key: cord-0711990-aiwzgkq3
authors: MCLAREN, Rodney A.; LONDON, Viktoriya; ATALLAH, Fouad; MCCALLA, Sandra; HABERMAN, Shoshana; FISHER, Nelli; STEIN, Janet L.; MINKOFF, Howard L.
title: Delivery For Respiratory Compromise Among Pregnant Women With COVID-19
date: 2020-05-23
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.05.035
sha: 074a28471ee56cafc72137c681e06d281e92bad0
doc_id: 711990
cord_uid: aiwzgkq3

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.

with COVID-19" Am J Perinatol., in press). The study was exempted by IRB. 34 35 Results: Of 125 confirmed cases of COVID-19, twelve (9.6%) had severe disease (Table 1) . 36

Among the 12, three resolved spontaneously after transient respiratory support in hospital and 37

were discharged home (one subsequently returned in preterm labor and delivered by cesarean 38 two weeks later). Of the remaining nine who continued to need respiratory support, seven 39 (77.8%) had iatrogenic preterm deliveries (six by cesarean delivery) for maternal respiratory 40 distress (needing increasing levels of respiratory support without improved oxygen saturation), 41 one had an early term delivery due to PROM, and one, now 30 weeks, has required intensive 42 care with high-flow nasal cannula for three weeks. 43

Of the eight patients delivering with maternal respiratory distress, seven did not require 45 intubation, and one was intubated for emergent cesarean delivery, and remained on a ventilator 46 for 19 days. Among the non-intubated, four had an improvement in oxygenation within two 47 hours postpartum; two required less respiratory support, and two were taken completely off 48 respiratory support. None of the other three required an increased level of respiratory support, 49

and were off of all support between four and seven days postpartum. 50 51 Conclusion: Delivery did not worsen the respiratory status of women with persistent oxygen 52 desaturation and the need for increasing respiratory support. Among women not needing a 53 ventilator, return of normal respiratory status after delivery occurred within hours to days. The 54 one patient intubated intraoperatively took longer to recover. It is possible delivery may be less 55 salutary when damage to the lungs are sufficient to warrant intubation. This series suggests that 56 maternal respiratory distress should not be a contraindication to delivery. 57 58 As noted in a recent SMFM-SOAP guideline, it's not known whether uterine decompression 59 improves respiratory status; we are unable to shed light on that issue. 4 While we saw no harm, we 60 cannot be certain that delivery per se caused the improvement we saw, or whether a similar 61 outcome could have been achieved with ongoing respiratory support (although one of three 62 patients managed conservatively, remained on respiratory support for three weeks). In sum, 63 while more data on the effects of delivery are needed, we have shown in a small series that 64 women with COVID-19 requiring respiratory support fared well when they underwent delivery. 

Society for Maternal-Fetal Medicine (SMFM)

Amniotic fluid embolism: diagnosis and 68 management

Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young

Society for Maternal-Fetal Medicine. Management Considerations for Pregnant Patients 76

With COVID-19

COVID_pos_preg_patients_4-29-20_final.pdf. Accessed

Labor and Delivery COVID-19 Considerations

SOAP_COVID_LD_Considerations_-_revision_4-14-20_-_changes_highlighted