Covid pregnancies critical illness
2021-08-05 WoSOA Shared Learning ICU Deliveries During Covid
First Talk (Kathryn Norman)
So far, no woman who have received both doses of the vaccine and been admitted to hospital. All pregnant women are now recommended to get vaccinated.
Of pregnant women: ~1/2 of patients needed oxygen went to critical care. ~1/3 of patients needing oxygen went to ICU
Prednisolone and hydrocortisone are metabolised by placenta, so won't get to foetus
REMAP-CAP did not include pregnant patients
Tociluzumab is an IL6 antagonist, will completely suppress CRP. No evidence of harm in pregnancy It does get across placenta So baby will be immunosuppressed to an extent after birth if drug given to mum
What about treatment anticoagulation? Case by case basis.
Vaccine for pregnant mums seems ok. Antibodies seem to go across in breast milk.
30% of women admitted to ICU in childbearing age were either pregnant or recently pregnant.
Second Talk (Lisa Gemmell)
2x Risk of prematurity if covid and level 2 or level 3 care
More likely to be preeclamptic
More likely to be still birth
Pregnant woman over 35, obese, comorbid are more at risk
Case report
This patient was admitted 2 days after illness onset
Went straight onto CPAP on first day
On day 2 switched to HFNO2
CTPA: No PE. echo: normal right heart, NAD
Later on day 2 switched to CPAP in ICU
Patient was given betamethasone (but next time they would give dex)
All the NICU and obstetric stuff was brought to ICU
Received daily CTGs and midwifery input next couple of days
But was having increasing time not managing without CPAP, was having worsening PF ratio and RR.
So had delivery on day 4 on CPAP.
Had GA section, extremely hypoxic. Had tociluzumab.
Did really well after proning (was proned after section)
Was successfully extubated 1 week afterwards.
Baby was 1.7kg. Did require intubated as well.
Learning Points
- They would give tociluzimab earlier (pre delivery)
- They would maybe do more monitoring next time around
- They feel doing in daylight hours was much more beneficial
Third Talk (Rob Hart)
This patient was also a good outcome, with successful delivery and survival of both.
This was a 29 week obese patient.
Presented to hospital one day after positive test. Deteriorated to HFNO2 2 days after hospital admission.
She did get tociluzimab after discussion at MDT
On deterioration was reviewed by obs, obs anaes, ICU
Was transferred to ICU with possibility of delivery overnight.
- Had anaesthetic support from anaesthetics in obs
- Got a resuscitaire from paeds
- Got a named cons from obstetrics
Deteriorated to point almost immediately
Put on theatre table in ICU, theatre teams came to here.
Was intubated for a week but never proned. Baby did fine.
Has had a PE
Learning Points
Fourth Case (Adam Capek)
This was another 30 week pregnant (like all of them)
Intubated in ICU by team at 05:00 in morning
Plan was to deliver ASAP, in hope would improve mum's condition. Also baby had a v poor CTG.