Characteristics and Outcomes of Critically Ill Pregnant/Postpartum Women with COVID-19 Pneumonia in Western Balkans, The Republic of Srpska Report

Abstract

Background and Objectives: Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. As of 5 March 2020, the COVID-19 pandemic has resulted in approximately 111,767 cases and 6338 deaths in the Republic of Srpska and 375,554 cases and 15,718 deaths in Bosnia and Herzegovina. Our objective in the present study was to determine the characteristics and outcomes of critically ill pregnant/postpartum women with COVID-19 in the Republic of Srpska. Materials and Methods: The retrospective observational study of prospectively collected data included all critically ill pregnant/postpartum women with COVID-19 in a university-affiliated hospital between 1 April 2020 and 1 April 2022. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Patients’ demographics, clinical and laboratory data, pharmacotherapy, and neonatal outcomes were analysed. Results: Out of the 153 registered pregnant women with COVID-19 treated at the gynaecology department of the University Clinical Centre of the Republic of Srpska, 19 (12.41%) critically ill pregnant/postpartum women (median age of 36 (IQR, 29–38) years) were admitted to the medical intensive care unit (MICU). The mortality rate was 21.05% (four patients) during the study period. Of all patients (19), 14 gave birth (73.68%), and 4 (21.05%) were treated with veno-venous extracorporeal membrane oxygenation (vvECMO). Conclusions: Fourteen infants were born prematurely and none of them died during hospitalisation. A high mortality rate was detected among the critically ill pregnant/postpartum patients treated with mechanical ventilation and vvECMO in the MICU. The preterm birth rate was high in patients who required a higher level of life support (vvECMO and ventilatory support).

Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With Critical Coronavirus Disease 2019 (COVID-19) Acute Respiratory Distress Syndrome

“…After the elimination of studies not relevant to the subject of interest and meeting abstracts, 25 were retrieved for complete analysis. 4,6,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Four studies were excluded: three for including duplicate patients published in other included articles [40][41][42] and one because of the inability to determine from published information the number of women with maternal mortality. 43 The corresponding authors for the latter study were contacted and indicated that they could not provide the additional information requested.…”

“…In total, 21 studies with 386 pregnant individuals who had critical COVID-19 managed with ECMO were included in the review. 4,6,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Study characteristics and results were summarized and verified for accuracy independently by two authors. Features of the included studies are shown in Table 1.…”

“…Nine were retrospective case series, 21,22,24,[27][28][29]32,34,38 and 12 were retrospective cohort studies. 4,6,23,25,26,30,31,33,[35][36][37]39 Studies evaluated pregnant women who underwent ECMO from January 2020 to October 2022. All studies included singleton pregnancies.…”

“…6,21,22,24,[27][28][29]32,34,35,37,38 Fourteen studies provided information on the type of ECMO cannulation used, with 96.6% of women (199/206) supported with venovenous ECMO. 4,21,22,24,[26][27][28][29][31][32][33][34][35]38 Eleven of the 12 cohort studies were rated as having a low risk of bias (Appendix 2, available online at http://links.lww.com/AOG/D493). 4,6,23,25,26,30,31,33,34,36,39 One cohort study was rated as having a high risk of bias by both reviewers (mean Newcastle Ottawa Scale score 6).…”

“…4,21,22,24,[26][27][28][29][31][32][33][34][35]38 Eleven of the 12 cohort studies were rated as having a low risk of bias (Appendix 2, available online at http://links.lww.com/AOG/D493). 4,6,23,25,26,30,31,33,34,36,39 One cohort study was rated as having a high risk of bias by both reviewers (mean Newcastle Ottawa Scale score 6). 37 The nine case series studies were rated as having a high risk of bias (Appendix 2, http://links.lww.com/AOG/ D493).…”