ADRS due to COVID-19 in midterm pregnancy: successful management with plasma transfusion and corticosteroids

Background: Management of acute respiratory distress syndrome (ARDS) in pregnant women infected with new severe acute respiratory syndrome Corona virus 2 (SARS-CoV₂) is a challenging clinical task.

Case: A 30- year-old woman (gravid 3, parity 2) presented at her 21 and 2/7 weeks gestation (pre pregnancy BMI: 36.1 kg/m²), with ARDS caused by SARS-CoV₂ infection. She received lopinavir/ritonavir and azithromycin as well as early methyl prednisolone therapy. Given the persistent hypoxemia despite oxygen therapy via non rebreather face mask (FiO₂:80%), convalescent plasma transfusion was administered that led to a mild clinical improvement as well as decrease in inflammatory markers. Growth of her fetus assessed by obstetric sonography was normal during hospital stay.

Conclusion: Judicious corticosteroid therapy along with convalescent plasma transfusion to suppress viremia and cytokine storm can lead to favorable outcome in the pregnant women with ARDS caused by SARS-CoV₂ infection without superimposed bacterial infection.

Keywords: Pregnancy; SARS-CoV2; acute respiratory distress syndrome; convalescent plasma transfusion; corticosteroid.