Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report

Abstract Background Infection with SARS-CoV-2 during pregnancy can lead to a severe condition in the patient, which is challenging for obstetricians and anaesthesiologists. Upon severe COVID-19 and a lack of improvement after multidrug therapy and mechanical ventilation, extracorporeal membrane oxyg...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Anna Rosner-Tenerowicz, Tomasz Fuchs, Aleksandra Zimmer-Stelmach, Michał Pomorski, Martyna Trzeszcz, Jacek Zwierzchowski, Mariusz Zimmer
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Pregnancy COVID-19 Respiratory failure Acute respiratory distress syndrome ARDS ECMO Gynecology and obstetrics RG1-991
Acceso en línea:	https://doaj.org/article/0e33fac0ec1a4dad84b9b9be2d116a39
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:0e33fac0ec1a4dad84b9b9be2d116a39
record_format	dspace
spelling	oai:doaj.org-article:0e33fac0ec1a4dad84b9b9be2d116a392021-11-14T12:32:42ZPlacental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report10.1186/s12884-021-04228-z1471-2393https://doaj.org/article/0e33fac0ec1a4dad84b9b9be2d116a392021-11-01T00:00:00Zhttps://doi.org/10.1186/s12884-021-04228-zhttps://doaj.org/toc/1471-2393Abstract Background Infection with SARS-CoV-2 during pregnancy can lead to a severe condition in the patient, which is challenging for obstetricians and anaesthesiologists. Upon severe COVID-19 and a lack of improvement after multidrug therapy and mechanical ventilation, extracorporeal membrane oxygenation (ECMO) is introduced as the last option. Such treatment is critical in women with very preterm pregnancy when each additional day of the intrauterine stay is vital for the survival of the newborn. Case presentation We report a case of a 38-year-old woman at 27 weeks of gestation treated with multidrug therapy and ECMO. The woman was admitted to the intensive care unit (ICU) with increasing fever, cough and dyspnoea. The course of the pregnancy was uncomplicated. She was otherwise healthy. At admission, she presented with severe dyspnoea, with oxygen saturation (SpO2) of 95% on passive oxygenation, heart rate of 145/min, and blood pressure of 145/90. After confirmation of SARS-CoV-2 infection, she received steroids, remdesivir and convalescent plasma therapy. The foetus was in good condition. No signs of an intrauterine infection were visible. Due to tachypnea of 40/min and SpO2 of 90%, the woman was intubated and mechanically ventilated. Due to circulatory failure, the prothrombotic activity of the coagulation system, further saturation worsening, and poor control of sedation, she was qualified for veno-venous ECMO. An elective caesarean section was performed at 29 weeks on ECMO treatment in the ICU. A preterm female newborn was delivered with an Apgar score of 7 and a birth weight of 1440 g. The newborn had no laboratory or clinical evidence of COVID-19. The placenta showed the following pathological changes: large subchorionic haematoma, maternal vascular malperfusion, marginal cord insertion, and chorangioma. Conclusions This case presents the successful use of ECMO in a pregnant woman with acute respiratory distress syndrome in the course of severe COVID-19. Further research is required to explain the aetiology of placental disorders (e.g., maternal vascular malperfusion lesions or thrombotic influence of COVID-19). ECMO treatment in pregnant women remains challenging; thus, it should be used with caution. Long-term assessment may help to evaluate the safety of the ECMO procedure in pregnant women.Anna Rosner-TenerowiczTomasz FuchsAleksandra Zimmer-StelmachMichał PomorskiMartyna TrzeszczJacek ZwierzchowskiMariusz ZimmerBMCarticlePregnancyCOVID-19Respiratory failureAcute respiratory distress syndromeARDSECMOGynecology and obstetricsRG1-991ENBMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pregnancy COVID-19 Respiratory failure Acute respiratory distress syndrome ARDS ECMO Gynecology and obstetrics RG1-991
spellingShingle	Pregnancy COVID-19 Respiratory failure Acute respiratory distress syndrome ARDS ECMO Gynecology and obstetrics RG1-991 Anna Rosner-Tenerowicz Tomasz Fuchs Aleksandra Zimmer-Stelmach Michał Pomorski Martyna Trzeszcz Jacek Zwierzchowski Mariusz Zimmer Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report
