A mortal case of coronavirus disease in a pregnant diabetic woman. Clinical case

Abstract

INTRODUСTION The pandemic of coronavirus infection is a novel reality for the obstetrical community. Since pregnancy is known to be associated with the suppressed immune response, the issues of the prevention and treatment of coronavirus disease (COVID-19) are of outstanding importance [1-3]. This infection was found to be involved in the disturbing fetal-maternal immune interaction. Therefore the increased level of pre-eclampsia and preterm birth was reported in pregnant women with COVID-19 [4]. Life-threatening pneumonia with respiratory distress syndrome was found in the majority of fatal cases of COVID-19 [5]. The elevated intraabdominal pressure in pregnancy reduces the motility of diaphragm and lung vital capacity. Severe comorbidity is a serious risk factor for the mortal outcome in COVID-19 [6, 7]. Diabetes mellitus is a systemic disease that impairs immunity and vascular system. Gestational diabetes mellitus (GDM) enhances proinflammatory mechanisms of end-organ lesions. COVID-19 patients were found to have an increased level of Il-6 and C-reactive protein. Thus, pregnant women with GDM are at risk of systemic inflammatory response (SIRS) syndrome and fatal complications of COVID-19 [7]. We report a mortal case of COVID-19 associated with bilateral pneumonia and SIRS syndrome in a pregnant woman with GDM. The study protocol was approved by the Bioethics Committee of the Kharkiv Medical Academy of Postgraduate Education (registration number 0116U002865). CASE PRESENTATION A pregnant woman aged 35 years was admitted to Kocaeli Derince Training and Research Hospital (Kocaeli, Turkey) at 31 weeks of gestation. She complained of dry cough, fever, dizziness for three days. She felt fetal activities. She had blood pressure of 130/80 mm Hg, a pulse of 96 per minute, the rate of respiration of 20 per minute, and a body temperature of 38.2 °C at the time of hospitalization. Woman was obese with body mass index 40 kg/m 2. This pregnancy was 4 th , and two of pregnancies were completed by cesareans. She had regular antenatal visits. GDM was diagnosed at 24 weeks of gestation and insulin injections were started. The uterine tone was normal, palpation of the postcesarean scar was painless, and the cervix was closed. The fetal status was found to be normal via Doppler ultrasound. Computer tomography of the chest was performed. The bilateral pneumonia was diagnosed (Fig.). The tests for COVID-19 were positive. Patient was admitted to the Intensive Care Unit. The majority of laboratory tests were unremarkable (hemoglobin, leukocytes, platelet count, serum aspartate aminotransaminase (AST), serum alanine aminotransaminase (ALT), serum urea, serum creatinine concentration, and coagulation profile were normal). But lymphopenia, hyperglycemia, trace of proteinuria, and ketonuria in urinalysis were detected. C-reactive protein (131.2 mg/l) was considerably elevated, and procalcitonin (0.08 ng/ml) was slightly increased. Therefore, she had a disturbed carbohydrate metabolism and markers of the systemic inflammation. Anti-infla...

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“…Moreover, Oliva et al [ 33 ] outlined that the status of the patient (fever, dyspnea, respiratory status worsening from oxygen saturation as measured by pulse oximetry [SpO 2 ] 95%-92%) improved rapidly post–cesarean delivery (2 hours after delivery SpO 2 to the low 90th percentile on room air, which improved to 100% on 15 L/min of oxygen) and that the cesarean delivery was uncomplicated. Uzel and Lakhno [ 35 ] found leukocytosis (19 × 103/μL) and mild anemia (hemoglobin 10.1 g/dL) in the clinical blood test (n=1 woman). Activated partial thromboplastin time, prothrombin time, and international normalized ratio were prolonged, levels of C-reactive protein (179.7 mg/L) and procalcitonin (0.15 ng/ml) were raised, and low oxygen saturation (75%) was detected.…”

“…The mean Apgar score (1 minute) was 5.9 in 8 newborns [ 29 - 33 , 35 , 36 , 39 ]. In addition, the mean Apgar score (5 minutes) was 7.5 in 17 newborns (including 1 set of triplets) [ 29 - 33 , 35 - 37 , 39 ].…”

“…The mean Apgar score (1 minute) was 5.9 in 8 newborns [ 29 - 33 , 35 , 36 , 39 ]. In addition, the mean Apgar score (5 minutes) was 7.5 in 17 newborns (including 1 set of triplets) [ 29 - 33 , 35 - 37 , 39 ]. The birth weight [ 30 , 32 - 37 , 40 , 41 ] was between 1250 g [ 40 ] (a triplet) and 4165 g [ 32 ], whereas the mean birth weight was approximately 2621.29 g (n=17 newborns).…”

“…Moreover, Oliva et al [ 33 ], Uzel and Lakhno [ 35 ], Majachani et al [ 39 ] and Rabiei et al [ 40 ] noted admissions to the neonatal intensive care unit (NICU) (n=6 newborns). In total, 2 newborns needed supplement oxygen [ 32 , 33 ].…”

“…In total, 2 newborns needed supplement oxygen [ 32 , 33 ]. Additionally, 7 children tested negative for COVID-19 after their births [ 29 , 35 , 36 , 40 , 41 ], and 1 had a positive nasopharyngeal swab after 24 hours. Pulinx et al [ 42 ] reported the death of 2 fetuses (twins).…”