J Korean Med Sci.  2021 Nov;36(44):e309. 10.3346/jkms.2021.36.e309.

Maternal and Neonatal Outcomes of Critically Ill Pregnant and Puerperal Patients Diagnosed with COVID-19 Disease: Retrospective Comparative Study

• Eman A
• Balaban O
• Kocayiğit H
• Süner KÖ
• Cırdı Y
• Erdem AF

• KMID: 2522364
• DOI: http://doi.org/10.3346/jkms.2021.36.e309

Abstract

Background
We assessed maternal and neonatal outcomes of critically ill pregnant and puerperal patients in the clinical course of coronavirus disease 2019 (COVID-19).
Methods
Records of pregnant and puerperal women with polymerase chain reaction positive COVID-19 virus who were admitted to our intensive care unit (ICU) from March 2020 to August 2021 were investigated. Demographic, clinical and laboratory data, pharmacotherapy, and neonatal outcomes were analyzed. These outcomes were compared between patients that were discharged from ICU and patients who died in ICU.
Results
Nineteen women were included in this study. Additional oxygen was required in all cases (100%). Eight patients (42%) were intubated and mechanically ventilated. All patients that were mechanically ventilated have died. Increased levels of C-reactive protein (CRP) was seen in all patients (100%). D-dimer values increased in 15 patients (78.9%); interleukin-6 (IL-6) increased in 16 cases (84.2%). Sixteen patients used antiviral drugs. Eleven patients were discharged from the ICU and eight patients have died due to complications of COVID-19 showing an ICU mortality rate of 42.1%. Mean number of hospitalized days in ICU was significantly lower in patients that were discharged (P = 0.037). Seventeen patients underwent cesarean-section (C/S) (89.4%). Mean birth week was significantly lower in patients who died in ICU (P = 0.024). Eleven preterm (57.8%) and eight term deliveries (42.1%) occurred.
Conclusion
High mortality rate was detected among critically ill pregnant/parturient patients followed in the ICU. Main predictors of mortality were the need of invasive mechanical ventilation and higher number of days hospitalized in ICU. Rate of C/S operations and preterm delivery were high. Pleasingly, the rate of neonatal death was low and no neonatal COVID-19 occurred.

Keyword

SARS-CoV-2; COVID-19; Critical Ill; Pregnancy; Puerperium; Clinical Outcome

Figure

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  Fig. 1 Computerized tomography image of a puerperal woman with severe respiratory distress.

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  Fig. 2 X-ray radiographic images showing diffuse opacity and infiltrates in two patients.

Reference

1. Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PB, et al. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg. 2020; 107(10):1250–1261. PMID: 32350857.

2. Huntley BJ, Huntley ES, Di Mascio D, Chen T, Berghella V, Chauhan SP. Rates of maternal and perinatal mortality and vertical transmission in pregnancies complicated by severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) infection: a systematic review. Obstet Gynecol. 2020; 136(2):303–312. PMID: 32516273.

3. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020; 370:m3320. PMID: 32873575.

4. Vallejo V, Ilagan JG. A postpartum death due to coronavirus disease 2019 (COVID-19) in the United States. Obstet Gynecol. 2020; 136(1):52–55. PMID: 32384387.

5. Blauvelt CA, Chiu C, Donovan AL, Prahl M, Shimotake TK, George RB, et al. Acute respiratory distress syndrome in a preterm pregnant patient with coronavirus disease 2019 (COVID-19). Obstet Gynecol. 2020; 136(1):46–51. PMID: 32384385.

6. Mattar CN, Kalimuddin S, Sadarangani SP, Tagore S, Thain S, Thoon KC, et al. Pregnancy outcomes in COVID-19: a prospective cohort study in Singapore. Ann Acad Med Singapore. 2020; 49(11):857–869. PMID: 33381779.

7. Poon LC, Yang H, Kapur A, Melamed N, Dao B, Divakar H, et al. Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals. Int J Gynaecol Obstet. 2020; 149(3):273–286. PMID: 32248521.

8. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010; 303(15):1517–1525. PMID: 20407061.

