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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 48-year-old woman exhibited lack of efficacy during treatment with immune globulin for COVID-19.
The woman presented at 28 weeks and 4 days of gestation with twin pregnancy, for symptoms suggestive of COVID-19, and was admitted. Examinations were suggestive of COVID-19 pneumonia and a subsequent PCR test confirmed the diagnosis. She was treated with off label oral
oseltamivir, azithromycin and ceftriaxone, alongside supplemental oxygen therapy. After an obstetrics and gynaecology consult, she was initiated on betamethasone for fetal lung maturity. After 48 hrs, her condition worsened with worsening arterial blood gas parameters. Hence, she was transferred to operating room to undergo an emergency Cesarean section for terminating the pregnancy. She delivered the first baby with an Apgar of 8/10, and the second baby with an Apgar score of 7/10. Examinations of the neonates revealed acidosis and respiratory distress; they were intubated and transferred to the NICU, however, they died 2 days later. After the surgery, the woman was transferred to the ICU with bilevel positive airway pressure. Two days later, her condition deteriorated further and she required invasive mechanical ventilation and intubation. On hospital day 5, she was treated with IV immune globulin, along with plasmapheresis. However, she showed no effect of the therapy. Her condition worsened significantly. She received a series of cardiopulmonary resuscitations, however, she died on day 15 of hospitalisation.
Reference
- Farsani HA, et al. Termination of pregnancy in a twin pregnant patient with COVID-19. Journal of Cellular and Molecular Anesthesia 5: 206-208, No. 3, Jul 2020. Available from: URL: 10.22037/jcma.v5i3.30428 [DOI]