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CC BY-NC-ND 4.0 · AJP Rep 2021; 11(01): e29-e33
DOI: 10.1055/s-0040-1721672
Case Report

Expectant Management of Severe COVID-19 Pneumonia in Late Preterm Pregnancy and Subsequent Cholecystitis: Lessons Learned

Neggin B. Mokhtari 
1   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center/Georgetown University, Washington, District of Columbia
,
Daphnie Drassinower
2   Division of Maternal Fetal Medicine, MedStar Georgetown University, Washington, District of Columbia
,
Lindsey A. Orr
3   Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University, Washington, District of Columbia
,
Nathan K. Cobb
3   Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University, Washington, District of Columbia
,
Oscar L. Mims Jr.
2   Division of Maternal Fetal Medicine, MedStar Georgetown University, Washington, District of Columbia
,
Helain J. Landy
2   Division of Maternal Fetal Medicine, MedStar Georgetown University, Washington, District of Columbia
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Abstract

Introduction Since the emergence of coronavirus disease 2019 (COVID-19) as a pandemic in March 2020, research and guidance have been published with regard to the management of infection and considerations in pregnancy, but much is still unknown. Pregnant women with COVID-19 infection are more likely to be hospitalized and are at increased risk for intensive care unit admissions and intubation than nonpregnant women with COVID-19 infection. The optimal timing of delivery among pregnant women with COVID-19 infection has not been established at this time, especially when the infection arises in late preterm and early term gestation. It is suggested that COVID-19 infection should not be considered a sole indication for delivery. The risks and benefits of prolonging pregnancy versus delivery should be taken into consideration at any given gestational age in a patient with COVID-19 infection.

Case Report We report a case of a patient in the late third trimester of pregnancy that presented with severe COVID-19 infection and was managed expectantly through her disease course with improvement of respiratory status without necessitating delivery. We also discuss the unique development of cholecystitis in her hospitalization that may represent another clinical association to COVID-19 infection.

Conclusion This case illustrates that delaying delivery is an option even in later gestational ages for maternal stabilization. A multidisciplinary approach and teamwork is needed to manage pregnant women with COVID-19 infection for optimal outcomes for both mother and fetus.

Key Points

  • Delaying delivery in severe coronavirus disease 2019 (COVID-19) infection is a reasonable option even in late gestation.

  • A multidisciplinary team is of utmost importance when managing a pregnant woman with COVID-19.

  • Other clinical sequalae such as cholecystitis may arise in the setting of COVID-19 infection.

Keywords

coronavirus - COVID-19 - pregnancy - cholecystitis - early term gestation


Publication History

Received: 29 July 2020

Accepted: 24 September 2020

Article published online:
12 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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