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).