Оценка клинико-анамнестических характеристик тяжести течения ковидной пневмонии в разные сроки беременности и развития риска досрочного родоразрешения

Abstract

Aim: To evaluate the influence of clinical and anamnestic factors on the severity of the course and early delivery in pregnant women with covid pneumonia. Study design: Retrospective cohort single-center study. Materials and methods. The study included 81 pregnant women with covid pneumonia at a gestational age of 22.0–41.3 weeks. Depending on the severity of the condition, the women were divided into three groups: the 1st group included 13 patients who did not require respiratory support, the 2nd group included 52 pregnant women who received non-invasive respiratory support, the 3rd group included 16 patients who required invasive respiratory support. On the first day after hospitalization, clinical and anamnestic indicators, clinical manifestations of viral pneumonia, data from laboratory and instrumental studies of patients were analyzed. Computed tomography (CT) of the chest organs was prescribed to pregnant women after a consultation on the need for this study. An assessment of anthropometric data and the condition of children at birth was performed. Results. Women of all groups were comparable in clinical and anamnestic characteristics. A higher risk of invasive respiratory support was determined in patients with the onset of the disease at gestational age ≤ 207 (187–233) days (p < 0.001), with an increase in body temperature during illness ≥ 38.6 (38.0–39.0) °C (p = 0.009), saturation in atmospheric air ≤ 90.0 (87.0–93.0)% (p < 0.001). With this combination of parameters, a higher probability of changes in the structure of the lungs according to chest CT data was revealed: ≥ 77.5 (68.2–90.0)% (p < 0.001). Pregnant women with ferritin levels ≥ 125.0 (84.4–268.9) ng/ml had a higher risk of severe viral pneumonia and preterm delivery (p = 0.001). Compared with women in other groups, patients with invasive respiratory support had a shorter delivery time (≤ 210.0 (203.5–238.5) days) (p < 0.001) and a higher chance of preterm birth (odds ratio = 7.07 (95% confidence interval — 1.44; 69.02)). Children of patients with severe viral pneumonia received a statistically significantly worse Apgar score at 1 and 5 minutes of life (p < 0.001), and also had lower weight and body length at birth compared to newborns at 1 and 2 groups (p < 0.001). Conclusion. The study revealed the most informative factors of severity and early delivery in pregnant patients with viral pneumonia caused by a new coronavirus infection. These predictors are important to consider during outpatient monitoring of pregnant patients with coronavirus pneumonia in order to make a timely decision on hospitalization. Keywords: pregnancy, coronavirus infection, covid pneumonia, early delivery.