Gynecology and Reproductive Endocrinology

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Conference Proceedings - Gynecology and Reproductive Endocrinology (2021) Volume 5, Issue 0

Conservative Management of Severe COVID-19 Pneumonia in the 3rd Trimester

Background: The novel coronavirus (SARS-CoV-2) has significantly affected the healthcare system throughout the past year. Regarding obstetrics, it has been an extremely challenging situation as the infection could have a negative impact on the mother as well as the fetus. The available evidence is limited to a handful of case reports and case series. The purpose of this clinical scenario is to aid by sharing our interesting experience and enriching the clinical evidence slightly further. Case report: a 25-year old Turkish woman, 33 weeks pregnant, with limited English language presented with fever, persistent cough, shortness of breath, anosmia, myalgia, vomiting, lethargy and responding only to sounds. Five days prior, she tested positive for SARS-CoV-2 using reverse transcription-PCR test. Accordingly, she was admitted and required continuous oxygen support. Given the severity of her symptoms, an emergency Caesarean section (CS) was planned. However, with one to one close observation, prompt planning and multidisciplinary teams (MDT) involving 9 different clinical teams including; obstetrics, medics, anesthetics, respiratory team, critical care outreach, microbiology, physiotherapy, midwives and interpreters, her symptoms improved. Therefore, our plan for CS was deferred, and the patient was discharged 9 days later. Afterwards, she delivered as planned at 39 weeks by elective CS on account of cervical fibroid and previous CS. Conclusion & Significance: Acute respiratory distress syndrome (ARDS) on its own is not an absolute indication for immediate delivery in COVID-19. Providing the oxygen requirement is under control and both mother and baby are otherwise stable, we suggest avoiding delivery of an immature baby and risk the outcome of this pregnancy. We would like to acknowledge that teamwork and constant care are the epitome of managing every challenging SARS-CoV-2 case successfully during pregnancy. Recommendations: Emergency delivery should not be offered in the absence of fetal distress or intractable maternal disease

Author(s): Mahmoud Elkhouly

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