Pregnant woman wins 22-day battle against Covid

**Note that this work is presented at the Euroanaesthesia congress in Milan, June 4-6. Please credit Congress when using this story**

Croatian doctors detail a pregnant COVID-19 patient’s 22-day battle for survival, in a case report presented at Euroanaesthesia, the annual meeting of the European Society for Anaesthesiology and Intensive Care (ESAIC) in Milan, Italy (June 4-6).

The 31-year-old woman, who had not been vaccinated against Covid, underwent an emergency caesarean section before being put on ECMO (extracorporeal membrane oxygenation a machine), a “last resort” treatment which replaces the function of the heart and lungs, allowing them to heal.

The woman developed symptoms of COVID-19 on October 16, 2021 and tested positive four days later on October 20. She was admitted to Split University Hospital, Split, Croatia on October 26 with shortness of breath, cough and weakness.

The woman, who was 33 weeks pregnant when admitted, had no significant underlying medical conditions.

His symptoms were mild at first but progressed rapidly, raising concerns. A few hours after admission, her breathing worsened, despite receiving supplemental oxygen.

An interdisciplinary team, led by Ass. Professor Sanda Stojanovic Stipic and doctors from ICU and Maternal-Fetal Medicine included, decided to intubate the woman and perform a Caesarean section.

“The patient’s condition was rapidly deteriorating,” says Dr Filip Peris, of the Anaesthesiology and Intensive Care Department at Split University Hospital, anesthesiologist and member of the team caring for the woman.

“We had little time before the baby’s health followed suit, so we formed a team and discussed the best thing for mother and child to do, to try and save both of their lives.

“Since the child’s gestational age was quite advanced and the mother’s health was rapidly deteriorating, we decided to perform a caesarean section.

“Pregnancy is a stressful time for the body and giving birth would give the mother’s lungs time to heal on their own.”

The baby, a boy weighing 2,380 g (5 lb 4 oz), was in good health and did not require any special medical attention.

After the caesarean, the woman was transferred to the hospital’s Covid intensive care unit, where she was placed on a ventilator. Despite this, she had a lung function (P/F) ratio of 85. Ratios below 100 are classified as severe ARDS (acute respiratory distress syndrome, a condition in which the lungs are so badly damaged that the alveoli – sacs air – begin to fill with liquid.)

Her lung function report deteriorated further to 70 and she was put on ECMO.

“The mother’s condition was life-threatening and mechanical ventilation was not sufficient to heal her lungs,” says Dr Peris. “ECMO was his last chance. In our hospital, we use ECMO 3 to 5 times a year.

“Her lung function gradually improved and she was weaned from ECMO after nine days. On November 17, and after a 22-day long battle for survival, mother and child were sent home.

The woman underwent extensive physiotherapy in the hospital and after returning home and made a full recovery. Her son is also healthy.

Dr Peris says: “Every step of his fight was closely monitored by our wonderful team of anesthesiologists and intensive care nurses. Their team effort, led by Ass. Sanda Stojanovic Stipic, and hard work was crucial in winning this battle.

The woman’s doctors say pregnancy should not be considered a contraindication to ECMO. They say, “Recent studies show us that survival rates after the use of ECMO in pregnancy are high for both mother and child. This could be because pregnant patients are usually young and healthy.

Dr. Peris adds: “The risks and benefits to mother and fetus must be weighed against each other. In this situation, the advanced gestational age of the fetus was balanced against the rapidly deteriorating clinical condition of the mother.

“Timing is everything in medicine. The right timing saves lives.

The woman had not been vaccinated against COVID-19. Dr Peris says: “Vaccination is extremely important – it saves lives.

“Studies show that there are no safety concerns for babies born to women who were vaccinated against COVID-19 during pregnancy.

“I urge you to get vaccinated as soon as possible.”