Characteristics and clinical outcomes of critically ill pregnant patients with COVID-19 disease

Abstract

Aim To investigate the characteristics and clinical outcomes among critically-ill pregnant patients with COVID-19 and compare them to non-pregnant critically-ill COVID-19 patients. Settings and design This retrospective cohort study was carried out at the ICUs of both Ain Shams University Quarantine Hospital and the Obour Specialized Hospital between April 2020 and September 2021. Methods and material The study included critically-ill, COVID-19 patients above 18 years old. The enrolled participants were divided into two groups, pregnant patients, and a control group of non-pregnant patients. Patient data were retrieved from the medical records. Outcomes included general outcomes (length of ICU stay, need for mechanical ventilation, thromboembolic events, and mortality), obstetric outcomes (pre-eclampsia and mode of delivery), and neonatal outcomes (preterm delivery, neonatal intensive care unit [NICU] admission, intrauterine fetal death, and total perinatal mortality). Results The levels of ferritin and D-dimer, length of ICU stay, need for mechanical ventilation, incidence of thromboembolic events, and mortality showed significant differences between pregnant and non-pregnant women. Women who were critically ill in the second and third trimesters had significantly higher D-dimer and ferritin levels compared to the first trimester critically ill patients. They also had significantly longer ICU stay, higher rate of cesarean delivery, and more incidence of neonatal admission to NICU. Conclusions Pregnant, critically ill women are more prone to adverse pregnancy and neonatal outcomes compared to non-pregnant women. Critical illness in the second and third trimesters poses a higher risk in terms of length of ICU stay and NICU admission.