Pregnant Woman in the Context of the Covid-19 Pandemic. Our Experience in a Hospital Setting
Author(s): Zelmat SA, Bouabida D, Boucherit DE, Boucherit E, Mazour F
Pregnant women did not escape the SARS-CoV-2 pandemic. Unlike scheduled surgical activities, obstetrical activities could not, in essence, be postponed or cancelled! The management of these parturients therefore had to be adapted and modified in order to limit the complications due to this infection and the risks of spreading the virus.
The objective of this work was to describe the clinical, para-clinical and evolutionary parameters of patients with COVID 19 hospitalized at the department.
We conducted a retrospective survey over a period of 21 months from February 10, 2020 (date of confirmation of the first case of pregnant woman Covid 19 in the department of gynecology-obstetrics) to December 10, 2021, and including all cases of COVID 19 collected in the department of gynecology-obstetrics of the EHUO Results were expressed as number, percentage or mean ± standard deviation. For univariate analysis, quantitative variables were compared by Student's t test and qualitative variables by Chi2 or Fisher's exact test. Statistics were performed using epi info software.
61 patients were included, of whom 29 presented with severe COVID 19 (group 1) and 32 patients with moderate or minimal COVID 19 (group 2). The mean age was 29.7 ± 7 years for group 1 and 28.5 ± 7 years for group 2. The mean gestational age was 2.8 for group 1 and 2.5 for group 2. Three patients in Group 1 developed pulmonary embolism, whereas no patient in Group 2 developed this complication (P=0.06). The diagnosis was confirmed each time by spiral angioscan. There were three cases of maternal death in group 1 against no case in the moderate form, we note the factors associated with a maternal death increase in D-dimer (> 3 μg/L), fibrinogen (> 8 g/L) and thrombocytopenia
Increased D-dimer (>3 μg/L), fibrinogen (>8 g/L), and thrombocytopenia are poor prognostic factors for the mother. These markers should be monitored regularly during hospitalization of pregnant parturients. The diagnosis of pulmonary embolism may be difficult in this setting but should be considered if there is unexplained worsening of hypoxemia or right heart failure
The postpartum period is the period that has been the subject of the greatest number of modifications with The thromboembolic risk that must be stratified to adapt; thrombo-prophylaxis by taking into account the renal function and the overweight of the patients and the restricted use of NSAIDs. The key point of obstetrical management in this period of pandemic was finally the interdisciplinary cooperation, involving anesthesiologist-resuscitator, gynecologist and pediatricians.