High case fatality rate maternal with COVID-19:

lesson learned from tertiary hospital in Indonesia

Putri Sekar Wiyati1*,, Rabiah Adawiyah1 , Ratnasari Dwi Cahyanti1, Besari
Adi Pramono, Raden Soerjo Hadijono1
1
Obstetrics and Gynecology Division, Faculty of Medicine, Diponegoro University,
dr. Kariadi Hospital, Semarang, Indonesia

*
Corresponding author’s Email : putrisekardspog@gmail.com

ABSTRACT
Objective : To evaluate maternal and perinatal outcomes on pregnant women
with COVID-19 in Kariadi as tertiary hospital in Central Java

Design: cross sectional study

Method : We collected and analysed data maternal with COVID-19

between March 2020 and january 2021 in Kariadi tertiary hospital, Central
Java, Indonesia. This was a single-center, observational study of patients
with suspected COVID-19 and confirmed COVID-19. Case fatality rate,
patient comorbidities, clinical course, laboratory and chest x-ray findings,
and the perinatal outcomes were evaluated.
Results : A total of 12 maternal death from 172 cases confirmed infection from
COVID-19. Case fatality rate was 6.9 %, a significantly increased risk of
dying from pregnant women with a SARS-CoV-2 infection. Among 346
cases, complete data was 269 cases ( 77.7%). Gestational age mostly in
their second and third trimester. Diabetes in pregnancy and HIV were the
most common comorbidities found in this study, there were patients came
with preeclampsia, SLE, and thyroid disease. The clinical characteristics
of 153 confirmed COVID-19 patients were compared with those of 116
non-COVID-19 patients. Patients symptoms statistically significant at
admission were cough ( P =.015) , fatique/malaise (P=.028) and dyspneu
(P=.043). The COVID-19 group had significantly higher rates of
subnormal white blood cell counts/lymphopenia (P<.001) than the non-
COVID-19 group. Abnormal chest x-ray findings in COVID-19 group had
significantly higher rates of pneumonia (P=.038). Caesarean section was
the most mode of delivery in COVID-19 grup (P=.029). Perinatal oucomes
were Apgar score lower than 7 at 1 minutes in the COVID -19 grup with
(P=.019). Perinatal death was higher rates in COVID-19 grup (P=.028).
Maternal death had significantly higher rates in COVID-19 grup (P<.001)
than the non-COVID-19 group All maternal death 12 cases had critical ill
at admission, need mechanical ventilator and died in intensive care unit.
Complications mostly were acute respiratory distress syndrome (83.3%)
and coagulopathy COVID-19 (83.3%). Perinatal mortality in cases
maternal died at ICU were IUFD 6 cases (50%) and still birth 1 cases
(8.3%)
Conclusions: maternal and perinatal case fatality rates higher in COVID-19, it is
urgent in depth analysis for potential risk factor contributing in maternal and
perinatal death with COVID-19, in low resources country.

Keywords: case fatality rate, maternal death, perinatal death, COVID-19