The efficacy of high dose IVIG, convalescent plasma combination, and dexmedetomidine in severe COVID ARDS during pregnancy: A retrospective case series

Abstract

Objective

Physiological and immunological changes during pregnancy may cause COVID-19 infection to progress more severely. This study presents the potential protective effect of the combination of intravenous immunoglobulin (IVIG) and convalescent plasma (CP) in preventing intubation in three pregnant patients who developed severe COVID-19-associated acute respiratory distress syndrome (CARDS).

Methods

During the early phase of the pandemic (2020–2021), three pregnant patients at the threshold of intubation were treated with high-dose IVIG (0.4 g/kg/day) and two doses of CP administered 48 h apart. All patients also received nasal high-flow oxygen (HFNC), low-molecular-weight heparin, antibiotics, and dexamethasone. Patients with severe back and chest pain received a short-term (24-hour) dexmedetomidine infusion to control anxiety and improve positional oxygenation. Patients were monitored for fetal well-being using NST and Doppler ultrasound.

Results

None of the cases required intubation and all were discharged from the intensive care unit. No serious side effects were observed except for transient and isolated troponin elevation associated with IVIG treatment. All mothers delivered healthy babies, and the neurodevelopmental follow-up of the infants was uneventful for 36 months.

Conclusion

This case series demonstrates that the combination of IVIG and convalescent plasma in pregnant women with severe CARDS may reduce the need for intubation and improve maternal and fetal outcomes. Additionally, the role of dexmedetomidine infusion in reducing the risk of intubation by facilitating positional oxygenation is noteworthy. Our findings may serve as a guide in similar clinical scenarios during future pandemics.