by The European Society of Anaesthesiology and Intensive Care (ESAIC)

Credit: Pixabay/CC0 Public Domain

Doctors in Croatia give details of a pregnant COVID-19 patient's 22-day-long battle for survival, in a case report being presented at Euroanaesthesia, the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC) in Milan, Italy (4-6 June).

The 31-year-old woman, who had not been vaccinated against COVID, underwent an emergency C-section before being put on ECMO (extracorporeal membrane oxygenation a machine), a "last resort" treatment which replaces the function of the heart and lungs, allowing them to heal.

The woman developed symptoms of COVID-19 on October 16 2021 and tested positive four days later, on October 20. She was admitted to University Hospital Split, Split, Croatia on October 26 with shortness of breath, a cough and weakness.

The woman, who was 33 weeks pregnant when admitted, did not have any significant underlying medical conditions.

Her symptoms were mild initially but progressed quickly, which caused concern. A few hours after admission, her breathing was worse, despite her being given supplementary oxygen.

An interdisciplinary team, which was led by Ass. Prof. Sanda Stojanovic Stipic and included ICU and maternal-fetal medicine physicians, decided to intubate the woman and perform a C-section.

"The patient's condition was deteriorating quickly," says Dr. Filip Peris, of the Department of Anaesthesiology & Intensive Care, University Hospital Split, an anaesthesiologist and one of those on the team caring for the woman.

"We had a short timeframe before baby's health would do the same, so we put a team together and discussed the best thing for both mother and child, to try to save their both lives.

"Given that the gestational age of the child was quite advanced, and the mother's health was deteriorating quickly, we decided to do a C-section.

"Pregnancy is a stressful time for the body and delivering the baby would give the mother's lungs time to heal on their own."

The baby, a boy weighing 2,380g (5lb 4oz), was healthy and did not require any special medical care.

After the C-section, the woman was transferred to the hospital's COVID ICU, where she was placed on a ventilator. Despite this, she had a lung function ratio (P/F) ratio of 85. Ratios of below 100 are classed as severe ARDS (acute respiratory distress syndrome, a condition in which the lungs are so badly damaged that the alveoli—air sacs—start to fill with fluid.)

Her lung function ratio further deteriorated to 70 and she was put on ECMO.

"The mother's condition was life-threatening and mechanical ventilation was not enough to heal her lungs," says Dr. Peris. "ECMO was her last chance. In our hospital we use ECMO 3-5 times in a year.

"Her lung function gradually improved and she was weaned off ECMO after nine days. On 17 November, and following a 22-long-day battle for survival, mother and child were discharged home."

The woman had extensive physiotherapy in hospital and after returning home and has made a full recovery. Her son is also healthy.

Dr. Peris says: "Every step of her battle was closely monitored by our wonderful team of anaesthesiologists and our ICU nurses. Their team effort, led by Ass. Prof. Sanda Stojanovic Stipic, and hard work was crucial in winning this battle."

The woman's doctors say that pregnancy should not be regarded as a contraindication for ECMO. They say: "Recent studies show us that survival rates after ECMO use in pregnancy are high, for both mother and child. This could be because pregnant patients are generally young and in good health."

Dr. Peris adds: "The risks and benefits for both the mother and foetus must be weighed against each other. In this situation, the foetus's advanced gestational age was balanced against the mother's rapidly deteriorating clinical condition.

"Timing is everything in medicine. The right timing saves lives."

The woman had not been vaccinated against COVID-19. Dr. Peris says: "Vaccination is tremendously important—it saves lives.

"Studies show there are no safety concerns for babies born to women who were vaccinated against COVID-19 during pregnancy.

"I urge you to have your vaccine as soon as possible."

Provided by The European Society of Anaesthesiology and Intensive Care (ESAIC)