Kolkova Zuzana, Bjurström Martin F, Länsberg John-Kalle, Svedas Eimantas, Hamer Maria Andrada, Hansson Stefan R, Herbst Andreas, Zaigham Mehreen
Department of Obstetrics & Gynaecology, Institute of Clinical Sciences Lund, Lund University and Skåne University Hospital, Malmö/Lund, Sweden.
Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden.
Case Rep Womens Health. 2020 Jul 8;27:e00240. doi: 10.1016/j.crwh.2020.e00240. eCollection 2020 Jul.
With the disease burden increasing daily, there is a lack of evidence regarding the impact of COVID-19 in pregnancy. Healthy pregnant women are still not regarded as a susceptible group despite physiological changes that make pregnant women more vulnerable to severe infection. However, high-risk pregnancies may be associated with severe COVID-19 disease with respiratory failure, as outlined in this report. We discuss the importance of timely delivery and antenatal steroid administration in a critically ill patient.
A 27-year-old pregnant woman (gravida 2, para 1) with type I diabetes, morbid obesity, hypothyroidism and a previous Caesarean section presented with critical respiratory failure secondary to COVID-19 at 32 weeks of gestation. A preterm emergency Caesarean section was performed, after steroid treatment for foetal lung maturation. The patient benefited from prone positioning; however, transient acute renal injury, rhabdomyolysis and sepsis led to prolonged intensive care and mechanical ventilation for 30 days. The baby had an uncomplicated recovery.
COVID-19 infection in high-risk pregnancies may result in severe maternal and neonatal outcomes such as critical respiratory failure requiring mechanical ventilation and premature termination of the pregnancy. Antenatal steroids may be of benefit for foetal lung maturation but should not delay delivery in severe cases.
随着疾病负担日益加重，关于新冠病毒病（COVID-19）对妊娠影响的证据不足。尽管生理变化使孕妇更容易受到严重感染，但健康孕妇仍未被视为易感人群。然而，如本报告所述，高危妊娠可能与伴有呼吸衰竭的严重COVID-19疾病相关。我们讨论了在危重症患者中及时分娩和产前使用类固醇的重要性。
一名27岁孕妇（孕2产1），患有I型糖尿病、病态肥胖、甲状腺功能减退且曾行剖宫产，在妊娠32周时因COVID-19继发严重呼吸衰竭就诊。在进行类固醇治疗促进胎儿肺成熟后，实施了早产紧急剖宫产。患者得益于俯卧位通气；然而，短暂的急性肾损伤、横纹肌溶解和脓毒症导致其在重症监护病房接受长时间治疗并机械通气30天。婴儿恢复情况良好。
高危妊娠中的COVID-19感染可能导致严重的母婴结局，如需要机械通气的严重呼吸衰竭和早产。产前使用类固醇可能有助于胎儿肺成熟，但在重症病例中不应延迟分娩。
