Factors Related to Maternal Mortality Rate in COVID-19 Patients: A Cross-Sectional Study from an Indonesian COVID-19 Referral Hospital

Abstract

Background: The COVID-19 pandemic may cause severe clinical manifestation in vulnerable population, such as pregnant women. Based on Indonesian Obstetrics and Gynecology Association (POGI), the number of maternal deaths due to COVID-19 for the period from April 2020 to April 2021 reached 3% and increased to 9% since the delta variant of COVID-19  emerged. This research was expected to identify factors that are related to mortality rate of pregnant women with COVID-19.

Material and methods: This was a cross-sectional study using secondary data collected from June 2020-August 2021. The study was conducted in Universitas Indonesia Hospital, a national COVID-19 referral hospital. Patient characteristics, pregnancy profile, comorbidities, laboratory results, chest x-ray examination, treatment options, and the severity of symptoms were evaluated. In addition, bivariate data analysis was carried out using the SPSS device.

Results: Of 114 research subjects, 7 patients (6.1%) died, and 107 patients (93.9%) survived. The risk of mortality was significantly (p<0.05) related to patients’ age, duration of hospitalization, gestational age, severity rate of COVID-19, the level of haemoglobin, leukocyte count, platelet count, lymphocytes, the levels of D-dimer, C-reactive protein, transaminase enzymes, urea, creatinine, eGFR, sodium, potassium, and procalcitonin. In addition, significant differences (p<0.05) related to maternal mortality rate were also shown in the presence of comorbidities (type 2 diabetes, congestive heart failure, coronary artery disease/ acute coronary syndrome, and urinary tract infection), and the use of steroid and tocilizumab.

Conclusion: Various factors significantly related to the mortality rate of pregnant women with COVID-19. This study may become the basis for further study with larger number of subjects, adjustment of assessment and management of COVID-19 infected pregnant women, thus hopefully reduce the risk of mortality in pregnant women with COVID-19.