VP45.09: Lung ultrasound in the management of obstetric patients with COVID‐19 infection

Abstract

Repeated x-rays diagnostic examinations in obstetric patients are discouraged. The aim of this study was to assess the correlation between lung ultrasound (LUS) patterns, clinical presentation and chest x-Ray (CXR) imaging as well as the role of LUS in the management of obstetric patients with symptomatic COVID-19 infection. Consecutive hospitalised infected patients were included. Clinical and imaging data were prospectively recorded. CXR and LUS were performed in double blind at admission. LUS was repeated in case of worsening respiratory symptoms and at discharge. LUS was performed by two experts in obstetric ultrasound imaging, using a wide-band 4-8 MHz convex probe, with B-mode evaluation according to standardised protocols. Bilateral peribronchial hazy increased opacity at CXR and irregular and thickened pleural line with multiple B-lines at LUS were considered a positive finding for COVID-19 pneumonia. Descriptive analysis and correlation between LUS and CXR patterns were performed. 33 patients were included. 22 were pregnant and eleven on postpartum. At admission, 20 patients presented mild symptoms and thirteen moderate symptoms, according to NIH classification. In 31 patients LUS correlated with CXR (Cohen's K 0.90). LUS patterns was negative and positive in twenty and eleven cases, respectively. Two false-negative LUS findings occurred. During hospitalisation, all patients with positive LUS at admission showed negative LUS findings at discharge, in agreement with symptoms resolution. Two patients with negative LUS at admission reported worsening respiratory symptoms, with LUS at time of symptoms showing bilateral basal abnormal findings. This series supports the use of LUS in the management of obstetric patients with COVID-19 infection. Future studies may clarify if LUS can replace CXR in this population, potentially relevant, efficacious and efficient in developing countries.