description	Abstract Background Infection with SARS-CoV-2 during pregnancy can lead to a severe condition in the patient, which is challenging for obstetricians and anaesthesiologists. Upon severe COVID-19 and a lack of improvement after multidrug therapy and mechanical ventilation, extracorporeal membrane oxygenation (ECMO) is introduced as the last option. Such treatment is critical in women with very preterm pregnancy when each additional day of the intrauterine stay is vital for the survival of the newborn. Case presentation We report a case of a 38-year-old woman at 27 weeks of gestation treated with multidrug therapy and ECMO. The woman was admitted to the intensive care unit (ICU) with increasing fever, cough and dyspnoea. The course of the pregnancy was uncomplicated. She was otherwise healthy. At admission, she presented with severe dyspnoea, with oxygen saturation (SpO2) of 95% on passive oxygenation, heart rate of 145/min, and blood pressure of 145/90. After confirmation of SARS-CoV-2 infection, she received steroids, remdesivir and convalescent plasma therapy. The foetus was in good condition. No signs of an intrauterine infection were visible. Due to tachypnea of 40/min and SpO2 of 90%, the woman was intubated and mechanically ventilated. Due to circulatory failure, the prothrombotic activity of the coagulation system, further saturation worsening, and poor control of sedation, she was qualified for veno-venous ECMO. An elective caesarean section was performed at 29 weeks on ECMO treatment in the ICU. A preterm female newborn was delivered with an Apgar score of 7 and a birth weight of 1440 g. The newborn had no laboratory or clinical evidence of COVID-19. The placenta showed the following pathological changes: large subchorionic haematoma, maternal vascular malperfusion, marginal cord insertion, and chorangioma. Conclusions This case presents the successful use of ECMO in a pregnant woman with acute respiratory distress syndrome in the course of severe COVID-19. Further research is required to explain the aetiology of placental disorders (e.g., maternal vascular malperfusion lesions or thrombotic influence of COVID-19). ECMO treatment in pregnant women remains challenging; thus, it should be used with caution. Long-term assessment may help to evaluate the safety of the ECMO procedure in pregnant women.
format	article
author	Anna Rosner-Tenerowicz Tomasz Fuchs Aleksandra Zimmer-Stelmach Michał Pomorski Martyna Trzeszcz Jacek Zwierzchowski Mariusz Zimmer
author_facet	Anna Rosner-Tenerowicz Tomasz Fuchs Aleksandra Zimmer-Stelmach Michał Pomorski Martyna Trzeszcz Jacek Zwierzchowski Mariusz Zimmer
author_sort	Anna Rosner-Tenerowicz
title	Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report
title_short	Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report
title_full	Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report
title_fullStr	Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report
title_full_unstemmed	Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report
title_sort	placental pathology in a pregnant woman with severe covid-19 and successful ecmo treatment: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/0e33fac0ec1a4dad84b9b9be2d116a39
work_keys_str_mv	AT annarosnertenerowicz placentalpathologyinapregnantwomanwithseverecovid19andsuccessfulecmotreatmentacasereport AT tomaszfuchs placentalpathologyinapregnantwomanwithseverecovid19andsuccessfulecmotreatmentacasereport AT aleksandrazimmerstelmach placentalpathologyinapregnantwomanwithseverecovid19andsuccessfulecmotreatmentacasereport AT michałpomorski placentalpathologyinapregnantwomanwithseverecovid19andsuccessfulecmotreatmentacasereport AT martynatrzeszcz placentalpathologyinapregnantwomanwithseverecovid19andsuccessfulecmotreatmentacasereport AT jacekzwierzchowski placentalpathologyinapregnantwomanwithseverecovid19andsuccessfulecmotreatmentacasereport AT mariuszzimmer placentalpathologyinapregnantwomanwithseverecovid19andsuccessfulecmotreatmentacasereport
_version_	1718429149280862208

Placental pathology in a pregnant woman with severe COVID-19 and successful ECMO treatment: a case report

Ejemplares similares