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Grand Rounds

ICU Admission for COVID-19 and Maternal Outcomes

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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

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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

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