A Case of 2019 Novel Coronavirus in a Pregnant Woman With Preterm Delivery
Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery [published online ahead of print, 2020 Feb 28]. Clin Infect Dis. 2020;ciaa200. doi:10.1093/cid/ciaa200
Review written by:
Danya Ziazadeh, edited by Elizabeth Harty
Red - lack of statistical analysis and small sample size (case study of 1 individual).
Researchers at the Soochow University, China, wrote a case study of a 28-year-old pregnant woman with COVID-19 who delivered a healthy baby with no evidence of the disease. Although pregnant women are at high risk of developing infection, it is still unknown whether SARS-CoV-2 viral shedding occurs during the delivery process, or if vertical transmission is possible. Previous studies of patients with SARS noted that SARS-CoV infection could possibly be associated with poor pregnancy outcomes, such as maternal illness, spontaneous abortion, preterm birth, and maternal death.
In this case report, the woman was 30 weeks pregnant and presented to a clinic with fever. Initial throat-swab tests were negative. On her 2nd day at the hospital, chest CT scans displayed left-sided subpleural patchy consolidation and right-sided ground-glass opacities. On her 4th day, sputum tests came back positive for COVID-19. The patient was transferred to the ICU.
Vital signs at ICU admission: 36.2 ºC, blood pressure of 95/64 mm Hg, 92 beats per minute, 22 breaths per minute and oxygen saturation of 97 % with a facial mask at 5 L/min of oxygen.
Laboratory analysis at ICU admission: leukocyte count of 10.60 × 10^9/L, neutrophils of 9.14 × 10^9/L, lymphocytes of 0.86 × 10^9/L, albumin of 24.6 g/L, C-reactive protein of 19.6 mg/L, D-dimer of 840 μg/L, procalcitonin of 0.288 ng/mL, lactate dehydrogenase of 544 U/L, and N-terminal probrain natriuretic peptide of 318 pg/mL. Levels of creatinine and aminotransferase were within normal limits.
After multiple consultations, the patient was noted to be at risk for preterm birth.
Treatment: Arbidol tablets (0.2g PO Q8 hours), lopinavir and ritonavir tablets (400/100 mg PO Q8 hours), cefoperazone sodium and sulbactam sodium (3.0 g IV Q8 hours), and human serum albumin (20 g IV Q24 hours) were initiated; dexamethasone and magnesium sulfate as prophylaxis for the fetus were given; and an emergency cesarean section was prepared.
An emergency cesarean section was performed, and a pre-term male infant was successfully delivered. The procedure was performed in a negative-pressure isolation room and all medical personnel wore protective gear (gown, N95 mask, eye protection and gloves).
The preterm male infant weighted 1.83 kg and had Apgar scores of 9 and 10 at 1 and 5 minutes. He was kept in isolation without any contact with his mother and was given formula instead of breast milk. Samples of amniotic fluid, placenta, umbilical cord blood, gastric juice and throat swabs of the infant were tested for COVID-19and all results were negative. On day 3 after birth, throat swabs and stool samples are still negative for COVID-19.
Follow-up throat-swabs of the mother and the infant were negative and the mother’s chest CT scan demonstrated resolution of infiltrates of both lungs. They had an uneventful postpartum and neonatal course.
The patient had no prior medical history or underlying conditions and had regular prenatal care. Early detection of COVID-19 and late stage of gestation were also deemed to be essential for healthy delivery. Finally, the team handling the delivery took great caution with regard to possible transmission to the infant, including contact, droplet, and airborne precautions. It was further noted that because SARS-CoV-2 may be present in other parts of the body, infection-control protocols during delivery were necessary in order to prevent any possible transmission during delivery.
Single case report