Morton Sarah, Lamont Holly, Silvey Natalie, Browning Thomas, Hayes Michelle, Keays Richard, Christie Linsey, Davies Roger, Singh Suveer, Lockie Chris, Sisson Alice, Vizcaychipi Marcela
Adult Intensive Care Unit, Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea, London, UK.
Academic Department of Anaesthesia, Chelsea Campus, Imperial College London, Chelsea, London, UK.
J Intensive Care Soc. 2021 Nov;22(4):288-299. doi: 10.1177/1751143720947547. Epub 2020 Aug 26.
UK data suggest 6% of COVID-19 hospital admissions are either currently pregnant or immediately post-partum. However, the current literature suggests that if COVID-19 occurs in pregnancy, or post-partum, symptoms are mostly mild.
All COVID-19 admissions to one acute London National Health Service Foundation trust were reviewed since the beginning of the COVID-19 pandemic to 1 May 2020 to establish whether there were any pregnant or immediately post-partum admissions. Data were extracted from hospital electronic records and anonymised. Any patients admitted to adult intensive care unit had their case notes reviewed in detail and comparison made to a local risk-assessment guideline identifying patients at-risk of thromboembolic events or cytokine storms. Local hospital guidelines were followed. Patients admitted to adult intensive care unit gave written consent.
A total of 24 pregnant or immediately post-partum patients with COVID-19 were admitted. Three patients required long adult intensive care unit admissions for severe single-organ respiratory failure after emergency C-sections. Two of these patients required proning (three times and eight times, respectively). All were considered medium risk for thromboembolic events but had rising D-dimers following adult intensive care unit admission, resulting in increased dosing of pharmacological thromboprophylaxis throughout their admission. All were considered low risk for a cytokine storm, and none had any significant cardiovascular or renal involvement. One patient developed a super-imposed fungal lung infection. All three patients developed delirium following cessation of sedation.
Pregnant or immediately post-partum women can develop severe COVID-19 symptoms requiring prolonged adult intensive care unit admission. It is likely to be single-organ failure, but patients are at a high risk of a thromboembolic event and delirium.
英国的数据表明，6%的新冠肺炎住院患者目前处于孕期或产后不久。然而，当前的文献表明，如果新冠肺炎发生在孕期或产后，症状大多较轻。
对自新冠肺炎疫情开始至2020年5月1日期间，伦敦一家急性国民保健服务基金会信托医院收治的所有新冠肺炎患者进行回顾，以确定是否有孕期或产后不久的患者入院。数据从医院电子记录中提取并匿名化。所有入住成人重症监护病房的患者的病历均进行了详细审查，并与当地风险评估指南进行比较，以确定有血栓栓塞事件或细胞因子风暴风险的患者。遵循当地医院指南。入住成人重症监护病房的患者均签署了书面同意书。
共有24名患有新冠肺炎的孕期或产后不久的患者入院。3名患者在紧急剖宫产术后因严重的单器官呼吸衰竭需要长期入住成人重症监护病房。其中2名患者需要俯卧位通气（分别为3次和8次）。所有患者均被认为有血栓栓塞事件的中度风险，但在入住成人重症监护病房后D-二聚体升高，导致在整个住院期间增加了预防性药物抗凝的剂量。所有患者均被认为有细胞因子风暴的低风险，且均无明显的心血管或肾脏受累。1名患者发生了叠加的真菌性肺部感染。所有3名患者在镇静停止后均出现了谵妄。
孕期或产后不久的女性可能会出现严重的新冠肺炎症状，需要长期入住成人重症监护病房。可能是单器官衰竭，但患者有血栓栓塞事件和谵妄的高风险。
