Through this case, we present the thought process, team-based strategy and sequel of managing a complex, critically ill pregnant with ARDS and COVID-19 pneumonia. This case also confirms the feasibility of using convalescent plasma and ECMO during early postnatal period in acutely ill parturient with respiratory failure. TITLE PAGE Title Management of life-threatening acute respiratory syndrome and severe pneumonia secondary to COVID-19 in pregnancy: a case report and literature review Short title Management of critically ill obstetric patient diagnosed with COVID-19
BackgroundAs COVID-19 continues to infect women of all gestational ages; gravida in labor and the acutely ill parturient are particularly at higher risk of infection. No therapeutic agent or vaccine is approved to treat COVID-19 till date. Thus, managing COVID-19 and associated complications during pregnancy is often challenging and requires a multidisciplinary approach to treatment. Case PresentationWe narrate our perspectives on managing a 32-year-old, critically ill obstetric patient at 32-week gestation, diagnosed with acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia. Upon confirmation of COVID-19, as per the local protocol antivirals, antimalarial, and antibiotics were commenced. Due to rapidly exacerbating maternal respiratory functions, and potential chances of fetal hypoxemia emergency caesarian was performed. Following delivery, the maternal respiratory functions further deteriorated as she required prolonged mechanical ventilation and initiation of extracorporeal membrane oxygenation until she was clinically stable on day 23. The patient also received convalescent plasma and tocilizumab as a part of the treatment protocol. The newborn was shifted to neonatal intensive care for intubation for respiratory distress and was found negative for SARS-CoV-2 and COVID-19 immunoglobulin (Ig). At day 25, the patient was clinically stable and was transferred to step down unit and discharged thereafter. Conclusion Through this case, we present the thought process, multidisciplinary team-based strategy and sequel of managing a complex, critically ill obstetric patient with ARDS and COVID-19 pneumonia. We anticipate that this case report will assist other healthcare institutions to manage critically ill patients with COVID-19 pneumonia.Key words: COVID-19, maternal, pandemic, perinatal, ECMO, convalescent plasma, pharmacological interventions.
A prospective observational study at the newly estab-lished Fetal Medicine Unit, Hamad Hospital, Qatar; evalu-ated the impact of the service on the detection rate of criti-cal congenital heart defects, patterns of referral and sub-sequent yield for structural congenital heart disease in a population with a significant proportion of high risk fac-tors. Of 391 pregnant females examined between January 2003 and December 2004, 58 (14.8%) had fetal cardiac abnormalities of which 23 (5.8% of total referrals) had major structural malformations of the heart. Cases of fetal congenital heart disease had further evaluation us-ing real time three-dimensional echocardiography (RT3DE) which is new equipment in the paediatric cardi-ology department. All cases with cardiac defects whether minor or major had follow up fetal echocardiography. Neonatal echocardiography confirmed the diagnosis in all cases with major defects (100% specificity). False positive cases that were found to be normal post natal were 1% of the total cases referred (12% of cases with congenital mal-formation). False negative cases were 1% and all had a small ventricular septal defect (VSD) except for one Down's syndrome with a very large VSD. Three patients needed urgent Caesarean section (CS) deliveries, one with complete heart block (HB) and two with supraventricular tachycardia (SVT). One patient traveled abroad as the fetus had left isomerism and major cardiac defects and complete HB. Fifteen newborns had to receive prostaglandin based on the fetal diagnosis before being seen by paediatric cardiologists. There was no termination of pregnancy due to major cardiac defects even in cases of HLHS. The preliminary results of this clinic are very satisfac-tory and have affected favorably the outcome of the new-borns with congenital heart defects. It is hoped that the results of this study will encourage more referrals to the FMU.
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