800 Does delivery affect time to recovery in COVID-19-related ARDS during pregnancy?

Abstract

Pregnant people with Coronavirus Disease 2019 (COVID-19) are more likely to be hospitalized and mechanically ventilated compared to other people of reproductive age. Whether delivery improves time to recovery in this population is unknown. The objective of this study is to examine whether delivery affects time to recovery in pregnant people with COVID-19-related acute respiratory distress syndrome (ARDS). All hospitalized pregnant people admitted for symptomatic COVID-19 with laboratory-confirmed SARS-CoV2 infection at one of several hospitals staffed by a single academic institution were included. ARDS was defined as a pO2/FiO2 (P/F) ratio <300. When blood gases were unavailable, oxygen saturation (SpO2) was converted to pO2 using an oxyhemoglobin dissociation curve. Among delivered people with ARDS, the lowest P/F ratio was computed for each day and for the 12 hours before and after delivery. Characteristics of patients were compared by delivery status using chi-squared, Fisher’s exact and Wilcoxon tests. Linear regression was used to model the effect of delivery on length of stay. Linear mixed models were used to investigate time trends of the P/F ratio. Between May 4, 2020 and July 26, 2020, 61 pregnant people were admitted with COVID-19. Delivered patients had more severe disease, including ARDS, and were at a later gestational age than patients not delivered (Table). Patients delivered during their hospitalization had a similar length of stay compared to patients not delivered, adjusting for age, race/ethnicity, parity, obesity, comorbidities, gestational age at admission and severity of illness (p=0.076). The P/F ratio had a negative slope that improved after delivery (p<0.001, Figure). Delivery slows the deterioration of P/F ratio in pregnant people with COVID-19-related ARDS, but the effect size is small. Hospital length of stay is not affected by delivery. Clinicians should individualize care for patients with COVID-19, recognizing that respiratory distress may improve with delivery but half of the critical cases in this series recovered without delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)