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16th International Conference on Virology, Emerging Diseases & vaccines

Vancouver, Canada

Mahmoud Elkhouly

Professor Helwan university

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

Biography: Mahmoud Elkhouly

Abstract

Objective:

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. Consequently, this clinical scenario aims to aid by sharing an interesting experience and enriching the clinical evidence slightly further.

Case report:

A 25-year old Turkish woman, who was 33 weeks pregnant, with limited English language presented with fever, persistent cough, shortness of breath, anosmia, myalgia, nausea, vomiting, lethargy and responding only to sounds. Five days prior, she tested positive for the new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) using reverse transcription-PCR test. Accordingly, she was admitted and required continuous oxygen support.

Given the severity of the acute respiratory distress syndrome (ARDS), 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.

Discussion:

The scarcity of data regarding severe SARS-CoV-2 infection in pregnancy and management protocols, in addition to the language barrier gave rise to a uniquely challenging situation.

ARDS on its own isn’t an absolute indication for immediate delivery in COVID-19. We suggest that as long as the oxygen requirement is under control and both mother and baby are otherwise stable, we should avoid delivering an immature baby and risk the outcome of this pregnancy. It was reported that a pregnant woman was mechanically ventilated for 10 days on account of COVID pneumonia; however, she managed to continue her pregnancy successfully for 8 weeks afterwards. An emphasis on the benefits of MDT meetings must be highlighted in such case.

Conclusion:

Emergency delivery should not be offered in the absence of fetal distress or intractable maternal disease. We would like to acknowledge that teamwork and constant care are the epitome of managing every challenging SARS-CoV-2 case during pregnancy with successfully.

 


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