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Risk factors and outcomes of critically ill pregnant COVID-19 patients: Experience from the first and second waves of the pandemic Cover

Risk factors and outcomes of critically ill pregnant COVID-19 patients: Experience from the first and second waves of the pandemic

The Journal of Critical Care Medicine
Volume 11 (2025): Issue 1 (January 2025)
By: ,  ,  ,  ,   and    
Open Access
|Jan 2025
Figures & tables

Figures & Tables

Table 1.

Criteria of adult COVID-19 severity classification according to the Indonesian COVID-19 Management Guidelines

Severity LevelCriteria
MildNo evidence of pneumonia or hypoxia.
Symptoms are limited to fever, cough, fatigue, anorexia, shortness of breath, myalgia, and/or other non-specific
symptoms such as sore throat, nasal congestion, headache, diarrhea, nausea and vomiting, anosmia, or ageusia.
SpO2 > 95% on room air.
ModerateClinical signs of pneumonia (fever, cough, dyspnea, tachypnea) with no sign of severe pneumonia.
SpO2 ≥ 93% on room air.
SevereClinical signs of pneumonia (fever, cough, dyspnea, tachypnea) with at least one of the following: Respiratory rate > 30 breaths per minute, severe respiratory distress, and/or SpO2 < 93% on room air.
CriticalPatients with acute respiratory distress syndrome, sepsis and septic shock, or other conditions requiring external life support such as mechanical ventilation or vasopressor therapy.

[i] SpO2, Peripheral oxygen saturation

Table 2.

Baseline characteristics of maternal COVID-19 patients in ICU

Improvement (N=11)Death (N=8)
Age (years)34±534±30.911
Gestational age (weeks)30 (22–41)32 (5–38)0.901
Pregnancy status at admission1.000
Pregnant8 (61.5%)5 (38.5%)
Post delivery3 (50%)3 (50%)
COVID-19 severity0.048
Mild2 (100%)0 (0%)
Severe7 (77.8%)2 (22.2%)
Critical2 (25%)6 (75%)
Length of stay (days)9 (1–31)10 (2–13)0.901
Comorbidities
  Nasopharyngeal cancer0.421
Yes0 (0%)1 (100%)
No11 (61.1%)7 (38.9%)
  Congestive heart failure0.546
Yes1 (33.3%)2 (66.7%)
No10 (62.5%)6 (37.5%)
  Coronary artery disease0.421
Yes0 (0%)1 (100%)
No11 (61.1%)7 (38.9%)
  Chronic hypertension0.421
Yes0 (0%)1 (100%)
No11 (61.1%)7 (38.9%)
  Obesity0.164
Yes0 (0%)2 (100%)
No11 (64.7%)6 (35.3%)
  Asthma1.000
Yes1 (100%)0 (0%)
No10 (55.6%)8 (44.4%)
  Type-2 diabetes mellitus1.000
Yes2 (66.7%)1 (33.3%)
No9 (56.2%)7 (43.4%)
  Tuberculous lymphadenitis1.000
Yes1 (100%)0 (0%)
No10 (55.6%)8 (44.4%)

[i] Data are n (%), mean ± standard deviation, and median (minimum-maximum). COVID-19, coronavirus disease 2019

Table 3.

Associations of complications with admission to ICU

General ward (N= 94)ICU (N= 19)
Acute kidney injury0.003
Yes1 (20%)4 (80%)
No93 (86.1%)15 (13.9%)
Liver injury<0.001
Yes0 (0%)5 (100%)
No94 (87.0%)14 (13.0%)
Sepsis0.001
Yes0 (0%)4 (100%)
No94 (86.2%)15 (13.8%)
Gestational hypertension0.033
Yes2 (40%)3 (60%)
No92 (85.2%)16 (14.8%)
Preeclampsia0.526
Yes3 (75%)1 (25%)
No91 (83.5%)18 (16.5%)
Eclampsia1.000
Yes1 (100%)0 (0%)
No93 (83.0%)19 (17.0%)

[i] ICU, intensive care unit

Table 4.

