Covid & pregnancy - ESRA

ESRA Updates

November 2020 | Issue 03

Covid & pregnancy

Stephanie Poels, MD (Academic Hospital Turnhout, Belgium)
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As anesthesiologist and intensive care specialist, I was working in the OR and intensive care unit when Covid-19 started to spread through Europe.
In the beginning of march 2020 we were preparing our intensive care unit for the Covid pandemic. Adaptations were made to double our ICU capacity and protocols were written to admit and treat the first Covid patients.
In this period I started to experience a sore throat, dry cough and shortness of breath. Also, I developed a fever up to 39°C and was feeling unwell.
A Covid test (PCR) came back negative. After seven days of quarantine at home the fever cleared up and I resumed work.
However my dyspnea and fatigue persisted, but I attributed these complaints to my pregnancy.

Because I was pregnant, I was deployed in our non-Covid ICU.
In this period Covid testing and personal protection equipment (PPE) were scarce and only used in highly suspected or confirmed cases. One of the presumed non-Covid patients I took care of turned out to be Covid positive. During this period I had performed high risk procedures without PPE.
About one week later, at 30 weeks gestation, I developed a fever again (39.6°C) and my dyspnea got worse. I got hypotensive and had multiple syncopes. A Covid test was repeated and came back negative again. Laboratory tests only showed a mildly elevated CRP. A chest X-ray was not performed considering my pregnancy. Obstetric ultrasound showed a normal biophysical profile. I was advised to recover at home.

«[…] a contrast-enhanced chest CT was performed, showing bilateral ground glass opacities and crazy paving pattern with a consolidation in the right lower lobe.»

My condition deteriorated however. I remained febrile, the shortness of breath kept increasing and at this stage I also developed anosmia.
Vital signs showed borderline hypotension and my saturations started to drop to 95%. Clinical examination revealed crackles at the right lower lung base, tachy- and dyspnea.
New biochemistry revealed a further elevated CRP of 74 mg/L, lymfopenia (0.6 x 109/L) and thrombocytopenia (134000/μg/L).
All cultures (including haemocultures) and Mycoplasma serology came back negative.
After consulting a university hospital, a contrast-enhanced chest CT was performed, showing bilateral ground glass opacities and crazy paving pattern with a consolidation in the right lower lobe. Pulmonary embolism was excluded. Cardiotocography (CTG) now showed fetal tachycardia.

«CTG for fetal monitoring was performed two times a day and remained reactive and variable.»

At 31 weeks gestation, I was diagnosed with a Covid-19 pneumonia and admitted to the hospital. I was treated with oxygen, antipyretics, empiric antibiotics for five days and thrombosis prophylaxis. Corticosteroids for fetal lung maturation were not administered, as they were advised against at the time in Covid-19 patients and there were no signs of fetal distress or impending premature labor.
CTG for fetal monitoring was performed two times a day and remained reactive and variable. My husband, who is a surgeon, cancelled his on call activities and stayed at home in quarantaine with our son for 14 days. They were both asymptomatic and were never tested, following the guideline at that time.
After six days I remained afebrile again and was discharged home with oxygen, which I needed for two more weeks. Thrombosis prophylaxis was continued up to 37 weeks gestation. When I got home, I did not isolate myself from my husband and son since I was no longer considered contagious and it would have been very difficult to organise.
For several weeks the fatigue and dyspnea persisted but after all I made an almost complete recovery – except for the anosmia. I delivered a healthy baby girl at 40 weeks of gestation. Fortunately I recovered enough to give normal birth and no caesarean section was needed.

Despite the good outcome, I prefer not walking down this memory lane too often. The isolation in the hospital and the fear for preterm or urgent delivery made it a mentally challenging experience for me. I feel like I missed out on an important part of my pregnancy and was not able to enjoy it. I also feel guilt towards my collegues that I was not able to help out when they were working long shifts in difficult circumstances.

Topics: COVID-19 , Doctor , Recovery , Pregnancy

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