Critical respiratory failure in pregnancy complicated with COVID-19: A case report

Chinen, Yukiko; Kinjyo, Yoshino; Mekaru, Keiko; Kinjo, Tadatsugu; Higure, Yuuri; Kinjo, Takeshi; Miyagi, Kazuya; Yamada, Hisako; Masamoto, Hitoshi; Goya, Hideki; Yoshida, Tomohide; Maeshiro, Sakiko; Nakamatsu, Masashi; Fujita, Jiro; Aoki, Yoichi

The case is presented of a 29-year-old primiparous woman who was COVID-19-positive at 34 weeks of gestation and who developed severe acute respiratory distress syndrome. After a four-day history of fever and mild dyspnea, she was referred to hospital. Ciclesonide, dexamethasone, heparin sodium, and sulbactam/ampicillin were initiated, followed by remdesivir and tocilizumab. On the fourth day after admission (at 34 weeks 5 days of gestation), respiratory failure required ventilator management. An emergency cesarean section was performed and a 2565-g male infant was delivered with an Apgar score of 8/8 and negative COVID-19 status . However, on the following day the patient's respiratory condition deteriorated and mechanical ventilation was initiated. Subsequently, her respiratory condition quickly improved and mechanical ventilation was terminated 4 days after intubation. She was discharged 12 days after cesarean delivery. Our case provides additional evidence that raises concerns regarding the unfavorable maternal consequences of COVID-19 infection during pregnancy.