Delivery For Respiratory Compromise Among Pregnant Women With COVID-19

MCLAREN, Rodney A.; LONDON, Viktoriya; ATALLAH, Fouad; MCCALLA, Sandra; HABERMAN, Shoshana; FISHER, Nelli; STEIN, Janet L.; MINKOFF, Howard L.

Objective While rapid recourse to delivery after failed CPR has been shown to improve outcomes of pregnant patients with cardiac arrest,1,2 it is not known whether delivery improves or compromises the outcome of COVID patients with respiratory failure.3,4 Our objective was to evaluate the safety and utility of delivery of COVID-19 infected pregnant women needing respiratory support. Study Design This is a retrospective observational study of COVID-19 infected pregnant women (PCR diagnosed), with severe disease (defined per prior publications.3). A subset of these cases was previously presented, but without detail on the effect of delivery on disease (London, et al. “The Relationship Between Status at Presentation and Outcomes Among Pregnant Women with COVID-19” Am J Perinatol., in press). The study was exempted by IRB. Results Of 125 confirmed cases of COVID-19, twelve (9.6%) had severe disease (Table 1). Among the 12, three resolved spontaneously after transient respiratory support in hospital and were discharged home (one subsequently returned in preterm labor and delivered by cesarean two weeks later). Of the remaining nine who continued to need respiratory support, seven (77.8%) had iatrogenic preterm deliveries (six by cesarean delivery) for maternal respiratory distress (needing increasing levels of respiratory support without improved oxygen saturation), one had an early term delivery due to PROM, and one, now 30 weeks, has required intensive care with high-flow nasal cannula for three weeks. Of the eight patients delivering with maternal respiratory distress, seven did not require intubation, and one was intubated for emergent cesarean delivery, and remained on a ventilator for 19 days. Among the non-intubated, four had an improvement in oxygenation within two hours postpartum; two required less respiratory support, and two were taken completely off respiratory support. None of the other three required an increased level of respiratory support, and were off of all support between four and seven days postpartum. Conclusion Delivery did not worsen the respiratory status of women with persistent oxygen desaturation and the need for increasing respiratory support. Among women not needing a ventilator, return of normal respiratory status after delivery occurred within hours to days. The one patient intubated intraoperatively took longer to recover. It is possible delivery may be less salutary when damage to the lungs are sufficient to warrant intubation. This series suggests that maternal respiratory distress should not be a contraindication to delivery.