Expectant Management of Severe COVID-19 Pneumonia in Late Preterm Pregnancy and Subsequent Cholecystitis: Lessons Learned

Mokhtari, Neggin B.; Drassinower, Daphnie; Orr, Lindsey A.; Cobb, Nathan K.; Mims, Oscar L.; Landy, Helain J.

Introduction Since the emergence of coronavirus disease 2019 (COVID-19) as a pandemic in March 2020, research and guidance have been published with regard to the management of infection and considerations in pregnancy, but much is still unknown. Pregnant women with COVID-19 infection are more likely to be hospitalized and are at increased risk for intensive care unit admissions and intubation than nonpregnant women with COVID-19 infection. The optimal timing of delivery among pregnant women with COVID-19 infection has not been established at this time, especially when the infection arises in late preterm and early term gestation. It is suggested that COVID-19 infection should not be considered a sole indication for delivery. The risks and benefits of prolonging pregnancy versus delivery should be taken into consideration at any given gestational age in a patient with COVID-19 infection. Case Report We report a case of a patient in the late third trimester of pregnancy that presented with severe COVID-19 infection and was managed expectantly through her disease course with improvement of respiratory status without necessitating delivery. We also discuss the unique development of cholecystitis in her hospitalization that may represent another clinical association to COVID-19 infection. Conclusion This case illustrates that delaying delivery is an option even in later gestational ages for maternal stabilization. A multidisciplinary approach and teamwork is needed to manage pregnant women with COVID-19 infection for optimal outcomes for both mother and fetus. Key Points: Delaying delivery in severe coronavirus disease 2019 (COVID-19) infection is a reasonable option even in late gestation. A multidisciplinary team is of utmost importance when managing a pregnant woman with COVID-19. Other clinical sequalae such as cholecystitis may arise in the setting of COVID-19 infection.