Objective
The novel coronavirus disease 2019 (COVID-19), the outbreak of which has caused a global pandemic, is spreading rapidly throughout the United States, with major metropolitan areas such as Philadelphia, seeing a dramatic rise in infection rates. Although pregnant women are not affected more severely than nonpregnant patients, a number of obstetrical patients will nevertheless require intensive care similar to their nonpregnant counterparts. Here, we review 5 critical cases of COVID-19 during pregnancy, as well as general management principles.
Study Design
This was a retrospective, multicenter case series of symptomatic pregnant women who had a positive result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and required critical care.
Results
The clinical courses of 5 pregnant women with severe cases of COVID-19 disease, all requiring mechanical ventilation, are described below and summarized in the Table . Testing for the presence of SARS-CoV-2 was done through a reverse transcription polymerase chain reaction test of a nasopharyngeal swab unless otherwise specified.
| Characteristics | Case 1 | Case 2 | Case 3 | Case 4 | Case 5 |
|---|---|---|---|---|---|
| Age (y) | 29 | 33 | 39 | 27 | 35 |
| Race/ethnicity | Asian | White | Hispanic | Black | White |
| BMI (kg/m 2 ) | 24.6 | 27.8 | 42.5 | 34.7 | 32 |
| Admission GA | 31 wk 2 d | 26 wk 0 d | 28 wk 3 d | 30 wk 3 d | 25 wk 2 d |
| Chief complaint | Fever, dyspnea | Fever, cough, dyspnea | Fever, cough | Fever, cough, dyspnea | Fatigue, cough, rhinorrhea, headache, fever, dyspnea |
| Medical comorbidities | Chronic kidney disease (C1q nephropathy), hypertension (on ACE inhibitor before pregnancy) | Mild, intermittent asthma | Obesity, hypertension, insulin-dependent diabetes | Hypertension (no medication) | obesity |
| Notable admission laboratory results | Elevated creatinine (patient baseline) | None | Elevated CRP and lactic acid | Thrombocytopenia | Elevated amniotransferases |
| Number of days from symptom onset to intubation | 9 | 10 | 14 | 7 | 9 |
| Adjunctive therapy | HCQ, remdesivir | HCQ, remdesivir | HCQ, remdesivir | HCQ remdesivir | HCQ, remdesivir |
| Antenatal steroids and HD administered | Betamethasone, HD 3 | Dexamethasone, HD 3, 4 | Betamethasone, HD 7, 8 | Betamethasone, HD 3, 4 | Betamethasone, HD 1, 2 |
| Additional clinical details | Intubated at 31 wk 4 d, extubation HD 16 with reintubation, final extubation HD 20, discharged HD 24 | Intubated at 26 wk 1 d, prone ventilation (× 2), tracheostomy 29 wk 1 d, suspected inferior vena cava thrombus | Intubated at 28 wk 3 d, prone ventilation (× 1), extubated on HD 19 | Intubated at 30 wk 5d, bacteremia, extubated HD 15, discharged HD 20 | Intubated at 25 wk 2 d, extubation HD 6 with reintubation, final extubation HD 8, discharged HD 13 |
| Delivery | Yes | No | Yes | Yes | No |
| Indication | Maternal | Maternal | Maternal | ||
| GA at delivery | 31 wk 4 d | 30 wk 2 d | 31 wk 3 d | ||
| Mode | Cesarean | Cesarean | Cesarean | ||
| Neonatal birthweight (g) | 1500 | 2110 | 1845 | ||
| Apgar score | 9, 9 | 8, 9 | 2, 4, 4 | ||
| Neonatal SARS-CoV-2 PCR result at 24 HOL | Negative | Negative | Negative |
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