Acute Respiratory Distress Syndrome in a Preterm Pregnant Patient With Coronavirus Disease 2019 (COVID-19)

Abstract

As the epidemiology of COVID-19 evolves, obstetric care providers and obstetric anesthesiologists must thoughtfully consider routine aspects of inpatient obstetric management and discuss alterations in practice to optimize the safety of our patients and staff. Hospitals should begin collaborations with others in their health region to optimize testing and clinical management protocols for pregnant and postpartum women in their geographic area. These recommendations are not proscriptive and may not apply in your clinical setting. They are intended to introduce concepts to be considered in each setting and give examples of current practices in place. This guidance will be updated as additional data and information emerge. Systems-Level Responses Level of Care Broader health systems and networks should coordinate to identify each hospital's capacity and plans for transferring care as needed to meet both maternal and fetal needs. Communication should frequently occur, as hospital capacities may change rapidly. Cohorting and Other Strategies for Exposure Mitigation One public health intervention to reduce exposure risk is cohorting-co-locating patients who are persons under investigation (PUI) and women who test positive for SARS-CoV2 into a restricted area of the hospital. While not all facilities are able to create an independent obstetrics COVID-19 unit, attempts should be made to designate specific locations for the purposes of containment, which will limit the exposure of unaffected patients and staff.

Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis

“…Of the 30 case reports, 29 reports described neonatal outcomes of women in their third trimester, whereas only 2 case reports described outcomes of women in their second trimester. 13 , 18 , 25 , 27 , 28 , 29 , 30 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 66 To date, no reports are available describing the assessment for the presence of SARS-CoV-2 in products of conception of a first-trimester pregnancy. Most women in case report studies (32/44) underwent CD with a resultant CD rate of 73%.…”

Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

“…The meta-analysis was based on 745 COVID infected cases and 219 controls. A total of 34 case reports [ [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] ] yielding 45 cases were also included in the descriptive data analysis. Majority of the studies (12/34) were from China, 7 from the USA [ 62 , 67 , 68 , 70 , 76 , 85 , 87 ], 2 from Iran [ 63 , 80 ], 2 from Netherlands [ 82 , 83 ], 1 from Peru [ 75 ], 1 from Italy 1 [ 84 ], 1 from Sweden [ 64 ], 1 from Spain [ 73 ], 1 from Korea [ 55 ], 1 from Turkey [ 56 ], 1 from UK [ 78 ], 1 from Australia [ 88 ], 1 from Canada [ 79 ], 1 from Jordon [ 86 ], and 1 from India [ 72 ].…”

Management of life-threatening acute respiratory syndrome and severe pneumonia secondary to COVID-19 in pregnancy: a case report and literature review

“…We report a multidisciplinary approach to treating and complete recovery of acute respiratory failure and severe pneumonia secondary to SARS-COV2 infection during pregnancy. A plethora of studies have demonstrated the management of mild-moderate cases of SARS-COV2 infection in pregnancy with positive outcomes (2,10,20). However, very few studies have reported the management of critically ill patients, particularly in pregnancy.…”

“…Data collated from these patients demonstrated higher rates of intensive care unit admission, intubation, and death compared with non-pregnant patients (7,9). Anecdotal evidence demonstrates 0.1-0.2% of all pregnancies are complicated by respiratory failure (10,11).…”