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Am J Perinatol 2024; 41(S 01): e2115-e2123
DOI: 10.1055/a-2097-1852
Original Article

Maternal–Fetal Results of COVID-19-Infected Pregnant Women Treated with Extracorporeal Membrane Oxygenation: A Descriptive Report

Authors

  • Jorge Luis Alvarado-Socarras

    1   Department of Pediatrics, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Doris C. Quintero-Lesmes

    2   Research Center, Investigation Center, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Delia Theurel Martin

    3   Department of Pediatric-Neonatal Critical Care, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Raul Vasquez

    4   Department of Critical Care Medicine, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Mary Mendoza Monsalve

    5   ECMO Department, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Lizeth Mogollon Cristancho

    4   Department of Critical Care Medicine, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Leonardo Salazar Rojas

    5   ECMO Department, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Jenifer Leon Martinez

    6   Department of Radiology, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Carlos Riaño Medina

    7   Department of Perinatal Medicine, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

  • Camilo Pizarro Gomez

    4   Department of Critical Care Medicine, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia

Funding None.
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Abstract

Objective COVID-19 infection may produce severe pneumonia, mainly in the adult population. Pregnant women with severe pneumonia are at high risk of developing complications, and conventional therapy sometimes fails to reverse hypoxemia. Therefore, extracorporeal membrane oxygenation (ECMO) is an option in cases with refractory hypoxemic respiratory failure. This study aims to evaluate the maternal–fetal risk factors, clinical characteristics, complications, and outcomes of 11 pregnant or peripartum patients with COVID-19 treated with ECMO.

Study Design This is a retrospective descriptive study of 11 pregnant women undergoing ECMO therapy during the COVID-19 pandemic.

Results In our cohort, four patients underwent ECMO during pregnancy (36.3%) and 7 during the postpartum period. Initially, they started on venovenous ECMO, and three patients were required to change modality due to clinical conditions. In total, 4/11 pregnant women (36.3%) died. We established two periods that differed in the implementation of a standardized care model for reducing associated morbidities and mortality. Neurological complications were responsible for most deaths. Regarding fetal outcomes at early-stage pregnancies on ECMO (4), we report three stillbirths (75%), and one newborn (twin pregnancy) survived and had a favorable evolution.

Conclusion At later-stage pregnancies, all newborns survived, and we did not identify any vertical infection. ECMO therapy is an alternative for pregnant women with severe hypoxemic respiratory failure due to COVID-19, and may improve maternal and neonatal results. Regarding fetal outcomes, the gestational age played a definitive role. However, the main complications reported in our series and others are neurological. It is essential to develop novel, future interventions to prevent these complications.

Keywords

COVID-19 - fetal death - pneumonia - pregnancy - newborn - SARS-CoV-2


Publication History

Received: 22 November 2022

Accepted: 19 May 2023

Accepted Manuscript online:
22 May 2023

Article published online:
19 June 2023

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