COVID-19 nedeniyle maternal ölüm: Tedavi sırasında herhangi bir değişiklik oldu mu? Olgu sunumu

Maternal death due to COVID-19: is there anything that changed during the treatment? A case report

Resul KARAKUŞ, Ebru ÇÖĞENDEZ, Semra KAYATAŞ, Pınar KUMRU, Fırat ORTAK, Neslihan BAŞKILIÇ

Özet

Amaç: COVID-19 nedeniyle maternal ölüm gerçekleflen olgumuzu, gebelik s›ras›nda COVID-19 yönetimindeki stratejilerimizi ve epideminin farkl› dönemlerindeki de¤iflen stratejileri de¤erlendirmek amac›yla sunmaktay›z. Olgu: Hastam›z 35 yafl›nda, gravida 2, parite 1 ve gebeli¤in 28. haftas›nda fliddetli kuru öksürük, respiratuvar distres, atefl, abdominal a¤r› ve kusma flikayetleri eflli¤inde COVID-19 flüphesiyle hastanemizin acil servisine ilk kez baflvurdu. Do¤umhaneye al›nan hastan›n oksijen ihtiyac› saatler içinde artt›¤›ndan ve oksijen satürasyonu %60 azald›¤›ndan, olgu hastaneye yat›fl›ndan 21 saat sonra entübe edildi ve ikinci seviye yetiflkin yo¤un bak›m ünitesine yat› r›ld›. Entübasyondan 1 saat sonra fetal distresin ortaya ç›kmas› üzerine hasta acil sezaryene al›nd›. Hasta, operasyondan dört gün sonra transfer edildi¤i hastanenin üçüncü seviye yo¤um bak›m ünitesinde kardiyopulmoner arrest nedeniyle kaybedildi. Sonuç: Olgumuz, COVID-19’un gebelerde ciddi sonuçlar› olabilece¤ ini, erken tan› ve tedavinin önemini, hastal›¤›n ilerlemesi durumunda klinik yönetimin güçlüklerini ve son olarak maternal ve neonatal sonuçlar›n y›k›c› olabilece¤ini göstermektedir.

Abstract

Objective: We present a case of maternal death due to COVID-19 and aimed to review our COVID-19 management strategies during pregnancy and changing strategies at different times of the epidemic through the present case. Case: Our patient was 35 years old, gravida 2, parity 1, 28 weeks pregnant, who admitted to the emergency service of our hospital for the first time with the complaints of severe dry cough, respiratory distress, fever, abdominal pain and vomiting, with suspected COVID-19. She was admitted to the delivery room. As the oxygen need increased within hours and the oxygen saturation decreased to 60%, the patient was intubated 21 hours after hospitalization and was admitted to our second level adult intensive care unit. Due to the development of fetal distress 1 hour after intubation, the patient was taken to emergency cesarean section. Four days after the operation, the patient died due to cardiopulmonary arrest in the 3rd level intensive care unit of the hospital where she was transferred. Conclusion: This report demonstrates that COVID-19 can be severe in a pregnant woman, that the importance of early diagnosis and treatment, the difficulties of clinical management in case of progression of the disease, and ultimately, the maternal and neonatal consequences can be devastating.