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Doctors in Croatia give details of a pregnant COVID-19 patient’s 22-day struggle for survival in a case report presented at Euroanaesthesia, the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC) in Milan, Italy (4 -June 6).
The 31-year-old womanwho had not been vaccinated against COVID underwent an emergency caesarean section before being put on ECMO (extracorporeal membrane oxygenation a machine), a “last resort” treatment that replaces the function of the heart and lungs so that they can heal.
The woman developed symptoms of COVID-19 on October 16, 2021 and tested positive four days later, on October 20. She was admitted to University Hospital Split, Split, Croatia on October 26 with shortness of breath, cough and weakness.
The woman, who was 33 weeks pregnant at the time of admission, had no significant underlying cause medical conditions.
Her symptoms were mild at first, but developed rapidly, which caused concern. A few hours after admission, her breathing was worse, despite receiving supplemental oxygen.
An interdisciplinary team led by Ass. Prof. Sanda Stojanovic Stipic and including ICU and mother-fetal medicine, decided to intubate the woman and perform a caesarean section.
“The patient’s condition deteriorated rapidly,” says Dr. Filip Peris, from the Department of Anesthesiology & Intensive Care, Split University Hospital, an anesthetist and one of those on the team who take care of the woman.
“We had a short time frame before baby’s health would do the same, so we put together a team and discussed the best for both mother and child, to try to save their lives.
“Considering that the child’s gestational age was quite advanced and the mother’s health deteriorated rapidly, we decided to have a caesarean section.
“Pregnancy is a stressful time for the body, and giving birth to the baby would give the mother’s lungs time to heal on its own.”
The baby, a boy weighing 2,380 g (5 lb 4 oz), was healthy and required no special medical attention.
After the caesarean section, the woman was transferred to the hospital’s COVID ICU, where she was placed on a respirator. Despite this, she had a pulmonary function (P / F) ratio of 85. Ratios below 100 are classified as severe ARDS (acute respiratory distress syndromea condition in which the lungs are so severely damaged that the alveoli – the air sacs – begin to fill with fluid.)
Her lung function conditions further deteriorated to 70 and she was put on ECMO.
“The mother’s condition was life threatening and mechanical ventilation was not enough to heal her lungs, “says Dr. Peris.” ECMO was her last chance. At our hospital we use ECMO 3-5 times a year.
“Her lung function was gradually improved, and she was weaned from ECMO after nine days. On November 17, and after a 22-day battle for survival, mother and child were discharged home.”
The woman received extensive physiotherapy at the hospital and after returning home and has fully recovered. Her son is also fast.
Dr. Peris says: “Every step of her struggle was closely monitored by our wonderful team of anaesthesiologists and our ICU nurses. Their team effort, led by ass. Prof. Sanda Stojanovic Stipic, and hard work were crucial to winning this battle.”
The woman’s doctors say that pregnancy should not be considered a contraindication for ECMO. They say: “Recent studies show us that survival rates after ECMO use during pregnancy is high, for both mother and child. This may be because pregnant women are generally young and in good health. “
Dr. Peris adds: “Risks and benefits to both the mother and the fetus must be weighed against each other. In this situation, the fetus’ advanced gestational age was balanced against the mother’s rapidly deteriorating clinical condition.
“Timing is everything in medicine. The right timing saves lives.”
The woman was not vaccinated against COVID-19. Dr. Peris says: “Vaccination is extremely important – it saves lives.
“Studies show that there are no safety concerns for babies born to women who were vaccinated against COVID-19 during pregnancy.
“I encourage you to get your vaccine as soon as possible.”
Provided by the European Society of Anaesthesiology and Intensive Care (ESAIC)
Citation: Pregnant woman wins 22-day battle against COVID-19 (2022, June 5) retrieved June 5, 2022 from medicalxpress.com/news/2022-06-pregnant-woman-day-long-covid-. html
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