COVID-19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry-Communication from the ISTH SSC for Women's Health

J Thromb Haemost. 2020 Nov;18(11):3086-3098. doi: 10.1111/jth.15072. Epub 2020 Oct 14.

Abstract

Background: Novel coronavirus (SARS-CoV-2), which causes COVID-19, has thus far affected more than 15 million individuals, resulting in more than 600 000 deaths worldwide, and the number continues to rise. In a large systematic review and meta-analysis of the literature including 2567 pregnant women, 7% required intensive care admission, with a maternal mortality ~1% and perinatal mortality below 1%. There has been a rapid increase in publications on COVID-19-associated coagulopathy, including disseminated intravascular coagulopathy and venous thromboembolism, in the non-pregnant population, but very few reports of COVID-19 coagulopathy during pregnancy; leaving us with no guidance for care of this specific population.

Methods: This is a collaborative effort conducted by a group of experts that was reviewed, critiqued, and approved by the International Society on Thrombosis and Haemostasis Subcommittee for Women's Health Issues in Thrombosis and Hemostasis. A structured literature search was conducted, and the quality of current and emerging evidence was evaluated. Based on the published studies in the non-pregnant and pregnant population with a moderate to high risk of bias as assessed by Newcastle-Ottawa scale and acknowledging the absence of data from randomized clinical trials for management of pregnant women infected with SARS-CoV-2, a consensus in support of a guidance document for COVID-19 coagulopathy in pregnancy was identified.

Results and conclusions: Specific hemostatic issues during pregnancy were highlighted, and preliminary recommendations to assist in the care of COVID-19-affected pregnant women with coagulopathy or thrombotic complications were developed. An international registry to gather data to support the management of COVID-19 and associated coagulopathy in pregnancy was established.

Keywords: COVID-19; COVID-19 pregnancy registry; pregnancy and coagulopathy; pregnancy and venous thromboembolism; thromboprophylaxis in pregnancy.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Blood Coagulation*
  • COVID-19 / blood
  • COVID-19 / complications
  • COVID-19 / diagnosis
  • COVID-19 / therapy*
  • Consensus
  • Disseminated Intravascular Coagulation / blood
  • Disseminated Intravascular Coagulation / diagnosis
  • Disseminated Intravascular Coagulation / etiology
  • Disseminated Intravascular Coagulation / therapy*
  • Evidence-Based Medicine
  • Female
  • Humans
  • Practice Guidelines as Topic
  • Pregnancy
  • Pregnancy Complications, Infectious / blood
  • Pregnancy Complications, Infectious / diagnosis
  • Pregnancy Complications, Infectious / therapy*
  • Prognosis
  • Registries
  • Venous Thromboembolism / blood
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / therapy*
  • Women's Health*
  • Young Adult