Convalescent plasma use in pregnant patients with COVID-19 related ARDS: a case report and literature review

ABSTRACT

Background. Pregnancy does not appear to increase susceptibility to acquiring Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but pregnant people with the infection appear to be at increased risk for developing severe disease. Furthermore, infected pregnant people, especially those who develop pneumonia, appear to have an increased frequency of preterm birth and cesarean delivery, alternatively to other causes of peripheral infection.
Case presentation. The aim of this report is to describe a case of a third trimester pregnant woman with severe acute respiratory syndrome COVID-19, undergoing endotracheal intubation with invasive mechanical ventilation due to respiratory distress with a 12-hour daily cycle of pronation. The patient was the first case in Sicily treated with convalescent plasma and underwent urgent preterm cesarean section.
Conclusions. Several agents are being evaluated for treatment of COVID-19, with minimal or no information on safety in pregnancy. Our data confirmed that pregnant women can be safely pronated with clinical improvement and blood gasses findings. Instead, after the use of convalescent plasma, we had only a partial and transitory improvement of patient’s condition . Certainly the timing of delivery should be discussed by a multidisciplinary team of obstetricians, anesthetists and neonatologists. In the future other studies on larger numbers of pregnant women with COVID-19 need to be conducted to better understand the correct maternal and fetus care and the effectiveness of the treatments available also for a specialized specific approach on the long-covid effects.