Maternal oxygenation and fetal-neonatal mortality among patients with COVID-19 requiring advanced respiratory support in ICU: A multicenter prospective cohort study.
Daniela N Vasquez, Roberto Giannoni, Adriana Salvatierra, Karina Cisneros, Diego Lafosse, María F Escobar, Martín Montenegro, Paula Juárez, Lucía Visani, Verónica Mandich, Erika Barrozo, Mariana Kirschbaum, Andrea V Das Neves, María F Valenti, María C Canseco, Ignacio Romero, Pedro Macharé, Ana K Marquez, Eva Rodriguez, Cristina Palacio, Laura Rapela, José M Amillategui Scenna, Rosshanna Nuñez, Sebastián Torres, Miguel A González, Lorena Franconieri, Daniela Nasner, Patricia Okurzaty, Gustavo A Plotnikow, Alfredo D Intile
{"title":"Maternal oxygenation and fetal-neonatal mortality among patients with COVID-19 requiring advanced respiratory support in ICU: A multicenter prospective cohort study.","authors":"Daniela N Vasquez, Roberto Giannoni, Adriana Salvatierra, Karina Cisneros, Diego Lafosse, María F Escobar, Martín Montenegro, Paula Juárez, Lucía Visani, Verónica Mandich, Erika Barrozo, Mariana Kirschbaum, Andrea V Das Neves, María F Valenti, María C Canseco, Ignacio Romero, Pedro Macharé, Ana K Marquez, Eva Rodriguez, Cristina Palacio, Laura Rapela, José M Amillategui Scenna, Rosshanna Nuñez, Sebastián Torres, Miguel A González, Lorena Franconieri, Daniela Nasner, Patricia Okurzaty, Gustavo A Plotnikow, Alfredo D Intile","doi":"10.1002/ijgo.16046","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To explore the association of maternal characteristics, oxygenation, and mechanical ventilatory parameters with fetal and neonatal outcomes.</p><p><strong>Methods: </strong>The present study was a multicenter, binational (Argentina/Colombia), prospective, cohort study, conducted in 21 intensive care units (ICUs) and including pregnant or postpartum patients with COVID-19 pneumonia requiring advanced respiratory support and their fetuses/neonates. Advanced respiratory support was defined as high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV).</p><p><strong>Results: </strong>A total of 91 patients were admitted to 21 ICUs: 63 (69%) antepartum and 28 (31%) postpartum. Among those admitted antepartum (63), delivery was induced in 43 (68.3%), being the reasons mostly maternal (28/43; 65.1%). Of 71 births, 64 (90%) were preterm. A total of 14 fetal/neonatal losses (14/91;15.4%) occurred. The main differences between patients whose fetuses/neonates survived versus those who did not survive were in APACHE II (12 [7-15] vs. 16.5 [14-20]; P = 0.003), SOFA<sub>24</sub> (4 [3-5] vs. 6.5 [5-8]; P = 0.001), gestational age at delivery (32.9 ± 3 vs. 27.6 ± 6.2; P = 0.014), acute respiratory distress syndrome (54 [70.1%] vs. 14 [100%]; P = 0.011), septic shock (26 [33.8%] vs. 9 [64.3%]; P = 0.031), IMV (55 [71.4%] vs. 14 [100%]; P = 0.019) and plateau pressure before delivery (23 [21-26] vs. 28 [27-30]; P = 0.019). The incidence of fetal/neonatal mortality among 47 pregnant patients requiring IMV with SpO<sub>2</sub> < 95% versus SpO<sub>2</sub> >95% before intubation was 12/35 (34.28%) versus 1/12 (8.33%), respectively; P = 0.163. The incidence of fetal/neonatal mortality among those with SpO<sub>2</sub> <95% versus SpO<sub>2</sub> >95% before delivery was 5/18 (27.77%) versus 8/29 (25.58%), respectively; P = 0.999.</p><p><strong>Conclusion: </strong>The vast majority of births were preterm. Among patients admitted antepartum, most deliveries were induced for maternal reasons. Fetal/neonatal losses were associated with gestational age at delivery, maternal severity of illness on admission and certain ventilatory parameters but not with maternal oxygenation, as is commonly the focus in these patients.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Gynecology & Obstetrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ijgo.16046","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To explore the association of maternal characteristics, oxygenation, and mechanical ventilatory parameters with fetal and neonatal outcomes.
Methods: The present study was a multicenter, binational (Argentina/Colombia), prospective, cohort study, conducted in 21 intensive care units (ICUs) and including pregnant or postpartum patients with COVID-19 pneumonia requiring advanced respiratory support and their fetuses/neonates. Advanced respiratory support was defined as high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV).
Results: A total of 91 patients were admitted to 21 ICUs: 63 (69%) antepartum and 28 (31%) postpartum. Among those admitted antepartum (63), delivery was induced in 43 (68.3%), being the reasons mostly maternal (28/43; 65.1%). Of 71 births, 64 (90%) were preterm. A total of 14 fetal/neonatal losses (14/91;15.4%) occurred. The main differences between patients whose fetuses/neonates survived versus those who did not survive were in APACHE II (12 [7-15] vs. 16.5 [14-20]; P = 0.003), SOFA24 (4 [3-5] vs. 6.5 [5-8]; P = 0.001), gestational age at delivery (32.9 ± 3 vs. 27.6 ± 6.2; P = 0.014), acute respiratory distress syndrome (54 [70.1%] vs. 14 [100%]; P = 0.011), septic shock (26 [33.8%] vs. 9 [64.3%]; P = 0.031), IMV (55 [71.4%] vs. 14 [100%]; P = 0.019) and plateau pressure before delivery (23 [21-26] vs. 28 [27-30]; P = 0.019). The incidence of fetal/neonatal mortality among 47 pregnant patients requiring IMV with SpO2 < 95% versus SpO2 >95% before intubation was 12/35 (34.28%) versus 1/12 (8.33%), respectively; P = 0.163. The incidence of fetal/neonatal mortality among those with SpO2 <95% versus SpO2 >95% before delivery was 5/18 (27.77%) versus 8/29 (25.58%), respectively; P = 0.999.
Conclusion: The vast majority of births were preterm. Among patients admitted antepartum, most deliveries were induced for maternal reasons. Fetal/neonatal losses were associated with gestational age at delivery, maternal severity of illness on admission and certain ventilatory parameters but not with maternal oxygenation, as is commonly the focus in these patients.
期刊介绍：
The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
