Adult intensive care unit admissions with severe COVID-19 infection following emergency Caesarean section deliveries: A case series

Abstract

Background UK data suggest 6% of COVID-19 hospital admissions are either currently pregnant or immediately post-partum. However, the current literature suggests that if COVID-19 occurs in pregnancy, or post-partum, symptoms are mostly mild. Methods All COVID-19 admissions to one acute London National Health Service Foundation trust were reviewed since the beginning of the COVID-19 pandemic to 1 May 2020 to establish whether there were any pregnant or immediately post-partum admissions. Data were extracted from hospital electronic records and anonymised. Any patients admitted to adult intensive care unit had their case notes reviewed in detail and comparison made to a local risk-assessment guideline identifying patients at-risk of thromboembolic events or cytokine storms. Local hospital guidelines were followed. Patients admitted to adult intensive care unit gave written consent. Results A total of 24 pregnant or immediately post-partum patients with COVID-19 were admitted. Three patients required long adult intensive care unit admissions for severe single-organ respiratory failure after emergency C-sections. Two of these patients required proning (three times and eight times, respectively). All were considered medium risk for thromboembolic events but had rising D-dimers following adult intensive care unit admission, resulting in increased dosing of pharmacological thromboprophylaxis throughout their admission. All were considered low risk for a cytokine storm, and none had any significant cardiovascular or renal involvement. One patient developed a super-imposed fungal lung infection. All three patients developed delirium following cessation of sedation. Conclusion Pregnant or immediately post-partum women can develop severe COVID-19 symptoms requiring prolonged adult intensive care unit admission. It is likely to be single-organ failure, but patients are at a high risk of a thromboembolic event and delirium.

Critical care, maternal and neonatal outcomes of pregnant women with COVID‐19 admitted to eight intensive care units during the wildtype, alpha and delta waves of the pandemic across the North West of England—a retrospective review

“…Our previous work reporting anesthetic outcomes in women who tested positive for SARS‐CoV‐2 in the North West of England, highlighted ICU admission rates of 8% during the antepartum period, increasing to 11% postpartum 4 . Critical care outcomes and maternal morbidity of these women affected by SARS‐CoV‐2 and admitted to ICU in the UK are limited to small case series 10 . No study to our knowledge from the UK has delineated the characteristics of women admitted to ICU at different periods during their pregnancy.…”

“… 4 Critical care outcomes and maternal morbidity of these women affected by SARS‐CoV‐2 and admitted to ICU in the UK are limited to small case series. 10 No study to our knowledge from the UK has delineated the characteristics of women admitted to ICU at different periods during their pregnancy.…”

Tornar-se mãe em tempos de pandemia: revisão integrativa da literatura

“…No Quadro 2 são apresentados os 12 artigos, no qual organizou-se uma tabela com a identificação, periódico, ano de publicação, objetivo do estudo, tipo de estudo, base de dados em que está disponível e nível de evidência. Destaca-se que todos os artigos selecionados são da literatura internacional, destacando-se que as pesquisas foram desenvolvidas nos seguintes países: Estados Unidos, 10,13,20 Inglaterra, 11,14 China, 12 Canadá, 15 Austrália, 16 Espanha, 17 Israel, 18 Catar 19 e Chile 21 . Quanto ao ano de publicação, nove foram publicados em 2020 11,12,13,14,16,18,19,20,21 e três em 2021 10,15,17 Após a síntese dos resultados, os achados foram agrupados em quatro tópicos: saúde mental de gestantes e puérperas durante a pandemia da Covid-19; rede de apoio durante a gestação, parto e pós-parto durante a pandemia de Covid-19; repercussões do diagnóstico de Covid-19 durante a gravidez, parto e pós-parto; experiência do parto durante a pandemia de Covid-19.…”