The Association between Comorbidities and Outcomes

Improvement (N=11)Death (N=8)
At least 115 (78.9%)4 (21.1%)0.026
None90 (95.7%)4 (4.3%)
Table 5.

Oxygenation support in the ICU

Improvement (N = 11)Death (N = 8)
Baseline Respiratory Status
Oxygenation therapy at ICU admission0.014
  Simple mask2 (100%)0 (0%)N/A
  Non-rebreathing mask0 (0%)1 (100%)N/A
  HFNC7 (70%)3 (30%)N/A
  NIV2 (100%)0 (0%)N/A
  Ventilator0 (0%)4 (100%)N/A
Oxygen saturation levels at admission to the hospital95.45±3.0582.63±12.99N/A0.027
Chest X-ray0.013
  Bilateral infiltrate >50%4 (33.3%)8 (66.7%)N/A
  Bilateral infiltrate <50%7 (100%)0 (0%)N/A
Mechanical Ventilation
  NIV (N = 8)3 (37.5%)5 (62.5%)0.516 (0.916–1.353)0.181
  Invasive ventilators (N= 9)1 (11.1%)8 (88.9%)N/A<0.001
Intubation timing<0.001
  ER admission0 (0%)4 (100%)N/A
  Day 1–2 in ICU1 (50%)1 (50%)N/A
  ≥ Day 3 in ICU0 (0%)3 (100%)N/A
Days on ventilator support76.63+3.02N/AN/A
Pneumothorax on ventilator0 (0%)1(100%)N/A0.421
Prone positioning1.000
  Yes4 (57.1%)3 (42.9%)0.952 (0.144–6.281)
  No7 (58.3%)5 (41.7%)1.000

[i] Data are n (%), mean ± standard deviation, and median (minimum-maximum). ICU, intensive care unit; HFNC, high-flow nasal cannula; NIV, non-invasive ventilation; ER, emergency room

Table 6.

Hemodynamic status in the ICU

VariablesOutcomesOR (95% CI)P value
Improvement (N = 11)Death (N = 8)
Hemodynamic status
Arterial line inserted0.633
Yes6 (50%)6 (50%)0.400 (0.055–2.933)
No5 (71.4%)2 (28.6%)1.000
Echocardiography (N = 13)
Dimension1.000
Abnormal4 (44.4%)5 (55.6%)0.800 (0.076–8.474)
Normal2 (50%)2 (50%)1.000
Ejection fraction1.000
<55%0 (0%)1 (100%)N/A
≥55%6 (50%)6 (50%)N/A
TAPSE (N=11)N/A
≤1600
>165 (45.5%)6 (54.5%)
Diastolic dysfunction1.000
Yes1 (33.3%)2 (66.7%)0.500 (0.034–7.452)
No5 (50%)5 (50%)1.000
Valve abnormality (N=12)1.000
Yes4 (44.4%)5 (55.6%)0.800 (0.076–8.474)
No1 (33.3%)2 (66.7%)1.000
Pericardial effusion1.000
Yes0 (0%)1 (100%)N/A
No6 (50%)6 (50%)N/A
Any vasopressor0.003
Yes3 (27.3%)8 (72.7%)N/A
No8 (100%)0 (0%)N/A
Any antiarrhythmic0.005
Yes2 (22.2%)7 (77.8%)0.032 (0.002–0.426)
No9 (90%)1 (10%)1.000

[i] TAPSE, tricuspid annular plane systolic excursion

Table 7.

