The relationship between delivery and the PaO2/FiO2 ratio in COVID‐19: a cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 129; no. 3; pp. 493 - 499
• Main Authors: Pineles, BL, Stephens, A, Narendran, LM, Tigner, MA, Leidlein, C, Pedroza, C, Mendez‐Figueroa, H, Sibai, BM
• Format: Journal Article
• Language: English
• Published: London Wiley Subscription Services, Inc 01-02-2022; John Wiley and Sons Inc
• Subjects: Age; ARDS; Cohort analysis; coronavirus; COVID-19; critical care; Decision making; delivery; Gestational age; Hospitalization; Patients; Pregnancy; respiratory distress; Respiratory distress syndrome; SARS‐CoV‐2; Severe acute respiratory syndrome coronavirus 2
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.16858

Objective
To study the effect of delivery on the pO2/FiO2 ratio (P/F ratio) in patients with COVID‐19‐related acute respiratory distress syndrome (ARDS) and to compare characteristics between delivered and undelivered pregnant patients with COVID‐19.
Design
Retrospective cohort.
Setting
Four hospitals in Houston, Texas.
Population
Pregnant patients admitted to the hospital for COVID‐19.
Methods
Among patients with ARDS who were delivered during their hospitalisation for COVID‐19, linear mixed models were used to investigate time trends before and after delivery of the P/F ratio. Patient characteristics were compared between patients delivered during their hospitalisation for COVID‐19 and those discharged undelivered.
Main outcome measures
The P/F ratio, age, gestational age, length of stay and severity of illness,
Results
Between 4 May 2020 and 26 July 2020, a total of 61 pregnant patients were admitted for COVID‐19. Baseline characteristics were similar between the study groups. Delivery occurred in 21 (34%) of patients during their hospitalisation for COVID‐19. Delivered patients had more severe disease and were admitted at a later gestational age than patients not delivered. Ten of these 21 patients (48%) were delivered preterm; of these, six were delivered due to complications of COVID‐19 and four were delivered for obstetric indications. In patients with ARDS who were delivered (n = 17), the P/F ratio had a negative slope that improved after delivery.
Conclusions
COVID‐19‐related ARDS in pregnancy requires multidisciplinary care and individualised decision‐making, but delivery slows the deterioration of the P/F ratio in these patients.
Tweetable
Delivery improves the P/F ratio in COVID‐19‐related ARDS, though individualised delivery management is needed.
Tweetable
Delivery improves the P/F ratio in COVID‐19‐related ARDS, though individualised delivery management is needed.