• Sedigheh Hantoushzadeh, Alireza A Shamshirsaz, Ashraf Aleyasin, Maxim D Seferovic, Soudabeh Kazemi Aski, Sara E Arian, Parichehr Pooransari, Fahimeh Ghotbizadeh, Soroush Aalipour, Zahra Soleimani, Mahsa Naemi, Behnaz Molaei, Roghaye Ahangari, Mohammadreza Salehi, Atousa Dabiri Oskoei, Parisa Pirozan, Roya Faraji Darkhaneh, Mahboobeh Gharib Laki, Ali Karimi Farani, Shahla Atrak, Mir Mohammad Miri, Mehran Kouchek, Seyedpouzhia Shojaei, Fahimeh Hadavand, Fatemeh Keikha, Maryam Sadat Hosseini, Sedigheh Borna, Shideh Ariana, Mamak Shariat, Alireza Fatemi, Behnaz Nouri, Seyed Mojtaba Nekooghadam, and Kjersti Aagaard.
• Maternal Fetal Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
• Am. J. Obstet. Gynecol. 2020 Jul 1; 223 (1): 109.e1-109.e16.

BackgroundDespite 2.5 million infections and 169,000 deaths worldwide (as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity have been reported to be related to COVID-19 disease. Given the disproportionate burden of severe and fatal respiratory disease previously documented among pregnant women following other coronavirus-related outbreaks (SARS-CoV in 2003 and MERS-CoV in 2012) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected.ObjectiveTo describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease.Study DesignWe describe here a multiinstitution adjudicated case series from Iran that includes 9 pregnant women diagnosed with severe COVID-19 disease in their second or third trimester. All 9 pregnant women received a diagnosis of SARS-CoV-2 infection by reverse transcription polymerase chain reaction nucleic acid testing. Outcomes of these women were compared with their familial/household members with contact to the affected patient on or after their symptom onset. All data were reported at death or after a minimum of 14 days from date of admission with COVID-19 disease.ResultsAmong 9 pregnant women with severe COVID-19 disease, at the time of reporting, 7 of 9 died, 1 of 9 remains critically ill and ventilator dependent, and 1 of 9 recovered after prolonged hospitalization. We obtained self-verified familial/household cohort data in all 9 cases, and in each and every instance, maternal outcomes were more severe compared with outcomes of other high- and low-risk familial/household members (n=33 members for comparison).ConclusionWe report herein maternal deaths owing to COVID-19 disease. Until rigorously collected surveillance data emerge, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed as having COVID-19 disease in their second or third trimester.Copyright © 2020 Elsevier Inc. All rights reserved.

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