Multiprofessional perinatal care in a pregnant patient with acute respiratory distress syndrome due to COVID-19

Palmrich, Pilar; Roessler, Bernhard; Wisgrill, Lukas; Kampf, S.; Gattinger, Pia; Valenta, Rudolf; Fleischmann, Edith; Berger, Angelika; Kiss, Herbert; Farr, Alex

doi:10.1186/s12884-021-04059-y

Cited by 8 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some researchers subjected patients to extracorporeal membrane oxygenation (ECMO) without previous PP attempts [37][38][39] and others performed cesarean section before PP. 40 In a study on ECMO in pregnant and puerperal women with ARDS, PP was attempted before ECMO in only 2 of the 7 pregnant women with respiratory failure. 38 A more recent publication showed a greater tendency to use PP before ECMO in pregnant women with COVID-19; nevertheless, it was not attempted in 42% of the 100 pregnant and postpartum women in the study.…”

Section: Discussionmentioning

confidence: 99%

Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center

Barbosa¹,

Braga²,

Costa³

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The management of acute respiratory failure during pregnancy is a poorly defined issue in the literature, especially regarding the use of the prone position and the appropriate time for delivery. This study describes our experience in treating pregnant and postpartum women with severe or critical coronavirus disease 2019 (COVID-19). Materials and Methods: This descriptive retrospective study included 25 pregnant and 4 postpartum women admitted to an ICU due to respiratory complications from COVID-19 from June 2020 to August 2021. Results: The mean maternal age was 33.6 years, and the median gestational age (GA) at admission was 33 weeks. Obesity was the most common comorbidity. The median time between symptom onset and ICU admission was 10 days, while the median length of ICU stay was 14 days. Invasive mechanical ventilation (IMV) was required in 16 (55.2%) patients for a median time of 16.5 days. Prone positioning (PP) was performed in 68.7% of the patients on IMV, and resulted in an expressive increase in arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio). Eleven (44%) pregnant women delivered during their ICU stay for obstetric or fetal reasons: of these, 2 (18%) developed postpartum hemorrhagic shock and 1 (9%) developed abdominal wall infection. None of the 25 pregnant women underwent delivery due to acute respiratory failure or in an attempt to avoid intubation. There were 2 fetal deaths, but no maternal or neonatal deaths. Conclusion: We observed favorable outcomes in pregnant and postpartum women with severe and critical COVID-19 admitted to our institution. This finding reinforces the effectiveness of PP in the treatment of hypoxemic respiratory failure secondary to COVID-19 in pregnant women undergoing IMV, and suggests that gestation should only be interrupted in cases of obstetric and fetal complications, provided the patient is stable, or when hypoxemia is refractory to PP.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center

Barbosa¹,

Braga²,

Costa³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Several reports and studies demonstrated the use of PP with reservations. Some researchers subjected patients to extracorporeal membrane oxygenation (ECMO) without previous PP attempts [37][38][39] and others performed cesarean section before PP [40]. In a study on ECMO in pregnant and puerperal women with ARDS, PP was attempted before ECMO in only 2 of the 7 pregnant women with respiratory failure [38].…”

Section: Discussionmentioning

confidence: 99%

Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center

et al. 2022

View full text Add to dashboard Cite

Background The management of acute respiratory failure during pregnancy is a poorly defined issue in the literature, especially regarding the use of the prone position and the appropriate time for delivery. This study describes our experience in treating pregnant and postpartum women with severe or critical coronavirus disease 2019 (COVID-19). Materials and methods This descriptive retrospective study included 25 pregnant and 4 postpartum women admitted to an ICU due to respiratory complications from COVID-19 from June 2020 to August 2021. Results The mean maternal age was 33.6 years, and the median gestational age (GA) at admission was 33 weeks. Obesity was the most common comorbidity. The median time between symptom onset and ICU admission was 10 days, while the median length of ICU stay was 14 days. Invasive mechanical ventilation (IMV) was required in 16 (55.2%) patients for a median time of 16.5 days. Prone positioning (PP) was performed in 68.7% of the patients on IMV, and resulted in an expressive increase in arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio). Eleven (44%) pregnant women delivered during their ICU stay for obstetric or fetal reasons: of these, 2 (18%) developed postpartum hemorrhagic shock and 1 (9%) developed abdominal wall infection. None of the 25 pregnant women underwent delivery due to acute respiratory failure or in an attempt to avoid intubation. There were 2 fetal deaths, but no maternal or neonatal deaths. Conclusion We observed favorable outcomes in pregnant and postpartum women with severe and critical COVID-19 admitted to our institution. This finding reinforces the effectiveness of PP in the treatment of hypoxemic respiratory failure secondary to COVID-19 in pregnant women undergoing IMV, and suggests that gestation should only be interrupted in cases of obstetric and fetal complications, provided the patient is stable, or when hypoxemia is refractory to PP.

show abstract

“…Sepsis was defined as a confirmed or suspected infection requiring vasopressors, elevated serum lactate levels, and a Sequential Organ Assessment (SOFA) score increase of ≥2 points. Retrieved data also included risk factors that are known to increase the probability of intensive care treatment, such as pre-existing hypertension, diabetes, rheumatoid disease, renal insufficiency, hyper- or hypothyroidism, pulmonary disease, cardiac disease, thrombosis/embolism, obesity, nicotine abuse, influenza or COVID-19 [ 15 , 16 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

Peripartum Maternal Admission to the Intensive Care Unit: An Observational Study over a 15-Year Period at a Tertiary Center in Austria

Foessleitner,

Budil,

Mayer

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

Peripartum maternal admission to the intensive care unit is challenging for anesthesiologists, obstetricians, and all personnel involved. An understanding of altered maternal physiology, fetal considerations, and acute peripartum emergencies is required to ensure adequate maternal and neonatal outcomes. In this study, we analyzed data of peripartum maternal admissions to the intensive care unit at our large tertiary referral center in order to define trends and changes over time. This study retrospectively analyzed maternal morbidity, admission diagnoses, treatments, and outcomes of women with peripartum admission to the intensive care unit at our tertiary care center over a 15-year period. We found that patient characteristics and admission diagnoses remained remarkably consistent over the observational period; however, there was a significant increase in postpartum hemorrhage (r = 0.200, p < 0.001) and cesarean hysterectomy (r = 0.117, p = 0.027) over time. Moreover, we found a reduction in preterm births (r = −0.154, p = 0.004) and a decreased peripartum neonatal intensive care unit admission rate (r = −0.153, p = 0.006) among women who were transferred to the intensive care unit. Based on our long-term observational data, there is consistent need for intensive care in obstetrics due to a small number of different etiologies. Specialized training for the predominant diagnoses involved as well as multidisciplinary care of the affected patients are both warranted.

show abstract

Multiprofessional perinatal care in a pregnant patient with acute respiratory distress syndrome due to COVID-19

Cited by 8 publications

References 19 publications

Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center

Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center

Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center

Peripartum Maternal Admission to the Intensive Care Unit: An Observational Study over a 15-Year Period at a Tertiary Center in Austria

Contact Info

Product

Resources

About