Severe COVID-19 Pneumonia in a 30-Year-Old Woman in the 36(th) Week of Pregnancy Treated with Postpartum Extracorporeal Membrane Oxygenation

Takayama, Wataru; Endo, Akira; Yoshii, Junichiro; Arai, Hirokuni; Oi, Keiji; Nagaoka, Eiki; Toyama, Satoshi; Yamamoto, Hiroto; Uchida, Tokujiro; Otomo, Yasuhiro

Patient: Female, 30-year-old Final Diagnosis: Severe COVID-19 pneumonia Symptoms: Dyspena Medication: — Clinical Procedure: Extracorporeal membrane oxygenation Specialty: Critical Care Medicine • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: There are few reports of coronavirus disease 2019 (COVID-19) in pregnant women. Although coagulation dys-function was reported to affect the severity of COVID-19, the association between pregnancy, which is usually accompanied by changes in coagulation function, and the worsening of COVID-19 is unknown. We present a case of a 30-year-old woman in the 36(th) week of pregnancy who was diagnosed with severe COVID-19 pneumonia and required postpartum extracorporeal membrane oxygenation (ECMO) therapy. CASE REPORT: A 30-year-old, 36-weeks pregnant woman presented to our hospital and was diagnosed with severe COVID-19 pneumonia soon after she had undergone a cesarean section. Her respiratory failure could not be managed by conventional therapeutic approaches. Therefore, ECMO was administered on day 7. Controlling coagulation function to maintain ECMO therapy was challenging. Nafamostat mesylate and cryoprecipitate were administered to treat the hypercoagulative status and severe hypofibrinogenemia, respectively. Since coagulopathy and her respiratory state improved, the ECMO therapy was terminated on day 15. CONCLUSIONS: We report a case of severe COVID-19 pneumonia in a pregnant woman urgently treated with ECMO in the post-partum period. Thus, this case highlights the importance of close monitoring and appropriate medical care for pregnant women with severe COVID-19 pneumonia.