Features of the course and management of pregnant patients with COVID-19

Objective. To assess the effectiveness of the treatment of pregnant patients with moderate COVID-19 pneumonia.
Materials and methods. A dynamic prospective study of the course of pregnancy in the second and third trimesters was carried out in 36 female patients with moderate COVID-19 pneumonia undergoing treatment at the Department of Obstetrics and Observation of Gomel City Clinical Hospital No.3. The comparison groups consisted of 30 pregnant patients without COVID-19 and 30 female patients of childbearing age with moderate COVID-19 pneumonia. All pregnant patients with pneumonia received treatment with the antiviral drug «Remdesivir», all non-pregnant patients underwent clinical treatment without antiviral drugs.
Results. The study has found no significant differences in the frequency of gynecological and obstetric pathology in the anamnesis between the groups of the pregnant patients. However, the pregnant patients with pneumonia were characterized by comorbidity (anemia, chronic pyelonephritis, obesity). The main clinical symptoms in the patients with pneumonia did not differ significantly and were related to adaptive changes to pregnancy. The pregnant patients with pneumonia showed more rapid normalization of body temperature, oxygen dependence, and laboratory parameters. The remdesivir treatment for pneumonia did not lead to any progression of obstetric complications of pregnancy (thereatened miscarriage, chronic placental insufficiency) or development of any other complications. All the patients were discharged from the hospital with progressing pregnancy.
Conclusion. High efficiency of the treatment of pregnant patients with moderate pneumonia using the complex therapy with the antiviral drug «Remdesivir» has been shown. It leads to a rapid enhancement of clinical and laboratory parameters in patients, but does not affect the duration of the treatment. The absence of direct adverse side effects and complications of pregnancy makes it reasonable to use this drug in the complex therapy of moderate pneumonia in the second and third trimesters. It is necessary to continue this study to analyze the long-term treatment results.

1. Gulic T, Blagojevic Zagorac G. COVID-19 and pregnancy: are they friends or enemies? Horm Mol Biol Clin Investig. 2021 Feb 11;42(1):57-62. DOI: https://doi.org/10.1515/hmbci-2020-0054

2. Wang CL, Liu YY, Wu CH, Wang CY, Wang CH, Long CY. Impact of COVID-19 on Pregnancy. Int J Med Sci. 2021 Jan 1;18(3):763-767. DOI: https://doi.org/10.7150/ijms.49923

3. Kucirka LM, Norton A, Sheffield JS. Severity of COVID-19 in pregnancy: A review of current evidence. Am J Reprod Immunol. 2020 Nov;84(5):e13332. DOI: https://doi.org/10.1111/aji.13332

4. Mourad M, Bousleiman S, Wapner R, Gyamfi-Bannerman C. Conducting research during the COVID-19 pandemic. Semin Perinatol. 2020 Nov;44(7):151287. DOI: https://doi.org/10.1016/j.semperi.2020.151287

5. Rajewska A, Mikołajek-Bedner W, Lebdowicz-Knul J, Sokołowska M, Kwiatkowski S, Torbé A. COVID-19 and pregnancy - where are we now? A review. J Perinat Med. 2020 Jun 25;48(5):428-434. DOI: https://doi.org/10.1515/jpm-2020-0132

6. Naidu SAG, Clemens RA, Pressman P, Zaigham M, Kadkhoda K, Davies KJA, Naidu AS. COVID-19 during Pregnancy and Postpartum. J Diet Suppl. 2022;19(1):115-142. DOI: https://doi.org/10.1080/19390211.2020.1834049

7. D’Souza R, Ashraf R, Rowe H, Zipursky J, Clarfield L, Maxwell C, Arzola C, Lapinsky S, Paquette K, Murthy S, Cheng MP, Malhamé I. Pregnancy and COVID-19: pharmacologic considerations. Ultrasound Obstet Gynecol. 2021 Feb;57(2):195-203. DOI: https://doi.org/10.1002/uog.23116

8. de Oliveira KF, de Oliveira JF, Wernet M, Carvalho Paschoini M, Ruiz MT. COVID-19 and pregnancy: A scoping review on pregnancy characteristics and outcomes. Int J Nurs Pract. 2021 Oct;27(5):e12956. DOI: https://doi.org/10.1111/ijn.12956

9. Prikaz Ministerstva zdravoohraneniya Respubliki Belarus’ ot 12.01.2021 № 13 «O dopolnitel’nyh merah po okazaniyu medicinskoj pomoshchi bere-mennym, rozhenicam i rodil’nicam s infekciej Covid-19 i pnevmoniej tya-zheloj formoj zabolevaniya» [date of access 2022 February 10]. Available from: http://minzdrav.gov.by (in Russ.).

10. Naidu SAG, Clemens RA, Pressman P, Zaigham M, Davies KJA, Naidu AS. COVID-19 during Pregnancy and Postpartum. J Diet Suppl. 2022;19(1):78-114. DOI: https://doi.org/10.1080/19390211.2020.1834047

11. Schmid MB, Fontijn J, Ochsenbein-Kölble N, Berger C, Bassler D. COVID-19 in pregnant women. Lancet Infect Dis. 2020 Jun;20(6):653. DOI: https://doi.org/10.1016/S1473-3099(20)30175-4

12. Oshay RR, Chen MYC, Fields BKK, Demirjian NL, Lee RS, Mosallaei D, Gholamrezanezhad A. COVID-19 in pregnancy: a systematic review of chest CT findings and associated clinical features in 427 patients. Clin Imaging. 2021 Jul;75:75-82. DOI: https://doi.org/10.1016/j.clinimag.2021.01.004

13. Wu H, Sun W, Huang X, Yu S, Wang H, Bi X, Sheng J, Chen S, Akinwunmi B, Zhang CJP, Ming WK. Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges. J Med Internet Res. 2020 Jul 22;22(7):e19916. DOI: https://doi.org/10.2196/19916

14. Gao L, Ren J, Xu L, Ke X, Xiong L, Tian X, Fan C, Yan H, Yuan J. Placental pathology of the third trimester pregnant women from COVID-19. Diagn Pathol. 2021 Jan 14;16(1):8. DOI: https://doi.org/10.1186/s13000-021-01067-6

15. Kazemi SN, Hajikhani B, Didar H, Hosseini SS, Haddadi S, Khalili F, Mirsaeidi M, Nasiri MJ. COVID-19 and cause of pregnancy loss during the pandemic: A systematic review. PLoS One. 2021 Aug 11;16(8):e0255994. DOI: https://doi.org/10.1371/journal.pone.0255994