Abstract

Objective:

This study examined the clinical consequences of pregnancy coexisting with severe acute respiratory syndrome coronavirus 2 in the intensive care unit (ICU).

Materials and Methods:

The study was designed as a retrospective observational study. After the ethical approval of the local ethics committee, the study was conducted for a period when the number of young coronavirus disease-2019 (COVID-19) cases increased in our country. The patients enrolled in the study were pregnant/puerperal patients followed up in our third-level ICU.

Results:

The mean age of 35 pregnant women included in the study was 29.57±4.36 years. Twenty-one of the births (80.8%) were preterm births. Twelve (34.3%) patients received invasive mechanical ventilation (IMV), and 5 (41.7%) of these patients were deceased. Twenty-six (74.3%) underwent a cesarean section (C/S). There were 5 (14.3%) patients who needed extracorporeal membrane oxygenation and 3 (8.5%) patients who needed continuous renal replacement therapy. The 28-day neonatal mortality rate for 26 births was 3.8%. The maternal mortality rate in the ICU was 14.3%.

Conclusion:

The preterm birth rate was high in our pregnant patients followed up in the ICU with a diagnosis of COVID-19. Because of clinical and radiological progression in pregnant women, it is difficult to indicate any gestational week in which maternal outcomes are better to undergo C/S. IMV mortality is not higher than in non-pregnant patients, so endotracheal intubation should not be avoided in appropriate patients, whether pregnancy continues or not. The absence of fully vaccinated patients in the study group revealed the protective effect of vaccination during pregnancy.

Keywords: COVID-19, pregnancy, SARS-CoV-2, intensive care unit, extracorporeal membrane oxygenation

