Emergency Cesarean Section at 38 Weeks of Gestation with COVID-19 Pneumonia: A Case Report

Patel, Priya; Kulkarni, Sayali; Guerrero, Manrique; Persaud, Clive; Zuberi, Jamshed; Rebein, Benjamin

Patient: Female, 30-year-old Final Diagnosis: COVID-19 Symptoms: Chills • cough • diarrhea • fatigue • fever • headache • myalgia • nausea • rhinorrea • shortness of breath • vomiting Medication: — Clinical Procedure: Cesarean section Specialty: Critical Care Medicine • Obstetrics and Gynecology • Surgery OBJECTIVE: Rare disease BACKGROUND: Up to 47% of pregnant women with COVID-19 have preterm deliveries. A severe, symptomatic COVID-19 infection in close-to-term pregnancies can have a poor prognosis. Early identification of COVID-19 in pregnant women can prevent the progression of the disease. Currently, there is very little guidance on treating pregnant close-to-term women with COVID-19; this case report suggests changes to current management to maximize positive maternal and fetal outcomes. CASE REPORT: A pregnant woman (37 weeks of gestation) presented to the Emergency Department with a chief complaint of fever with an associated cough for 2 days. She was diagnosed with COVID-19 in the Emergency Department, and discharged in a stable condition. She returned 5 days later in preterm labor with severe respiratory distress. After an emergency cesarean section, she remained intubated in the Surgical Intensive Care Unit; she was persistently hypotensive and hypoxic despite maximal ventilator and medical treatment. She died after a cardiac arrest and unsuccessful resuscitation, 15 days after the delivery. We discuss the possible benefit of a planned C-section for close-to-term pregnancies prior to the onset of COVID-19 symptoms. The patient’s next of kin gave informed consent for this case report. Approval from the Institutional Review Board or Ethics Review Board was not required as this is a case report. CONCLUSIONS: Currently, asymptomatic pregnant women are not tested for COVID-19 infection until hospitalization for delivery. It could be beneficial to have a protocol in place to screen asymptomatic pregnant women so they can be identified early and monitored, as COVID-19 symptoms can escalate quickly.