Findings from the new MBRRACE-UK 2021 rapid report, Learning from SARS-CoV-2-related and associated maternal deaths in the UK June 2020-March 2021, suggest that there needs to be wider awareness of how best to treat pregnant and postnatal women with COVID-19.
Report authors reviewed the care of all pregnant and postnatal women who died with SARS-CoV-2 infection, and women who died and whose care or engagement with care was influenced by changes resulting from the pandemic, between 1 June 2021 and 1 March this year. Fourteen women died with SARS-CoV-2 infection, ten from COVID-19 and four from other causes. Three further women’s deaths were influenced by changes as a consequence of the pandemic.
Only one out of ten women who died from COVID-19 was treated in accordance with the evidence-based guidance developed by the Royal College of Obstetricians and Gynaecologists and Royal College of Midwives. This comprehensive national guidance should be followed wherever pregnant or postpartum women are cared for. The report also highlights a need to ensure early involvement of senior members of the maternal medical team. Clinicians should avoid withholding treatment due to misplaced concerns that treatment may be inappropriate due to a woman’s pregnancy, as well as recognise other causes for symptoms when a positive test for SARS-CoV-2 is coincidental.
The report also noted ongoing indirect impacts of the pandemic, with some women delaying or not seeking face-to-face care because they were fearful of catching COVID-19. Other pregnancy complications remain many times more frequent than COVID-19 in pregnancy, and the need to ensure women are able to access the care they need is essential. This includes making sure that women are confident about their safety in attending face to face visits, and recognising situations in which remote consultations are inadequate. This may be for several reasons including language difficulties, lack of access to appropriate technology, repeated presentation, clinical complexity or potentially severe or high risk conditions.
Professor Marian Knight, lead author of the report said ‘It is unacceptable that women with COVID-19 do not receive the best quality of care simply because they are pregnant or recently pregnant. The RECOVERY trial ensured inclusion of pregnant and postpartum women to make sure that we had the evidence about how best to treat their COVID-19. The Royal Colleges of Obstetricians and Gynaecologists and Midwives, with anaesthetic and paediatric colleagues, ensured that evidence was rapidly included into definitive treatment guidance. We must ensure that the cultural and structural biases around treatment in pregnancy and the postnatal period are tackled to ensure that women receive the care they need.’
Professor Jenny Kurinczuk, lead for MBRRACE-UK said ‘It is extremely important that women continue to attend antenatal visits during pregnancy and after giving birth and seek advice from their midwife or doctor if they have any concerns. Maternal deaths from COVID-19 in the UK are uncommon, but this report highlights once again the importance of prevention of severe illness through vaccination. All pregnant and postpartum women are eligible to receive a COVID-19 vaccine as part of the UK programme.’