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Management of Critically Ill Pregnant Patients with COVID-19 Infection in a Rural State
Objective There is limited data on the treatment of coronavirus disease 2019 (COVID-19) in pregnancy. Arkansas saw an increase in COVID-19 cases in June 2020. The first critically ill pregnant patient was admitted to our institution on May 21st, 2020. The objective of this study was to evaluate outcomes in critically ill pregnant women with COVID-19 at a single tertiary care center who received remdesivir and convalescent plasma (CCP).
Study Design This is a retrospective observational review of critically ill pregnant women with COVID-19 who received remdesivir and CCP. This study was approved by the institutional review board (#261354).
Results Seven pregnant patients with COVID-19 were admitted to the intensive care unit (ICU). All received remdesivir and CCP. Six received dexamethasone. The median ICU length of stay (LOS) was 8 days (range 3–17). Patient 1 had multi-organ failure requiring vasopressors, renal dialysis, and had an intrauterine fetal demise. Patients 4 and 6 required mechanical ventilation, were delivered for respiratory distress and were extubated at 2 and 1 days postpartum, respectively. The only common risk factor was obesity. There were no adverse events noted with remdesivir or CCP.
Conclusion There is little data regarding the use of remdesivir or CCP for the treatment of COVID-19 in pregnant women. In our cohort, these were well tolerated with no adverse events. Previously reported median ICU LOS in critically ill pregnant women with COVID-19 was 8 days (range 4–15). Our study found a similar ICU LOS (8 days; range 3–17). Patient 1 did not receive remdesivir or CCP until transport to our facility on hospital day 3. Excluding patient 1, median ICU LOS was 6.5 days (range 3–9). Our institution's treatment of pregnant women with critical illness with remdesivir, CCP and dexamethasone combined with delivery in select cases has thus far had good outcomes.
Combined therapy: remdesivir, CCP, dexamethasone.
Remdesivir, CCP and dexamethasone was effective in treating critically ill pregnant women with COVID-19.
No adverse events were associated with combined therapy.
Delivery improved respiratory status.
KeywordsCOVID-19 - pregnancy - critical illness - remdesivir - convalescent plasma - dexamethasone - critical illness in pregnancy - coronavirus
The opinions or assertions contained herein are the private views of the authors and are not to be construed as the official policy of the Department of the Army, Department of Defense, or the U.S. Government.
Received: 07 August 2020
Accepted: 04 October 2021
14 November 2021 (online)
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- 1 Blitz MJ, Rochelson B, Minkoff H. et al. Maternal mortality among women with COVID-19 admitted to the intensive care unit. Am J Obstet Gynecol 2020; 3 (11) e2029256
- 2 Patel A, Jernigan DB. 2019-nCoV CDC Response Team. Initial Public Health Response and Interim Clinical Guidance for the 2019 novel coronavirus outbreak—United States, December 31, 2019-February 4, 2020. Morb Mortal Wkly Rep 2020; 69 (05) 140-146
- 3 CDC COVID-19 Response Team. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019—United States, February 12-March 28, 2020. Morb Mortal Wkly Rep 2020; 69 (13) 382-386
- 4 Ellington S, Strid P, Tong VT. et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status—United States, January 22-June 7, 2020. Morb Mortal Wkly Rep 2020; 69 (25) 769-775
- 5 Li L, Zhang W, Hu Y. et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: a randomized clinical trial. JAMA 2020; 324 (05) 460-470
- 6 Dzik S. COVID-19 convalescent plasma: now is the time for better science. Transfus Med Rev 2020; 34 (03) 141-144
- 7 Beigel JH, Tomashek KM, Dodd LE. Remdesivir for the treatment of Covid-19—preliminary report. Reply. N Engl J Med 2020; 383 (10) 994
- 8 Olender SA, Perez KK, Go AS. et al. Remdesivir for severe COVID-19 versus a cohort receiving standard of care. Clin Infect Dis 2020; ciaa1041
- 9 Lucarelli E, Behn C, Lashley S, Smok D, Benito C, Oyelese Y. Mechanical ventilation in pregnancy due to COVID-19: a cohort of three cases. Am J Perinatol 2020; 37 (10) 1066-1069
- 10 Society for Maternal-Fetal Medicine. Management considerations for pregnant patients with COVID-19. Published 2020 Accessed July 1, 2020 at: https://s3.amazonaws.com/cdn.smfm.org/media/2401/SMFM_COVID_Management_of_COVID_pos_preg_patients_6-16-20._PDF.pdf
- 11 McLaren Jr RA, London V, Atallah F. et al. Delivery for respiratory compromise among pregnant women with coronavirus disease 2019. Am J Obstet Gynecol 2020; 223 (03) 451-453
- 12 Pierce-Williams RAM, Burd J, Felder L. et al. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol MFM 2020; 2 (03) 100134
- 13 Silverstein JS, Limaye MA, Brubaker SG. et al. Acute respiratory decompensation requiring intubation in pregnant women with SARS-CoV-2 (COVID-19). AJP Rep 2020; 10 (02) e169-e175
- 14 Catanzarite VA, Willms D. Adult respiratory distress syndrome in pregnancy: report of three cases and review of the literature. Obstet Gynecol Surv 1997; 52 (06) 381-392
- 15 Horby P, Lim WS, Emberson J. et al. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report. Accessed July 22, 2020 at: https://doi.org/10.1101/2020.06.22.20137273
- 16 Beigel JH, Tomashek KM, Dodd LE. et al; ACTT-1 Study Group Members. Remdesivir for the treatment of COVID-19—final report. N Engl J Med 2020; 383 (19) 1813-1826
- 17 Lee TC, McDonald EG, Butler-Laporte G, Harrison LB, Cheng MP, Brophy JM. Remdesivir and systemic corticosteroids for the treatment of COVID-19: a Bayesian re-analysis. Int J Infect Dis 2021; 104: 671-676
- 18 Lunghi L, Pavan B, Biondi C. et al. Use of glucocorticoids in pregnancy. Curr Pharm Des 2010; 16 (32) 3616-3637
- 19 Park-Wyllie L, Mazzotta P, Pastuszak A. et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000; 62 (06) 385-392
- 20 Pradat P, Robert-Gnansia E, Di Tanna GL, Rosano A, Lisi A, Mastroiacovo P. Contributors to the MADRE database. First trimester exposure to corticosteroids and oral clefts. Birth Defects Res A Clin Mol Teratol 2003; 67 (12) 968-970
- 21 Sammaritano LR, Bermas BL, Chakravarty EE. et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol 2020; 72 (04) 529-556
- 22 Bhatraju PK, Ghassemieh BJ, Nichols M. et al. COVID-19 in critically ill patients in the Seattle Region—case series. N Engl J Med 2020; 382 (21) 2012-2022
- 23 Argenziano MG, Bruce SL, Slater CL. et al. Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series. BMJ 2020; 369: m1996