AB240. SOH25_AB_372. Severe coronavirus disease 2019 infection and pregnancy: a case report

Background: A 38-year-old pregnant woman (31 weeks of gestation), presented to the obstetric emergency room with an eight-day history of shortness of breath, fever and a positive coronavirus disease 2019 (COVID-19) test. On presentation, the oxygen saturation (StO2) in room air was 78% which improved to 94% after application of 15 litres of oxygen via non-rebreather mas; the respiratory rate was 28–32 and she was tachycardic. The patient’s arterial blood gas analysis revealed a partial pressure of oxygen (PaO2) of 69.5 mmHg with a PaO2/fraction of inspired oxygen (FiO2) ratio of 69.5.

Methods: As patient was deteriorating rapidly it was decided amongst the critical care and obstetric teams to proceed with an emergency C-section under general anaesthesia as the patient needed ventilator support ventilation post operatively. The procedure was uneventful.

Results: On the third day post-op, chest X-ray imaging showed improvement from the first picture of bilateral infiltrates and inflammatory markers were coming down. Due to limited resources, the patient was given a weaning trial at a PaO2 of 114 mmHg and PaO2/FiO2 ratio of 190.2; however, she became tachypneic and started desaturating, therefore, she placed back on mechanical ventilation with sedation and paralysis. On day five post-op her PaO2/FiO2 ratio improved to 272.5. The patient was extubated and her oxygen requirement significantly reduced over the next two days leading to her discharge from the intensive care unit (ICU).

Conclusions: Pregnancy is considered an underlying medical condition that increases a person’s risk of developing severe illness from COVID-19. Management of these patients is difficult and it often requires admission to ICU.

Keywords: Coronavirus disease 2019 (COVID-19); intubation; pregnancy; section; weaning