Takayama Watatu, Endo Akira, Yoshii Junichiro, Arai Hirokuni, Oi Keiji, Nagaoka Eiki, Toyama Satoshi, Yamamoto Hiroto, Uchida Tokujiro, Otomo Yasuhiro
Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
Department of Cardiovascular Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Am J Case Rep. 2020 Oct 28;21:e927521. doi: 10.12659/AJCR.927521.
BACKGROUND There are few reports of coronavirus disease 2019 (COVID-19) in pregnant women. Although coagulation dysfunction was reported to affect the severity of COVID-19, the association between pregnancy, which is usually accompanied by changes in coagulation function, and the worsening of COVID-19 is unknown. We present a case of a 30-year-old woman in the 36th week of pregnancy who was diagnosed with severe COVID-19 pneumonia and required postpartum extracorporeal membrane oxygenation (ECMO) therapy. CASE REPORT A 30-year-old, 36-weeks pregnant woman presented to our hospital and was diagnosed with severe COVID-19 pneumonia soon after she had undergone a cesarean section. Her respiratory failure could not be managed by conventional therapeutic approaches. Therefore, ECMO was administered on day 7. Controlling coagulation function to maintain ECMO therapy was challenging. Nafamostat mesylate and cryoprecipitate were administered to treat the hypercoagulative status and severe hypofibrinogenemia, respectively. Since coagulopathy and her respiratory state improved, the ECMO therapy was terminated on day 15. CONCLUSIONS We report a case of severe COVID-19 pneumonia in a pregnant woman urgently treated with ECMO in the postpartum period. Thus, this case highlights the importance of close monitoring and appropriate medical care for pregnant women with severe COVID-19 pneumonia.
关于孕妇感染2019冠状病毒病（COVID-19）的报道较少。尽管有报道称凝血功能障碍会影响COVID-19的严重程度，但通常伴随凝血功能变化的妊娠与COVID-19病情恶化之间的关联尚不清楚。我们报告一例30岁孕36周的女性，她被诊断为重症COVID-19肺炎，产后需要体外膜肺氧合（ECMO）治疗。病例报告：一名30岁、孕36周的女性到我院就诊，剖宫产术后不久被诊断为重症COVID-19肺炎。她的呼吸衰竭无法通过传统治疗方法控制。因此，在第7天给予ECMO治疗。控制凝血功能以维持ECMO治疗具有挑战性。分别给予甲磺酸萘莫司他和冷沉淀治疗高凝状态和严重低纤维蛋白原血症。由于凝血障碍和呼吸状态改善，ECMO治疗在第15天终止。结论：我们报告一例产后紧急接受ECMO治疗的孕妇重症COVID-19肺炎病例。因此，该病例突出了对重症COVID-19肺炎孕妇进行密切监测和适当医疗护理的重要性。
