PURPOSE:

• Blitz et al. (AJOG, 2020), sought to determine maternal outcomes in pregnant and postpartum women admitted to the ICU with a diagnosis of COVID-19

METHODS:

• Case series of consecutive admissions (March 1 to May 6, 2020)
  • Large integrated healthcare system
  • System responsible for 40,000 deliveries per year (1% of all US births)
• Participants
  • Pregnant and postpartum women (immediately following delivery) with laboratory-confirmed COVID-19 and admitted to the ICU
• Data source
  • Extracted from electronic health record
    • Demographics | Medical comorbidities | Duration of illness prior to hospitalization | Lab results | Radiology Reports | ICU treatments and outcomes

RESULTS:

• Total of 462 pregnant women tested positive for SARS-CoV-2
  • Severe or critical: 15% (70 patients)
  • 13 of 70 patients (19%) admitted to ICU
  • Mean gestational age at hospitalization: 33.3 weeks
  • Symptom onset: 8±3 days prior to admission
• Maternal characteristics of patients admitted to ICU
  • Mean maternal age: 33.8 years
  • Multiparous: 69% | All singletons
  • Largest racial/ethnic group: Hispanic (38%)
  • Comorbidities
    • Obesity: 38%
    • Pulmonary conditions: 23% (e.g, asthma and obstructive sleep apena)
    • No comorbidities: 46%

Clinical course of patients admitted to ICU

• Common clinical findings included tachycardia (77%) and tachypnea (23%) | 02 sat <93% (69%)
• Fever was uncommon (15%)
• Common lab findings
  • Lymphopenia | Elevated transaminases | Elevated inflammatory markers
• Mechanical ventilation: 8 cases (6 postpartum; 2 pregnant)

Treatment

• Prophylactic or therapeutic anticoagulation: 100%
• Hydroxychloroquine: 85%
• Antibiotics for community acquired pneumonia: 92%
• Enrolled in remdesivir trial: 23%
• Interleukin-6 receptor inhibitors: 38%
• Convalescent plasma therapy: 15%

Maternal Mortality

• Maternal mortality: 2 patients died
• Patient 1: periviable fetal demise with multisystem organ failure
  • BMI >40 kg/m2 | Obstructive Sleep Apnea
• Patient 2: “rapid clinical deterioration postpartum”
  • No comorbidities
  • Severe respiratory distress, multiple organ failure and cardiopulmonary arrest

Pregnancy Outcomes

• Deliveries during hospitalization: 54% (7 patients) | Preterm: 4 deliveries (57%)
• Cesarean deliveries
  • Respiratory decompensation: 5 patients
  • Cord prolapse (was induced for worsening respiratory status): 1 patient
• Vaginal delivery: 1 patient

CONCLUSION:  

• 2 patients (1 pregnant, 1 postpartum) hospitalized with COVID-19 died following ICU admission
  • 15% of patients admitted to ICU and 25% of patients on mechanical ventilation  
• The authors state

…pregnant and postpartum women admitted to the ICU with COVID-19 are at risk for maternal death, which may occur even in the absence of significant baseline comorbidities

Learn More – Primary Sources:

Maternal Mortality Among Women with COVID-19 Admitted to the Intensive Care Unit

Related ObG Topics:

Respiratory Support of Pregnant Women with COVID-19 Including Fetal Assessment Recommendations

SMFM Guideline Update on COVID-19 in Pregnancy

The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital