Abstract

Research Article

Clinical characteristics, management, maternal and neonatal outcome among seven severe and critically ill pregnant women with COVID-19 pneumonia

Komal Sundeep Hazari, Litty Paulose, Nimmi Kurien, Hozaifah Mohammad, Taghrid Faek A Elgergawi, Atif Bashir E Fazari* and Amar Hassan

Published: 30 November, 2020 | Volume 3 - Issue 2 | Pages: 158-166

Pneumonia caused by the Novel coronavirus disease 2019 (COVID-19) is a highly infectious disease and the ongoing outbreak has been declared as a Pandemic by the World health organization. Pneumonia is a serious disease in pregnancy and requires prompt attention. Viral pneumonia has higher morbidity and mortality compared to bacterial pneumonia in pregnancy. All efforts are well exerted to understand the newly emerged disease features but still some areas are gray.

The treatment is primarily supportive with antivirals, steroids, anticoagulation and antibiotics for secondary bacterial infection. Severe cases require intensive care monitoring with oxygen support, mechanical ventilation. Investigational therapies include convalescent plasma, cytokine release inhibitors and other immunomodulatory agents like interferons. The mortality appears driven by the presence of severe Adult Respiratory Syndrome (ARDS) and organs failure.

COVID pandemic is a challenging and stressful socio-economic situation with widespread fear of infection, disease and death. In the specialty of obstetrics and gynecology, studies are being conducted to ascertain the manifestation of disease in pregnant women and the fetal outcome.

The aim of our case series is to describe the demographics, clinical characteristics, laboratory and radiological findings, feto- maternal outcome of severe and critical COVID pneumonia in pregnant women in Latifa Hospital.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001071 Cite this Article Read Full Article PDF

Keywords:

Adult respiratory syndrome (ARDS); Novel coronavirus disease 2019 (COVID-19); Pregnancy; Cytokine storm; Maternal mortality and morbidity

References

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, et al. A Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382: 727-733. PubMed: https://pubmed.ncbi.nlm.nih.gov/31978945/
  2. World Health Organization. Novel Coronavirus—China. January 12, 2020.
  3. Gorbalenya AE, Baker SC, Baric R, Groot RJ, Drosten C, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses–a statement of the Coronavirus Study Group.
  4. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323: 1239-1242. PubMed: https://pubmed.ncbi.nlm.nih.gov/32091533/
  5. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020; 369. PubMed: https://pubmed.ncbi.nlm.nih.gov/32444460/
  6. Corey L, Mascola JR, Fauci AS, Collins FS. A strategic approach to COVID-19 vaccine R&D. Science. 2020; 368: 948-950. PubMed: https://pubmed.ncbi.nlm.nih.gov/32393526/
  7. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. JAMA. 2010; 303: 1517-1525. PubMed: https://pubmed.ncbi.nlm.nih.gov/20407061/
  8. Lam CM, Wong SF, Leung TN, Chow KM, Yu WC, et al. A case‐controlled study comparing clinical course and outcomes of pregnant and non‐pregnant women with severe acute respiratory syndrome. BJOG: Int J Obst Gynaecol. 2004; 111: 771-774. PubMed: https://pubmed.ncbi.nlm.nih.gov/15270922/
  9. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, et al. Miller's anesthesia e-book.: Elsevier Health Sciences; 2014.
  10. Metz TD. Clinical Management Guidelines for Obstetrician–Gynecologists Critical Care in Pregnancy. 2019.
  11. Greenberg M, Jacobziner H, Pakter J, Weisl BAG. Maternal mortality in the epidemic of Asian influenza, New York City, 1957. Am J Obstet Gynecol. 1958; 76: 897-902. PubMed: https://pubmed.ncbi.nlm.nih.gov/13583035/
  12. Rasmussen SA, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation. Obstet Gynecol. 2020; 135: 999-1002. PubMed: https://pubmed.ncbi.nlm.nih.gov/32213786/
  13. Rigby FB, PASTOREK JG. Pneumonia during pregnancy. Clin Obstet Gynecol 1996; 39: 107-119. PubMed: https://pubmed.ncbi.nlm.nih.gov/8635293/
  14. Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science (New York). 2020; 368: 473-474 PubMed: https://pubmed.ncbi.nlm.nih.gov/32303591/
  15. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the cytokine Storm' in COVID-19. J Infect 2020; 80: 607-613. PubMed: https://pubmed.ncbi.nlm.nih.gov/32283152/
  16. Zangrillo A, Beretta L, Scandroglio AM, Monti G, Fominskiy E, et al. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Crit Care Resusc. 2020. PubMed: https://pubmed.ncbi.nlm.nih.gov/32353223/
  17. Handbook of obstetric medicine 6th edition. Catherine Nelson-Piercy 6th Edition. April 2015.
  18. Toussie D, Voutsinas N, Finkelstein M, Cedillo MA, Manna S, et al. Clinical and chest radiography features determine patient outcomes in young and middle-aged adults with COVID-19. Radiology. 2020; 297: E197-E206. PubMed: https://pubmed.ncbi.nlm.nih.gov/32407255/
  19. Chen H, Guo J, Wang C, Luo F, Yu X, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395: 809-815. PubMed: https://pubmed.ncbi.nlm.nih.gov/32151335/
  20. Lei S, Jiang F, Su W, Chen C, Chen J, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. E Clin Med. 2020; 100331. PubMed: https://pubmed.ncbi.nlm.nih.gov/32292899/
  21. Paruk F, Chausse J. Monitoring the post-surgery inflammatory host response. J Emer Crit Care Med. 2019; 3.
  22. Tisoncik JR, Korth MJ, Simmons CP, Farrar J, Martin TR, et al. Into the eye of the cytokine storm. Microbiology and Molecular Biology Reviews. 2012; 76: 16-32. PubMed: https://pubmed.ncbi.nlm.nih.gov/22390970/
  23. Hirshberg A, Kern-Goldberger AR, Levine LD, Pierce-Williams R, Short WR, et al. Care of critically ill pregnant patients with coronavirus disease 2019: a case series. Am J Obstet Gynecol. 2020; 223: 286-290. PubMed: https://pubmed.ncbi.nlm.nih.gov/32371056/

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