Maternal oxygenation and fetal-neonatal mortality among patients with COVID-19 requiring advanced respiratory support in ICU: A multicenter prospective cohort study.

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), SOFA (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 < 95% versus SpO >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 <95% versus SpO >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.