Subscribe to RSS
Maternal-Neonatal Dyad Outcomes of Maternal COVID-19 Requiring Extracorporeal Membrane Support: A Case Series
Objective This study aimed to describe two cases of acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease 2019 (COVID-19) in pregnant women requiring extracorporeal membrane oxygenation (ECMO), and resulting in premature delivery.
Study Design The clinical course of two women hospitalized with ARDS due to COVID-19 care in our intensive care (ICU) is summarized; both participants provided consent to be included in this case series.
Results Both women recovered with no clinical sequelae. Neonatal outcomes were within the realm of expected for prematurity with the exception of coagulopathy. There was no vertical transmission to the neonates.
Conclusion This case series highlights that ECMO is a feasible treatment in the pregnant woman with severe COVID-19 and that delivery can be performed safely on ECMO with no additional risk to the fetus. While ECMO carries its natural risks, it should be considered a viable option during pregnancy and the postpartum period.
COVID-19 may present with a more severe course in pregnancy.
ECMO may be used in pregnant woman with severe COVID-19.
Delivery can be performed on ECMO without added fetal risk.
Keywordssevere acute respiratory syndrome-coronavirus-2 - COVID-19 - extracorporeal membrane oxygenation - respiratory distress syndrome - pregnancy
Received: 11 September 2020
Accepted: 16 September 2020
17 October 2020 (online)
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): COVIDView. Accessed September 25, 3030 from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
- 2 Lewnard JA, Liu VX, Jackson ML. et al. Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study. BMJ 2020; 369: m1923 DOI: 10.1136/bmj.m1923.
- 3 Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: what about pregnancies?. Lancet 2020; 395 (10224): e40
- 4 Centers for Disease Control and Prevention. Data on COVID-19 during Pregnancy. 2020 . Accessed Aug 19, 2020 at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19.html
- 5 Knight M, Bunch K, Vousden N. et al; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
- 6 Zeng Y, Cai Z, Xianyu Y, Yang BX, Song T, Yan Q. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series. Crit Care 2020; 24 (01) 148
- 7 Jacobs JP, Stammers AH, St Louis J. et al. Extracorporeal membrane oxygenation in the treatment of severe pulmonary and cardiac compromise in coronavirus disease 2019: experience with 32 patients. ASAIO J 2020; 66 (07) 722-730
- 8 ECMO in COVID-19. Accessed Aug 19, 2020 at: https://www.elso.org/COVID19.aspx
- 9 Naoum EE, Chalupka A, Haft J. et al. Extracorporeal life support in pregnancy: a systematic review. J Am Heart Assoc 2020; 9 (13) e016072
- 10 Mendoza M, Garcia-Ruiz I, Maiz N. et al. Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG 2020; 127 (11) 1374-1380
- 11 Halscott T, Vaught J, Miller E. Society for Maternal Fetal Medicine. Management considerations for pregnant patients with COVID-19. Accessed Aug 19, 2020 at: https://s3.amazonaws.com/cdn.smfm.org/media/2415/SMFM_COVID_Management_of_COVID_pos_preg_patients_7-2-20.PDF_.pdf
- 12 Committee on Ethics. ACOG committee opinion no. 646: ethical considerations for including women as research participants. Obstet Gynecol 2015; 126 (03) e100-e107
- 13 Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA. et al. Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol 2020; 39 (03) 246-250
- 14 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
- 15 Parazzini F, Bortolus R, Mauri PA, Favilli A, Gerli S, Ferrazzi E. Delivery in pregnant women infected with SARS-CoV-2: A fast review. Int J Gynaecol Obstet 2020; 150 (01) 41-46
- 16 Zeng L, Xia S, Yuan W. et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; 174 (07) 722-725
- 17 Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020; 55 (05) 586-592
- 18 Savasi VM, Parisi F, Patanè L. et al. Clinical findings and disease severity in hospitalized pregnant women with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2020; 136 (02) 252-258
- 19 Kotlyar A, Grechukhina O, Chen A. et al. Vertical transmission of COVID-19: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; DOI: 10.1016/j.ajog.2020.07.049.
- 20 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; 37 (08) 861-865
- 21 Nair P, Davies AR, Beca J. et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med 2011; 37 (04) 648-654
- 22 Sharma NS, Wille KM, Bellot SC, Diaz-Guzman E. Modern use of extracorporeal life support in pregnancy and postpartum. ASAIO J 2015; 61 (01) 110-114
- 23 Zhang JJY, Ong JA, Syn NL. et al. Extracorporeal membrane oxygenation in pregnant and postpartum women: a systematic review and meta-regression analysis. J Intensive Care Med 2019; DOI: 10.1177/0885066619892826.