Critical respiratory failure in pregnancy complicated with COVID-19: A case report

Abstract

The case is presented of a 29-year-old primiparous woman who was COVID-19-positive at 34 weeks of gestation and who developed severe acute respiratory distress syndrome. After a four-day history of fever and mild dyspnea, she was referred to hospital. Ciclesonide, dexamethasone, heparin sodium, and sulbactam/ampicillin were initiated, followed by remdesivir and tocilizumab. On the fourth day after admission (at 34 weeks 5 days of gestation), respiratory failure required ventilator management. An emergency cesarean section was performed and a 2565-g male infant was delivered with an Apgar score of 8/8 and negative COVID-19 status . However, on the following day the patient's respiratory condition deteriorated and mechanical ventilation was initiated. Subsequently, her respiratory condition quickly improved and mechanical ventilation was terminated 4 days after intubation. She was discharged 12 days after cesarean delivery. Our case provides additional evidence that raises concerns regarding the unfavorable maternal consequences of COVID-19 infection during pregnancy.

Remdesivir for pregnancy: A systematic review of antiviral therapy for COVID-19

“…Most of these observational studies (2 cohort studies, 4 case series, and 4 case reports) were conducted in the United States [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 28 ]. Other case reports were conducted in Indonesia [ 24 ], India [ 26 ], and Japan [ 27 ].…”

“…All 13 observational studies reported clinical outcomes [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Cohort studies that compared oxygen needs between pregnant and postpartum women used a modified ordinal scale with the following criteria: (6) death; (5) hospitalized, requiring mechanical ventilation (intermittent mandatory ventilation) and/or extracorporeal membrane oxygenation; (4) hospitalized, requiring high-flow oxygen therapy and/or noninvasive positive pressure ventilation; (3) hospitalized, requiring supplemental low-flow oxygen therapy; (2) hospitalized on room air; (1) discharge.…”

“…Based on consecutive case series and case reports, clinical recovery from oxygen-need reduction was 90% (20/22), and the average hospitalization duration was 13.3 ± 11 days [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. In the case series of five pregnant people with moderate to severe COVID-19, clinical conditions during hospitalization improved rapidly following remdesivir treatment, and the hospitalization time was shorter [ 24 ].…”

“…Ten observational studies reported laboratory outcomes [16,17,18,19,20,22,24,25,26,27]. In cohort studies, 67% of participants had treatment-emergent-graded laboratory abnormalities based on the criteria of "The Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Event version 2.1."…”

“…Neonatal outcome: Fetal wellbeing was monitored, and no immediate adverse effect was noted. Case 2 ALT (units/L) = HD1: 143, HD4: 121, HD8: 131, HD10: 115 AST (units/L) = HD1: 164.2, HD4: 137, HD8: 151, HD10: 122 CRP (mg/dL) = HD1: 18.2, HD4: 11.5, HD10: 2.2 Chinen et al., 2021 [ 27 ] On the 4th day of admission, the respiratory condition rapidly worsened. After cesarean section, the respiratory condition deteriorated, requiring mechanical ventilation.…”