• Kazemi AskiSoudabehSReproductive Health Research Center, Department of Obstetrics and Gynecology, Guilan University of Medical Scieneces, Rasht, Iran., Amir Hossein Norooznezhad, Amir A Shamshirsaz, Shayan Mostafaei, Ashraf Aleyasin, Seyedeh Maedeh Nabavian, Shohreh Alimohammadi, Roghaye Ahangari, Shideh Ariana, Fahimeh Ghotbizadeh, Fatemeh Tara, Parichehr Pooransari, Gharib LakiMahboobehMDepartment of Obstetrics and Gynecology, Qom University of Medical Science, Qom, Iran., Elaheh Zarean, Zahra Soleimani, Alireza Saliminia, Arash Havaei, Razieh Akbari, Masoud Ramezani, Azam Soleimani, Mahsa Naemi, Alireza A Shamshirsaz, and Sedigheh Hantoushzadeh.
• Reproductive Health Research Center, Department of Obstetrics and Gynecology, Guilan University of Medical Scieneces, Rasht, Iran.
• J. Matern. Fetal. Neonatal. Med. 2021 Feb 8: 1-5.

ObjectivesThe aim of this study was to evaluate differences in clinical features and laboratory parameters in critically ill pregnant women with acute respiratory distress syndrome (ARDS) compared to moderate and severe pregnant women with coronavirus disease-2019 (COVID-19) but without ARDS.MethodsThis was a retrospective multicenter study of all pregnant women with COVID-19 diagnosed with ARDS between February 15, and May 1, 2020 in nine level III maternity centers in Iran (ARDS group). The control COVID-19 pregnant women were selected from 3 of 9 level III maternity centers between March 15 and April 20, 2020. Univariate statistics were used to look at differences between groups. Cluster dendrograms were used to look at the correlations between clinical and laboratory findings in the groups. A value of p <.05 was considered statistically significant.ResultsFifteen COVID-19 infected women with ARDS were compared to 29 COVID-19 positive and ARDS negative control (moderate: (n = 26) 89.7% and severe: (n = 3)10.3%). The mean maternal age (35.6 vs. 29.4 years; p = .002) and diagnosis of chronic hypertension (20.0% vs. 0%, p = .034) were significantly higher in the ARDS group. There was no significant difference between the two groups in their presenting symptoms. The ARDS group had a significantly higher prevalence of tachypnea (66.6% vs. 10.3%, p = .042) and blood oxygen saturation (SpO2) <93% (66.6% vs. 10.3%, p = .004) at presentation. Relative lymphopenia (lymphocyte ratio < 10.5%, 66.6% vs. 17.2%, p = .002), lymphocytes to leukocytes ratio (11.3% vs. 17.7%, p = .010), and neutrophils to lymphocytes ratio (NLR) >7.5 were significantly different between the two groups (all p < .05).ConclusionOur data demonstrate that symptom-based strategies for identifying the critically ill pregnant women with SARS-CoV-2 are insufficient; however, vital signs and laboratory data might be helpful to predict ARDS in critically ill COVID-19 pregnant patients.

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