Severe COVID-19 in Third Trimester Pregnancy: Multidisciplinary Approach

Area of Science:

• Critical Care Medicine
• Obstetrics
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) poses significant risks to pregnant women, increasing hospitalization and ICU admission rates.
• Limited guidance exists for managing critically ill pregnant patients with COVID-19, necessitating case-based learning.

Observation:

• A 36-week gestation, morbidly obese pregnant woman with asthma and malignancy presented with severe COVID-19 symptoms.
• The patient required intensive management including remdesivir, convalescent plasma, steroids, anticoagulation, mechanical ventilation, and paralytics.
• Delivery via cesarean section was performed due to non-reassuring fetal heart tracing, with both mother and neonate surviving.

Findings:

• Successful management of respiratory acidosis, hypoxemia, and ventilator dyssynchrony was achieved through adjusted ventilator settings and paralytics.
• The patient underwent cesarean delivery, extubation on postpartum day 6, and discharge on hospital day 19.
• The neonate was discharged on day 2 of life.

Implications:

• This case highlights the complex disease progression of COVID-19 in pregnancy and critical care challenges.
• Multidisciplinary strategies and an algorithmic approach are crucial for optimizing outcomes in severe COVID-19 pregnancy.
• Effective management can lead to favorable maternal and neonatal outcomes despite severe illness.