Chest Radiography in COVID-19 Pregnancy and Its Clinico-biochemical Correlation: A Retrospective Single-center Study

Abstract

Aim: We have witnessed diverse presentations of coronavirus disease-2019 (COVID-19) in pregnant females during first and second waves. The aim of this study was to evaluate the usefulness of chest X-ray and its correlation of severity scoring with clinical, laboratory parameters and maternal-fetal outcome during management of COVID-19 pregnant women in low resource settings. Methodology: This was a retrospective observational study conducted at the Government Institute of Medical Sciences, Greater Noida, from May 2020 to May 2021. The study included 185 pregnant women in second and third trimesters with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 disease. The chest radiographs of all patients were analyzed and severity scoring was done using modified radiographic assessment of lung edema (RALE) criteria. The correlation of severity index with clinical and biochemical profile of patients with normal and abnormal X-ray findings was compared. Two-tailed p-value of <0.05 was considered significant in our study. Results: Out of 185 patients, 38 had abnormal X-ray findings, whereas 147 had normal X-ray. A significant difference was observed in mean values of lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), D-dimer, total leukocyte count (TLC), and interleukin 6 (IL-6) levels across both X-ray groups. The proportion of pregnant mothers with live birth, high-risk pregnancy, steroid treatment, oxygen supplementation, invasive ventilation, and number of presenting symptoms varied statistically across both the X-ray groups (p-value <0.05). Receiver-operating characteristic (ROC) analysis revealed that an X-ray score of “5.5” has the best prognostic significance of maternal death with sensitivity of 87.5 and 96.6% specificity. Conclusion: Chest radiography for the assessment of disease status in COVID-19 pregnancies is an effective and affordable alternative to CT scan in low resource settings.