Results
Six pregnant women with severe COVID-19 pneumonia at Henry Ford Hospital required intensive care unit hospitalization (mean age, 30 years old; range, 18-37 years old). One woman had a history of obstructive sleep apnea, well-controlled asthma, and uncontrolled type 2 diabetes mellitus; 1 had a history of hypothyroidism and hypertriglyceridemia. Four of 6 patients were morbidly obese (mean body mass index [BMI], 37.26 kg/m2; range 22.37-56.0 kg/m2). Patients’ race included 4 African Americans, one Hispanic, and one Arab American individual. Gestational age at time of admission ranged from 23 weeks to 37 weeks and 2 days (Table 1).
Key diagnostic findings included chest x-ray results indicative of viral pneumonia in all 6 patients; decreased absolute lymphocyte count in 4 of 6 patients tested; abnormal liver function tests in 2, and hypertriglyceridemia in 1. Clinical findings seen in all 6 of the patients included shortness of breath and tachycardia; 5 of 6 patients presented with tachypnea; 4 of 6 presented with hypoxia requiring immediate oxygen supplementation; and 2 of 6 patients had a known COVID-19 positive exposure (Table 2).
All women were treated with steroids, initially intravenous methylprednisolone 40 mg twice a day for 3 days. A shortage quickly developed and oral prednisone 40-80 mg twice a day for 7-10 days was substituted for 4 patients. Standard treatment also included hydroxychloroquine 400 mg oral loading dose for 2 doses and then 200 mg oral twice daily for a total of 5 days. One patient did not receive hydroxychloroquine therapy due to prolonged corrected QT interval of greater than 500 ms; one patient declined hydroxychloroquine due to concern for possible fetal effects; and 4 patients received a full course of hydroxychloroquine as described. Three of 6 patients were treated with antibiotics for superimposed bacterial pneumonia. All 6 patients received venous thromboembolism prophylaxis; 5 patients with preterm gestation received betamethasone secondary to the potential for preterm delivery (Table 3).
All 6 patients received antepartum testing with fetal non-stress tests. The 2 patients who were admitted at 23 weeks gestational age were monitored for 20 minutes once a day. The remaining 4 patients had fetal non-stress tests every 8 hours. As long as the tracing was reassuring, they would be taken off the monitor. Since our patients were sedated, we did not have expectations to have accelerations while monitoring.
There was 1 full-term delivery via cesarean section at 37 weeks and 4 days after intubation due to non-reassuring fetal heart tones remote from delivery with absent variability noted on fetal heart tracing. There were 2 preterm deliveries. One delivery was an urgent cesarean section at 36 weeks and 5 days for non-reassuring fetal status in the setting of preeclampsia with severe features and worsening respiratory compromise from COVID-19 pneumonia. The other preterm delivery was a vacuum-assisted vaginal delivery at 36 weeks and 3 days gestation following labor induction for a persistent category 2 fetal heart tracing. All neonates tested negative for COVID-19. One infant remained hospitalized for 7 days for respiratory distress and suspicion of sepsis. The other 2 infants were discharged on hospital day 2 (Table 4).