tetano
Editor, Senior Moderator
Case Rep Womens Health
. 2022 Apr;34:e00396.
doi: 10.1016/j.crwh.2022.e00396. Epub 2022 Feb 9.
Severe COVID-19 during pregnancy treated with pulse corticosteroid therapy and mid-trimester termination: A case report
Thinh N Bui[SUP] 1 [/SUP], Nhat M Huynh[SUP] 1 [/SUP], Nguyen-Huy Do-Tran[SUP] 2 [/SUP], Hoang-Anh Ngo[SUP] 3 4 [/SUP], Hung Tran[SUP] 1 [/SUP], Nhan T Nguyen[SUP] 1 [/SUP], Tung T Pham[SUP] 1 [/SUP], Kha D Le[SUP] 1 [/SUP], Thu-Anh Nguyen[SUP] 3 5 [/SUP]
Affiliations
Abstract
Background: At the early stage of the pandemic, severe COVID-19 was thought to be rare among pregnant women. However, cumulating data showed that gestational state is a risk factor for severe pneumonia, particularly due to the hyperinflammatory state. Recent reports suggested the efficacy of pulse corticosteroids in stopping the cytokine storm in people infected with SARS-CoV-2, but limited data exists regarding its use in pregnant women. Moreover, pregnancy termination is a treatment option in this population, but it has been reported mainly in the third trimester and rarely in the second trimester.
Case presentation: A 37-year-old woman infected with SARS-CoV-2 at 23 weeks of gestation presented with fatigue and dyspnea but soon deteriorated to severely acute respiratory failure and cytokine storm requiring mechanical ventilation combined with hemodialysis just one day after hospitalization. Low-dose corticosteroids and antibiotics were initiated, followed by antiviral therapy, anticoagulant and high-dose corticosteroid therapy. On hospital day 3, a decision to terminate her pregnancy was made; termination led to significant improvement in her clinical condition and a gradual decrease in demand for oxygen supplementation as well as the corticosteroid dose. She was discharged two weeks after admission.
Conclusions: Due to the specific immune response, pregnant women with COVID-19 may differ from others in their clinical presentation, especially the probability of classic acute respiratory distress syndrome (ARDS). This report provides evidence related to the efficacy of pulse corticosteroids on this group and the influence of the mid-trimester termination on recovery.
Keywords: ABG, Arterial blood gas; ARDS, Acute respiratory distress syndrome; CBC, Complete blood count; COVID-19; COVID-19, Coronavirus disease 2019; CRP, C-reactive protein; CRRT, Continuous renal replacement therapy; Case report; ECMO, Extracorporeal membrane oxygenation; FiO2, Fraction of inspired oxygen; HFNC, High-flow nasal cannula; Mid-trimester termination; PEEP, Positive end expiratory pressure; Pregnancy; Pulse corticosteroid therapy; RT-PCR, Reverse transcription-polymerase chain reaction; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; SpO2, Saturation of peripheral oxygen; Vt, Tidal volume.
. 2022 Apr;34:e00396.
doi: 10.1016/j.crwh.2022.e00396. Epub 2022 Feb 9.
Severe COVID-19 during pregnancy treated with pulse corticosteroid therapy and mid-trimester termination: A case report
Thinh N Bui[SUP] 1 [/SUP], Nhat M Huynh[SUP] 1 [/SUP], Nguyen-Huy Do-Tran[SUP] 2 [/SUP], Hoang-Anh Ngo[SUP] 3 4 [/SUP], Hung Tran[SUP] 1 [/SUP], Nhan T Nguyen[SUP] 1 [/SUP], Tung T Pham[SUP] 1 [/SUP], Kha D Le[SUP] 1 [/SUP], Thu-Anh Nguyen[SUP] 3 5 [/SUP]
Affiliations
- PMID: 35165651
- PMCID: PMC8826598
- DOI: 10.1016/j.crwh.2022.e00396
Abstract
Background: At the early stage of the pandemic, severe COVID-19 was thought to be rare among pregnant women. However, cumulating data showed that gestational state is a risk factor for severe pneumonia, particularly due to the hyperinflammatory state. Recent reports suggested the efficacy of pulse corticosteroids in stopping the cytokine storm in people infected with SARS-CoV-2, but limited data exists regarding its use in pregnant women. Moreover, pregnancy termination is a treatment option in this population, but it has been reported mainly in the third trimester and rarely in the second trimester.
Case presentation: A 37-year-old woman infected with SARS-CoV-2 at 23 weeks of gestation presented with fatigue and dyspnea but soon deteriorated to severely acute respiratory failure and cytokine storm requiring mechanical ventilation combined with hemodialysis just one day after hospitalization. Low-dose corticosteroids and antibiotics were initiated, followed by antiviral therapy, anticoagulant and high-dose corticosteroid therapy. On hospital day 3, a decision to terminate her pregnancy was made; termination led to significant improvement in her clinical condition and a gradual decrease in demand for oxygen supplementation as well as the corticosteroid dose. She was discharged two weeks after admission.
Conclusions: Due to the specific immune response, pregnant women with COVID-19 may differ from others in their clinical presentation, especially the probability of classic acute respiratory distress syndrome (ARDS). This report provides evidence related to the efficacy of pulse corticosteroids on this group and the influence of the mid-trimester termination on recovery.
Keywords: ABG, Arterial blood gas; ARDS, Acute respiratory distress syndrome; CBC, Complete blood count; COVID-19; COVID-19, Coronavirus disease 2019; CRP, C-reactive protein; CRRT, Continuous renal replacement therapy; Case report; ECMO, Extracorporeal membrane oxygenation; FiO2, Fraction of inspired oxygen; HFNC, High-flow nasal cannula; Mid-trimester termination; PEEP, Positive end expiratory pressure; Pregnancy; Pulse corticosteroid therapy; RT-PCR, Reverse transcription-polymerase chain reaction; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; SpO2, Saturation of peripheral oxygen; Vt, Tidal volume.