Laboratory findings on patients' clinical outcomes

Improvement (N = 11)Death (N = 8)
Haemoglobin12.0 – 15.0 g/dL1.4 – 2.0 g/dL decrease10.10±1.549.63±1.840.549
Leukocytes4.0 – 10.0 x 103/μL3.5 x 103/μL increase13.51 (5.20–46.34)33.03 (6.17–67.30)0.032
Thrombocytes150 – 410 x 103/μLSlight decrease248.74±149.46210.00±149.570.584
D-Dimer< 500.0 ng/mL130 – 170 ng/mL3107.46±2021.334248.74±2705.490.320
C-reactive protein<5.0 mg/L0.4 – 8.1 mg/L83.71±67.60148.03±40.380.031
Procalcitonin<0.05 ng/mL-0.20 (0.20–0.74)0.70 (0.20–7.13)0.074
SGOT0 – 31 U/L-36.00 (17.00–230.00)63.00 (37.00–309.00)0.028
SGPT0 – 31 U/L-36.50 (12.00–230.00)31.00 (22.00–379.00)0.770
Albumin3.2 – 4.6 g/dL1 g/dL decrease3.31±0.533.08±0.330.434
Urea15 –40 mg/dL50% decrease22.00 (12.00–141.00)66.00 (14.00–243.00)0.126
Serum creatinine0.50 –1.00 mg/dL-0.57 (0.41–1.38)1.12 (0.56–7.99)0.026
Arterial blood gas
pH7.350 – 7.450-7.36±0.107.13±0.170.019
pO275.00 – 100.00-80.70 (56.00–268.00)68.25 (57.50–118.40)0.307
pCO235.00 – 45.0025.00 – 33.0038.70±9.0659.67±13.530.007
P/F Ratio>300-127.09 (70–382.86)68.25 (57.50–118.40)0.006

[i] Data are n (%), mean ± standard deviation, and median (minimum-maximum). Pregnancy effects listed were for third-trimester changes if there were differences between the trimesters. Reference: Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians https://www.openanesthesia.org/keywords/pregnancy_laboratory_measurements/

Table 8.

Treatments in the ICU

Improvement (N = 11)Death (N = 8)
Kidney replacement0.031
  Hemodialysis0 (0%)2 (100%)N/A
  CRRT0 (0%)2 (100%)N/A
  No11 (73.3%)4 (26.7%)N/A
Any analgetic-sedation<0.001
  None given8 (100%)0 (0%)N/A
  1–3 medications3 (60%)2 (40%)N/A
  >3 medications0 (0%)6 (100%)N/A
Antiviral0.444
  Remdesivir10 (58.8%)7 (41.2%)N/A
  Remdesivir and Oseltamivir0 (0%)1 (100%)N/A
Corticosteroid0.251
  Dexamethasone7 (63.6%)4 (36.4%)N/A
  Methylprednisolone0 (0%)3 (100%)N/A
  Both2 (66.7%)1 (33.3%)N/A
Anticoagulant0.546
  Yes10 (62.5%)6 (37.5%)3.333 (0.246–45.109)
  No1 (33.3%)2 (66.7%)1.000
Tocilizumab (Actemra)0.319
  Yes2 (33.3%)4 (66.7%)0.222 (0.028–1.754)
  No9 (69.2%)4 (30.8%)1.000
Intravenous immunoglobulin0.421
  Yes0 (0%)1 (100%)N/A
  No11 (61.1%)7 (28.9%)N/A
Convalescent plasma0.319
  Yes2 (33.3%)4 (66.7%)0.222 (0.028–1.754)
  No9 (69.2%)4 (30.8%)1.000

[i] CRRT, continuous renal replacement therapy

DOI: https://doi.org/10.2478/jccm-2025-0008 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Journal RSS Feed
Language: English
Page range: 54 - 63
Submitted on: May 28, 2024
Accepted on: Jan 20, 2025
Published on: Jan 31, 2025
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
COVID-19,
ICU,
maternal outcomes,
pregnancy
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2025 Dita Aditianingsih, Noor Hafidz, Aino Nindya Auerkari, Zarah Tin Cahyaningrum, El Nissi Leonard, Chrisella Annabelle, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 11 (2025): Issue 1 (January 2025)
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