Six Critically Ill COVID-19 Pregnant Patients at a Detroit Hospital: A Case Series

Abstract Objective: Coronavirus-2019 (COVID-19) can cause viral pneumonia with rapid deterioration into acute respiratory distress syndrome requiring intubation. Pregnant patients with respiratory collapse secondary to COVID-19 present multiple management challenges. We present a case series of 6 pregnant patients with severe COVID-19 infection requiring admission into the intensive care unit. Their clinical course, medical management, and critical care interventions are described. Methods: This is a retrospective, single-center case series of pregnant women who were infected with COVID-19 and subsequently required critical care. Inclusion criteria were pregnant patients with a positive COVID-19 nasopharyngeal swab and admission to the intensive care unit. Results: Six pregnant women with severe COVID-19 pneumonia at Henry Ford Hospital required intensive care unit hospitalization. All women were treated with steroids. Standard treatment also included Hydroxychloroquine. There was 1 full-term delivery via cesarean section at 37 weeks and 4 days after intubation due to non-reassuring fetal heart tones remote from delivery with absent variability noted on fetal heart tracing. There were 2 preterm deliveries. One delivery was an urgent cesarean section at 36 weeks and 5 days for non-reassuring fetal heart tones in the setting of preeclampsia with severe features and worsening respiratory compromise from COVID-19 pneumonia. The other delivery was a vacuum-assisted vaginal delivery at 36 weeks and 3 days’ gestation following labor induction for a persistent category two fetal heart tracing. All neonates tested negative for COVID-19. All patients survived and were discharged home. Conclusion: This case series adds to the expanding literature describing the complex care surrounding pregnant patients with severe COVID-19 pneumonia requiring intensive care management. As the pandemic continues, we hope our experience and treatment modalities can contribute to future care of patients. Keywords Covid-19, Pregnancy, Delivery, Critical care, Intubation