key: cord-1020193-uorjs47z authors: Takemoto, Maira L. S.; Menezes, Mariane de O.; Andreucci, Carla B.; Nakamura‐Pereira, Marcos; Amorim, Melania M.R.; Katz, Leila; Knobel, Roxana title: The tragedy of COVID‐19 in Brazil: 124 maternal deaths and counting date: 2020-07-29 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13300 sha: a7737ca8e7fe53ee1aded1190ad6c8929854105c doc_id: 1020193 cord_uid: uorjs47z At the time of writing 124 pregnant or postpartum women in Brazil have died due to COVID‐19 (representing a mortality rate of 12.7%), a figure that currently surpasses the total number of COVID‐19‐related maternal deaths reported throughout the rest of the world. Initial reports at the onset of the COVID-19 pandemic indicated that the obstetric population did not appear to be at higher risk of developing severe symptoms of COVID-19 than the general population. 1 However, following recent publications showing that pregnancy and the postpartum period might indeed pose additional risks for both women and babies, these preliminary observations urgently require review. 2 Explanations for heightened risk may include relative immunodeficiency associated with maternal physiological adaptations, as well as organic response to virus infections. The present study aims to describe outcomes for pregnant and postpartum women with COVID-19 disease from the first documented case in (Table 1) , a figure which is 3.4 times higher than the total number of COVID-19-related maternal deaths reported throughout the rest of the world at the time of writing. [3] [4] [5] [6] [7] The current mortality rate is 12.7% in the Brazilian obstetric population, which is also higher than rates reported so far in the literature. 3, 4, 7 Notably, the mortality rate was higher for cases identified in the postpartum period than during pregnancy, likely reflecting the onset timing of COVID-19 symptoms. Brazil's elevated COVID-19 mortality rate in pregnant women and women in the postpartum period might have several explanations. In Brazil, obstetric care is beset by chronic problems that can affect maternal and perinatal outcomes, such as poor quality antenatal care, insufficient resources to manage emergency and critical care, racial disparities in access maternity services, obstetric violence, and the pandemic poses additional barriers for access to health care. Additionally, the rate of cesarean sections is among the highest in the world and questions remain regarding the increased risk of postoperative morbidity and mortality for patients with COVID-19 undergoing surgery. 8 Our findings identified diabetes, cardiovascular disease, and obesity as significant conditions associated with mortality in the obstetric population, similar to the general population ( to 14.6% of all fatal cases, while the remaining 21,4% received non-invasive ventilation only. Failure to adequately report these variables in the surveillance system cannot be ruled out due to its retrospective nature. The data seem to reflect that obstetric patients may face barriers to access ventilators and intensive care. This is not a novel issue within the Brazilian healthcare system and it is aggravated by the COVID-19 pandemic; shortage of healthcare providers and lack of intensive care resources are well-described chronic challenges in Brazilian maternity services. 9 Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Severe maternal morbidity and mortality associated with COVID-19: The risk should not be downplayed Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK a national cohort study using the UK Obstetric Surveillance System (UKOSS) A snapshot of the Covid-19 pandemic among pregnant women in, France Maternal mortality from COVID-19 in Mexico maternal death due to COVID-19 disease Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by Pregnancy Status -United States Hazardous postoperative outcomes of unexpected COVID-19 infected patients: A call for global consideration of sampling all asymptomatic patients before surgical treatment Adequacy of public maternal care services in Brazil The authors would like to thank all members of the Brazilian Group for Studies of COVID-19 and Pregnancy for their efforts in supporting this work. The authors have no conflicts of interest.