Maternal-Neonatal Dyad Outcomes of Maternal COVID-19 Requiring Extracorporeal Membrane Support: A Case Series

Abstract

Objective This study aimed to describe two cases of acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease 2019 (COVID-19) in pregnant women requiring extracorporeal membrane oxygenation (ECMO), and resulting in premature delivery. Study Design The clinical course of two women hospitalized with ARDS due to COVID-19 care in our intensive care (ICU) is summarized; both participants provided consent to be included in this case series. Results Both women recovered with no clinical sequelae. Neonatal outcomes were within the realm of expected for prematurity with the exception of coagulopathy. There was no vertical transmission to the neonates. Conclusion This case series highlights that ECMO is a feasible treatment in the pregnant woman with severe COVID-19 and that delivery can be performed safely on ECMO with no additional risk to the fetus. While ECMO carries its natural risks, it should be considered a viable option during pregnancy and the postpartum period. Key Points

The systemic inflammatory landscape of COVID-19 in pregnancy: Extensive serum proteomic profiling of mother-infant dyads with in utero SARS-CoV-2

“…7,8 The clinical spectrum of COVID-19 in pregnancy ranges from asymptomatic to critical disease, requiring mechanical ventilation or even ECMO, and in some cases, death. [9][10][11] Recent surveillance studies suggest that pregnant women are at an increased risk of severe COVID-19, marked by a dysregulated inflammatory response. 12 While episodes of SARS-CoV-2 mother-to-child transmission are estimated to be low, 5 the long-term consequences following in utero exposure are unknown.…”

Premature birth and COVID-19: an integrative review/ Nascimento prematuro e COVID-19: uma revisão integrativa

“…However, according to the latest report from the Center for Disease Control and Prevention 13 , pregnant women may have a greater need for mechanical ventilation (MV), extracorporeal membrane oxygenation, and intensive care unit (ICU) admission. Douglass et al 14 , consider that pre-existing conditions, such as diabetes and obesity, increase the susceptibility to develop severe forms of Covid-19 in pregnancy.…”

“…In our analysis, six pregnant women went into spontaneous premature labor 12,14,[16][17][18][19]22 , two had premature rupture of membranes 18,19 and one had a placenta abruption 20 . Three evolved to spontaneous vaginal delivery 13,17,18 and, among them, only one received intrapartum oxytocin 18 .…”

“…SARS-CoV-2 nasopharyngeal RT-PCR were sent at birth, 24 hours, 48 hours, and 7 days after birth which were all negative. The infant was extubated within 24 hours after birth the remained in the for routine care for prematurity 14 .…”

The Successful Use of Combined Extracorporeal Life Support in Treatment of the New Coronavirus Infection Complicated by the Development of Multiple Organ Dysfunction in a Pregnant Woman

“…[7,10,22,24,25,29,34,38], тяжелую пнев монию в сочетании с бронхиальной астмой [9,20], массивное легочное кровотечение [17], вторичный ОРДС на фоне сепсиса [31,33], ОРДС неизвестной этиологии [11], острое повреждение легких вслед ствие трансфузии [37] и ряд других более редких патологий. На сегодняшний день лишь несколько авторов сообщили о благоприятных исходах для матери и плода в случаях, когда было необходимо применение экстракорпорального замещения функ ции дыхания при COVID-19 [6,12,14,19,20,21,23,43]. Самая большая группа из девяти женщин опи сана J. Barrantes et al [6].…”