References

  1. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320.
  2. Badr DA, Mattern J, Carlin A, Cordier AG, Maillart E, El Hachem L, et al. Are clinical outcomes worse for pregnant women at ≥20 weeks’ gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching. Am J Obstet Gynecol 2020;223:764-8.
  3. Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, et al. Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2021;137:571-80.
  4. Qeadan F, Mensah NA, Tingey B, Stanford JB. The risk of clinical complications and death among pregnant women with COVID-19 in the Cerner COVID-19 cohort: a retrospective analysis. BMC Pregnancy Childbirth 2021;21:305.
  5. DeBolt CA, Bianco A, Limaye MA, Silverstein J, Penfield CA, Roman AS, et al. Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls. Am J Obstet Gynecol 2021;224:510.e1-12.
  6. Lokken EM, Huebner EM, Taylor GG, Hendrickson S, Vanderhoeven J, Kachikis A, et al. Disease severity, pregnancy outcomes, and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol 2021;225:77.e1-14.
  7. Dawood FS, Varner M, Tita A, Newes-Adeyi G, Gyamfi-Bannerman C, Battarbee A, et al. Incidence and Clinical Characteristics of and Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Among Pregnant Individuals in the United States. Clin Infect Dis 2022;74:2218-26.
  8. Yang H, Wang C, Poon LC. Novel coronavirus infection and pregnancy. Ultrasound Obstet Gynecol 2020;55:435-7.
  9. Roy S, Habashi N, Sadowitz B, Andrews P, Ge L, Wang G, et al. Early airway pressure release ventilation prevents ARDS-a novel preventive approach to lung injury. Shock 2013;39:28-38.
  10. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med 2020;382:2012-22.
  11. Shekar K, Badulak J, Peek G, Boeken U, Dalton HJ, Arora L, et al. Extracorporeal Life Support Organization Coronavirus Disease 2019 Interim Guidelines: A Consensus Document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers. ASAIO J 2020;66:707-21.
  12. Easter SR, Gupta S, Brenner SK, Leaf DE. Outcomes of Critically Ill Pregnant Women with COVID-19 in the United States. Am J Respir Crit Care Med 2021;203:122-5.
  13. Eman A, Balaban O, Kocayiğit H, Süner KÖ, Cırdı Y, Erdem AF. Maternal and Neonatal Outcomes of Critically Ill Pregnant and Puerperal Patients Diagnosed with COVID-19 Disease: Retrospective Comparative Study. J Korean Med Sci 2021;36:e309.
  14. Kalafat E, Prasad S, Birol P, Tekin AB, Kunt A, Di Fabrizio C, et al. An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women. Am J Obstet Gynecol 2022;226:403.e1-13.
  15. Pregnancy | COVID-19 Treatment Guidelines nd. Available from: URL: https://www.covid19treatmentguidelines.nih.gov/special-populations/pregnancy/. Accessed December 8, 2021.
  16. 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;323:1239-42.
  17. Huntley BJF, Huntley ES, Di Mascio D, Chen T, Berghella V, Chauhan SP. Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review. Obstet Gynecol 2020;136:303-12.
  18. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KWet al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020;323:2052-9.
  19. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641-7.
  20. Panagiotakopoulos L, Myers TR, Gee J, Lipkind HS, Kharbanda EO, Ryan DS, et al. SARS-CoV-2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics - Eight U.S. Health Care Centers, March 1-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1355-9.
  21. Mustafa AK, Alexander PJ, Joshi DJ, Tabachnick DR, Cross CA, Pappas PS, et al. Extracorporeal Membrane Oxygenation for Patients With COVID-19 in Severe Respiratory Failure. JAMA Surg 2020;155:990-2.
  22. Callaghan WM, Creanga AA, Jamieson DJ. Pregnancy-Related Mortality Resulting From Influenza in the United States During the 2009-2010 Pandemic. Obstet Gynecol 2015;126:486-90.
  23. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020;12:194.
  24. Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound Obstet Gynecol 2020;56:15-27.
  25. Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, Arian SE, et al. Maternal death due to COVID-19. Am J Obstet Gynecol 2020;223:109.e1-16.
  26. Shimabukuro T. National Center for Immunization & Respiratory Diseases COVID-19 vaccine safety update Advisory Committee on Immunization Practices (ACIP) CDC COVID-19 Vaccine Task Force Vaccine Safety Team 2021.
  27. Kharbanda EO, Haapala J, DeSilva M, Vazquez-Benitez G, Vesco KK, Naleway AL, et al. Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy. JAMA 2021;326:1629-31.
  28. Nir O, Schwartz A, Toussia-Cohen S, Leibovitch L, Strauss T, Asraf K, et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol MFM 2022;4:100492.
  29. Chamseddine RS, Wahbeh F, Chervenak F, Salomon LJ, Ahmed B, Rafii A. Pregnancy and Neonatal Outcomes in SARS-CoV-2 Infection: A Systematic Review. J Pregnancy 2020;2020:4592450.
  30. Pierce-Williams RAM, Burd J, Felder L, Khoury R, Bernstein PS, Avila K, et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM 2020;2:100134.
  31. Crozier TME. General Care of the Pregnant Patient in the Intensive Care Unit. Semin Respir Crit Care Med 2017;38:208-17.
  32. Rose CH, Wyatt MA, Narang K, Lorenz KE, Szymanski LM, Vaught AJ. Timing of delivery with coronavirus disease 2019 pneumonia requiring intensive care unit admission. Am J Obstet Gynecol MFM 2021;3:100373.
  33. Vaught J. Society for Maternal-Fetal Medicine Management Considerations for Pregnant Patients With COVID-19 Developed with guidance from Torre Halscott. The Society for Maternal-Fetal Medicine. 2020 (1). Available from: URL: https://education.smfm.org/products/management-considerations-for-covid-pregnant-patients#tab-product_tab_contents__1
  34. Chen D, Yang H, Cao Y, Cheng W, Duan T, Fan C, et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet 2020;149:130-6.
  35. Singh N, Perfect JR. Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis 2007;7:395-401.
  36. Hirshberg A, Kern-Goldberger AR, Levine LD, Pierce-Williams R, Short WR, Parry S, et al. Care of critically ill pregnant patients with coronavirus disease 2019: a case series. Am J Obstet Gynecol 2020;223:286-90.
  37. Lapinsky SE. Management of Acute Respiratory Failure in Pregnancy. Semin Respir Crit Care Med 2017;38:201-207.
  38. Schwaiberger D, Karcz M, Menk M, Papadakos PJ, Dantoni SE. Respiratory Failure and Mechanical Ventilation in the Pregnant Patient. Crit Care Clin 2016;32:85-95.

Copyright and license

Copyright © 2023 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Küçük AO, Pehlivanlar Küçük M, Pehlivanlar A, Ayçiçek O, Demir Ö, Öztuna F, et al. Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study. Turk J Intensive Care. 2023;21(4):254-262. https://doi.org/10.4274/tybd.galenos.2022.22438