS-CoV-2 N = 52
Gestational Age at Delivery, weeks*	39.00 (37.00, 39.71)
Preterm Delivery <37 Weeks*	12 (23.5)
Indication for Delivery
Worsening Maternal Status Secondary to COVID-19	2 (3.8)
Term or Post Term Normal	16 (30.8)
Prior Cesarean Section	5 (9.6)
Spontaneous Labor	21 (40.4)
Preeclampsia	1 (1.9)
Severe Preeclampsia	4 (7.7)
Worsening Preeclampsia	2 (3.8)
Bleeding Abruption	3 (5.8)
Non-reassuring Fetal Status	9 (17.3)
Gestational Hypertension	6 (11.5)
Intrauterine Growth Restriction	2 (3.8)
Premature Rupture of Membranes (PROM)	6 (11.5)
Induced*	18 (34.6)
Mode of Delivery
Vaginal	32 (61.5)
Instrumental	0 (0)
Cesarean Section	20 (38.5)
Indication for Cesarean Section
Prior Cesarean Section	10 (50.0)
Breech Presentation	2 (10.0)
Non-Reassuring Fetal Well-Being	12 (60.0)
Failed Induction	1 (5.0)
Arrest of Descent	3 (15.0)
Arrest of Dilation	2 (10.0)
Other Maternal Indication	3 (15.0)
Anesthesia for Cesarean Delivery
Spinal	1 (5.0)
De Novo Combined Spinal Epidural	6 (30.0)
Labor Neuraxial Catheter	7 (35.0)
General Anesthesia	6 (30.0)
Labor Analgesia (if patient labored)	N = 45
None	9 (20.0)
Opioids	1 (2.2)
Epidural†	35 (77.8)
Indication for General Anesthesia	N = 6
Emergency C-section	5 (83.3)
Patient Refusal of Neuraxial Anesthetic	1 (16.7)
Quantitative Blood Loss, cc	383 (141, 783)
Obstetrical Diagnosis and complications
Normal	13 (25.5)
Hypertensive Disorders, Total	26 (50.0)
Chronic Hypertension	0 (0)
Gestational HTN	15 (28.8)
Preeclampsia, total	11 (21.2)
Preeclampsia without severe features	3 (5.8)
Preeclampsia with severe features	7 (13.5)
Chronic HTN with superimposed preeclampsia	1 (1.9)
Placental Abruption	4 (7.7)
IUGR	3 (5.8)
Other Obstetric Complications
Blood Products Administered	4 (7.7)
Chorioamnionitis*	5 (9.8)
Cardiomyopathy	1 (1.9)
Thromboembolic Disease	1 (1.9)
Maternal Death	1 (1.9)
Thromboprophylaxis	31 (59.6)

Data is presented as median (quartile 1, quartile 3) or n (%) depending on variable type. *Missing for one subject. †Includes epidurals, combined spinal epidurals and dural puncture epidurals.

Table 4. Neonatal Outcomes.

	Neonates of Delivered Patients Positive for SARS-CoV-2 N = 53^a
Birth Weight	3165 (2650, 3448)
Birth Weight Percentile for Gestational Age, grams	40 (26, 69)
Small for Gestational Age (Below 10th Percentile)	3 (5.7)
APGAR (1 min)	8 (7, 9)
APGAR (5 min)	9 (8, 9)
Delivery Room Respiratory Support
None	35 (66.0)
Continuous Positive Airway Pressure	10 (18.9)
Intubation	8 (15.1)
Initial Blood Sugar	67 (48, 88)
Neonatal Care
No Escalation of Care	24 (46.2)
Care Escalated, No Increased Length of Stay	8 (15.4)
Prolonged Hospitalization	20 (38.5)
NICU Admission	27 (50.9)
NICU Length of Stay, days	6 (4, 17)
NICU Admission Solely Due to COVID-19 in Mother	4 (15.4)
Neonate was Tested for COVID-19	36 (67.9)
Neonate Positive COVID-19 Result	0 (0)
Complications
Fetal Death or Stillbirth	1 (1.9)
Respiratory Distress Syndrome	13 (25.0)
Intraventricular Hemorrhage	1 (1.9)
Necrotizing Enterocolitis	0 (0)
Bronchopulmonary Dysplasia	1 (1.9)
Seizures	0 (0)
Sepsis	2 (3.9)
Oxygen Requirement	20 (38.5)

Data is presented as median (quartile 1, quartile 3) or n (%) depending on variable type. Neonatal care was unavailable for one subject.

^aThis table includes two twin neonates that are correspondent to a single delivery in previous tables. Birthweight and percentile were unavailable for one subject. Care escalation and complications (not including fetal death) were unavailable in one subject.