Seriously Ill COVID Variant Pregnant Women

"There have never been this many pregnant women in ICU in the history of our country or our province. This is unprecedented."

"It is heartbreaking and terrifying. These are young, otherwise healthy women."

"[COVID-19 critical illness is] a new disease for us. It  hit us like a bullet train."

Dr.Mark Walker, professor of obstetrics, University of Ottawa

"Pregnant women who have COVID-19 appear more likely to develop respiratory complications requiring intensive care than women who aren't pregnant."

"Providing ventilator support in pregnancy is more challenging and the risks are greater to both mother and child."

"[SOGC members are reporting] a wave of daily pregnant women coming into Ontario ICUs, many requiring ventilators. These women are getting extremely sick, very quickly."

Society of Obstetricians and Gynecologists of Canada

 

Dr.Walker is scientific director of BORN (Better Outcomes Registry and Network), based in Ottawa, whose purpose is to improve care for mothers and children through the collection, interpretation and sharing of data relating to maternal and newborn health. Currently the group is involved in gathering information about the COVID-19 situation as it relates to pregnant women, in an effort to better understand it and to be in a position to render aid with their care.

As a high-risk obstetrician and researcher, Dr.Walker speaks of feeling utterly terrified in the face of growing numbers of pregnant women being admitted to intensive-care units across Ontario, as a result of seriously troubling cases of COVID-19. In Toronto, some intensive care units see women representing half, even more, of critically ill COVID-19 patients. And of their numbers, a large percentage have been placed on ventilators, a situation that has become critical in recent weeks.

These are the sickest pregnant women that Dr.Walker -- throughout the course of his career of several decades as an obstetrician -- has ever treated. There is now an urgent call by physicians and national and provincial organizations of obstetricians and gynecologists for pregnant women to be prioritized for vaccines. The situation currently is that unless pregnant women are in other priority groups, there is no move as yet to inoculate them as a demographic in need, against COVID-19.

Pregnancy is listed among at-risk health conditions in Ontario and in that category people are scheduled to receive vaccinations beginning mid-to-late May. While AstraZeneca is available now to people over age 40, that excludes many younger, pregnant women. Women who are pregnant must have a prescription from their physician, under guidance from the National Advisory Committee on Immunization when they do qualify for vaccination.

Unvaccinated, pregnant women with COVID-caused respiratory illness become three times likelier to end up in intensive care, and two times more likely to die, than those women who happen not to be pregnant. Variants, now dominating in Ontario, appear to be associated with greater levels of risk and sickness for women who are pregnant than had occurred with the original variants, points out Dr.Walker.

Growing numbers of women in pregnancy, have become critically ill in the past two weeks, at levels far surpassing the beginning of the pandemic. Rumours of a similar phenomenon had reached the ears of obstetricians and researchers, occurring in the United Kingdom, where the B.1.1.7 variant became the dominant strain. Published data had been unavailable until recently. The medical community in Ontario was taken by surprise at the degree to which the U.K. variant is affecting pregnant women.

"It is not often we run into a situation where we are not sure how to manage", stated Dr.Walker of a situation where experienced specialists are trying -- on the basis of their new and growing familiarity with the situation -- to understand its implications. Women's oxygen-saturation levels are being closely watched because of its impact on the health of both mother and baby. In treatment, some women are being subjected to the technique of proning, widely used during the pandemic where severely ill patients are turned on their stomachs to improve oxygen absorption.

For obvious reasons, the prone position becomes extremely difficult in pregnancy. There are also higher rates of pre-eclampsia in pregnant women infected with COVID-19, a pregnancy complication characterized by high blood pressure and symptoms damaging to organs, most frequently the liver and kidneys. Emergency C-sections are performed in some cases, in an effort to save the baby. Preterm labour is also associated with severe COVID-19-related illness in pregnant women.

These women, in their pregnancy make every effort to avoid close contact with others. Many of the women who are pregnant, however, already have children who have been attending school or daycare, and thus contact at some level is unavoidable.