Michika Hamada¹, Youichi Yanagawa^1,, Satomi Tanaka², Hiromichi Ohasaka¹, Kei Jitsuiki¹, Kouhei Ishikawa¹

A 35-year-old pregnant woman (gestational age, 35 weeks) developed general fatigue, headache, and joint pain following the onset fever, cough, and nasal discharge after the outbreak of the Omicron variant in Japan. The patient had obesity (body mass index, 41), depression and gestational diabetes mellitus, which was treated with insulin. On the 8th day after the onset of initial flu-like symptoms, she was admitted to our hospital because polymerase chain reaction for COVID-19 became positive. Initially, her vital signs were stable without any oxygen demand. On day 11, she required oxygen therapy (4 L/min). Chest computed tomography (CT) showed multiple bilateral centrilobular patch consolidations with several subpleural lesions. As she had multiple risk factors for acute respiratory distress syndrome (ARDS), she underwent emergency cesarean section and immune modulation therapy was initiated. After the operation, her oxygenation deteriorated and she underwent tracheal intubation and mechanical ventilation on day 13. After multimodal therapy, her lung function improved and she was extubated on day 16. After rehabilitation and baby care training, she was discharged on day 27 without sequelae. This is the case of a pregnant woman with severe COVID-19 pneumonia who was successfully treated by emergency cesarean section, intensive immune suppression therapy and mechanical ventilation during the Omicron variant outbreak in Japan. The present case suggests that even pregnant women should receive COVID-19 vaccination to avoid the onset of ARDS, a potentially fatal condition.

COVID-19, omicron variant, steroid pulse, pregnant