Materno-Fetal Outcomes of COVID-19 Infected Pregnant Women Managed at the Douala Gyneco-Obstetric and Pediatric Hospital—Cameroon

Abstract

Introduction: The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. Overall objective: To describe and understand the clinical burden of patients managed for COVID-19 in pregnancy or post-partum at the DGOPH. Methodology: Cross-sectional and descriptive study covering four months—March 24th to July 24th 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet. Results: A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%, and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30 - 39 years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were: fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%. Conclusion: The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.