Devastating pregnancy outcomes in the second wave of the COVID-19 pandemic

BACKGROUND: This study analyzed pregnancy outcomes in postpartum women who were infected with COVID-19 during their pregnancy in resource-limited settings during the second wave of the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study included all pregnant women with COVID-19 at a tertiary referral hospital in Surabaya, Indonesia, from June to August 2021. Patients were classified according to clinical presentation into asymptomatic-mild, moderate, and severe-critical. Data regarding their basic maternal characteristics, clinical symptoms, delivery, and neonatal outcomes were collected and analyzed across these severity levels through ANOVA, Kruskal-Wallis, or Mann-Whitney U test by incorporating SPSS Statistics software version 29.0. RESULTS: During the second wave of COVID-19 in Indonesia, a total of 184 COVID-19 cases were reported, with high mortality rate (22%). Only 26.6% of these cases were asymptomatic-mild, and the remaining 73.4% had more severe conditions. The severe-critical group had significantly lower gestational age, slower onset of diseases/symptoms, and higher maternal death proportions than the other two groups (P < 0.001). Clinical symptoms, vital signs, and inflammatory markers (NLR, CRP, and procalcitonin) were also significantly worse in the severe-critical group than in the other groups (P < 0.05). Consequently, severe cases showed a higher cesarean section rate (P = 0.034), lower birth weight, lower Apgar score, higher incidence of perinatal deaths (P < 0.001), and higher incidence of neonatal support (P = 0.003). CONCLUSIONS: The study's findings specified the devastating consequences of second wave of COVID-19 in a resource-limited setting. Focus on improving the health system and health facilities' capacity is warranted to anticipate all possibilities of other pandemics in the future.