Management and outcomes of pregnant women admitted to intensive care unit for severe pneumonia related to SARS-CoV-2 infection: the multicenter and international COVIDPREG study

Abstract

Purpose Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated. Methods A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported. Results Among the 187 pregnant women with COVID-19 (33 ± 6 years old and 28 ± 7 weeks’ gestation), 76 (41%) were obese, 12 (6%) had diabetes mellitus and 66 (35%) had pregnancy-related complications. Standard oxygenation, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV) were used as the only oxygenation technique in 41 (22%), 55 (29%) and 18 (10%) patients, respectively, and 73 (39%) were intubated. Overall, 72 (39%) patients required several oxygenation techniques and 15 (8%) required venovenous extracorporeal membrane oxygenation. Corticosteroids and tocilizumab were administered in 157 (84%) and 25 (13%) patients, respectively. Awake prone positioning or prone positioning was performed in 49 (26%) patients. In multivariate analysis, risk factors for intubation were obesity (cause-specific hazard ratio (CSH) 2.00, 95% CI (1.05–3.80), p = 0.03), term of pregnancy (CSH 1.07, 95% CI (1.02–1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH 2.69, 95% CI (1.30–5.60), p < 0.01) and NIV use (CSH 2.06, 95% CI (1.09–3.90), p = 0.03). Delivery was required during ICU stay in 70 (37%) patients, mainly due to maternal respiratory worsening, and improved the driving pressure and oxygenation. Maternal and fetal/neonatal mortality rates were 1% and 4%, respectively. The rate of maternal and/or neonatal complications increased with the invasiveness of maternal respiratory support. Conclusion In ICU, corticosteroids, tocilizumab and prone positioning were used in few pregnant women with COVID-19. Over a third of patients were intubated and delivery improved the driving pressure. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06833-8.

High flow nasal oxygen and awake prone positioning – Two allies against COVID-19: A systematic review

“…The search yielded thirteen relevant studies which fitted with our purpose ( Ehrmann et al, 2021 , Ferrando et al, 2020 , Ibarra-Estrada et al, 2022 , Jouffroy et al, 2021 , Kaur et al, 2021 , Kucukdemirci-Kaya et al, 2022 , COVIDPREG Study Group, 2022 , Vanderbilt Learning Healthcare System Platform Investigators, 2022 , PROFLO Study Group, 2021 , Tu et al, 2020 , Vianello et al, 2021 , Xu et al, 2020 , Yang et al, 2020 ). The search and selection strategies are shown in Fig.…”

“… FiO2≤0.4 with flow ≤20 L/min to maintain SpO2≥90% for 2 h, need for non-invasive mechanical ventilation, death. HFNO/ APP group: lower intubation rate (30%) than HFNO (43%) RR=0.7, shorter length of stay (11% vs 13%) Peju et al ( Péju et al, 2022 ) France, Belgium, Switzerland 187 (8 HFNO/ APP) According to the severity of respiratory failure and local protocol. NA NA NA Pregnant patients.…”

ECMO-Therapie bei COVID-19-ARDS in der Schwangerschaft ermöglicht den Erhalt einer Schwangerschaft mit termingerechter Entbindung

“…In ähnlichen Fällen wäre für die meisten Schwangeren vermutlich zunächst die konventionelle Beatmungstherapie das geeignetere Vorgehen, um ein adäquates Sauerstoffangebot bereitzustellen. Allerdings zeigen Fallserien und Multizenterstudien, dass die Komplikationsrate für Mutter und Kind mit zunehmender Invasivität der Beatmung zunimmt [ 3 , 12 ].…”

Risk Factors Associated with Severe Disease and Intensive Care Unit Admission of Pregnant Patients with COVID-19 Infection—A Retrospective Study

“…However, risk factors for ICU admission of pregnant patients diagnosed with COVID-19 are poorly explored. A retrospective multicenter study evaluated the management and outcomes of 187 pregnant women with COVID-19 admitted to several ICUs from Europe, and identified as risk factors for intubation obesity (cause-specific hazard ratio (CSH): 2.00, 95% CI: 1.05–3.80), p = 0.03), term of pregnancy (CSH: 1.07, 95% CI: 1.02–1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH: 2.69, 95% CI: 1.30–5.60), p < 0.01) and non-invasive ventilation (NIV) use (CSH 2.06, 95% CI (1.09–3.90), p = 0.03) [ 15 ]. A recent case-control study showed that gestational diabetes also presented with a higher rate of ICU admission in SARS-CoV-2 pregnant patients [ 16 ].…”