9. Remaeus K, Savchenko J, Brismar Wendel S, Brusell Gidlöf S, Graner S, Jones E, et al. Characteristics and short-term obstetric outcomes in a case series of 67 women test-positive for SARS-CoV-2 in Stockholm, Sweden. Acta Obstet Gynecol Scand. 2020; 99(12):1626–1631. PMID: 32981033.

10. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226):809–815. PMID: 32151335.

11. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(44):1641–1647. PMID: 33151921.

12. Hirshberg A, Kern-Goldberger AR, Levine LD, Pierce-Williams R, Short WR, Parry S, et al. Care of critically ill pregnant patients with coronavirus disease 2019: a case series. Am J Obstet Gynecol. 2020; 223(2):286–290. PMID: 32371056.

13. Oakes MC, Kernberg AS, Carter EB, Foeller ME, Palanisamy A, Raghuraman N, et al. Pregnancy as a risk factor for severe coronavirus disease 2019 using standardized clinical criteria. Am J Obstet Gynecol MFM. 2021; 3(3):100319. PMID: 33493707.

14. ICNARC. ICNARC report on COVID-19 in critical care: England, Wales and Northern Ireland, 26 February 2021 [Internet]. Updated 2020. Accessed March 4, 2021. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports .

15. Lei H, Xu X, Xiao S, Wu X, Shu Y.. Household transmission of COVID-19-a systematic review and meta-analysis. J Infect. 2020; 81(6):979–997.

16. Fajgenbaum DC, June CH. Cytokine storm. N Engl J Med. 2020; 383(23):2255–2273. PMID: 33264547.

17. Tanacan A, Yazihan N, Erol SA, Anuk AT, Yucel Yetiskin FD, Biriken D, et al. The impact of COVID-19 infection on the cytokine profile of pregnant women: a prospective case-control study. Cytokine. 2021; 140:155431. PMID: 33503581.

18. Saad AF, Chappell L, Saade GR, Pacheco LD. Corticosteroids in the management of pregnant patients with coronavirus disease (COVID-19). Obstet Gynecol. 2020; 136(4):823–826. PMID: 32769659.

19. Cao W, Liu X, Hong K, Ma Z, Zhang Y, Lin L, et al. High-dose intravenous immunoglobulin in severe coronavirus disease 2019: a multicenter retrospective study in China. Front Immunol. 2021; 12:627844. PMID: 33679771.

20. Martínez-Sánchez N, De la Calle Fernández-Miranda M, Bartha JL. Safety profile of treatments administered in COVID 19 infection in pregnant women. Clin Invest Ginecol Obstet. 2021; 48(3):100663. PMID: 33654337.

21. Li L, Wang X, Wang R, Hu Y, Jiang S, Lu X. Antiviral agent therapy optimization in special populations of COVID-19 patients. Drug Des Devel Ther. 2020; 14:3001–3013.

22. Joseph BA, Dibas M, Evanson KW, Paranjape G, Vegivinti CT, Selvan PT, et al. Efficacy and safety of lopinavir/ritonavir in the treatment of COVID-19: a systematic review. Expert Rev Anti Infect Ther. 2021; 19(6):679–687. PMID: 33187459.

23. Godino C, Scotti A, Maugeri N, Mancini N, Fominskiy E, Margonato A, et al. Antithrombotic therapy in patients with COVID-19? -rationale and evidence. Int J Cardiol. 2021; 324:261–266. PMID: 33002521.

24. Barrett CD, Moore HB, Yaffe MB, Moore EE. ISTH interim guidance on recognition and management of coagulopathy in COVID-19: a comment. J Thromb Haemost. 2020; 18(8):2060–2063. PMID: 32302462.

25. Li J, Wang Y, Zeng Y, Song T, Pan X, Jia M, et al. Critically ill pregnant patient with COVID-19 and neonatal death within two hours of birth. Int J Gynaecol Obstet. 2020; 150(1):126–128. PMID: 32369616.

26. Qadri SK, Ng P, Toh TS, Loh SW, Tan HL, Lin CB, et al. Critically ill patients with COVID-19: a narrative review on prone position. Pulm Ther. 2020; 6(2):233–246. PMID: 33085052.