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 Aug 26;10.1111/jth.15072. doi: 10.1111/jth.15072. Online ahead of print.

Abstract

Background: Novel coronavirus (SARS-CoV-2), which causes COVID-19, has thus far affected over 15 million individuals, resulting in over 600,000 deaths worldwide, and the number continues to rise. In a large systematic review and meta-analysis of the literature including 2,567 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 (DIC) and VTE, 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 which was reviewed, critiqued and approved by the ISTH 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 haemostatic issues during pregnancy were highlighted, 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 pregnancy registry; COVID-19; Pregnancy and VTE; Pregnancy and coagulopathy; Thromboprophylaxis in pregnancy.