Case Report: Late-Onset Congenital Adrenal Hyperplasia and Acute Covid-19 Infection in a Pregnant Woman: Multidisciplinary Management

Abstract

BackgroundThe impact of the Covid-19 infection on patients with chronic endocrine disease is not fully known. We describe here the first case of a pregnant woman with Covid-19 acute infection and non-classical congenital adrenal hyperplasia (NCAH).Case descriptionA woman at 36 weeks of gestation was referred to our Maternity Hospital for premature rupture of membranes (PROM). Her medical history was positive for NCAH on chronic steroid replacement till the age of 17 years (cortisone acetate and dexamethasone, both in the morning). At admission, her naso-oro-pharyngeal swab resulted positive for SARS-CoV-2. Due to hyperpyrexia and late preterm PROM, cesarean section was planned, and she was started on a 100 mg-bolus of hydrocortisone, followed by continuous infusion of 200 mg/24 h. A female neonate in good clinical condition and with a negative nasopharyngeal Covid-19 swab was delivered. On second postpartum day, the mother was in good condition and was switched to oral steroid therapy. On third postpartum day she worsened, with radiological signs of acute pulmonary embolism. Oro-tracheal intubation and mechanical ventilation were started, and she was switched back to intravenous steroid therapy. On April 30, pulmonary embolism was resolved, and on May 13th she was discharged in good condition.ConclusionsWe report the first case of Covid-19 acute infection that occurred in late-pregnancy in a woman with NCAH on chronic steroid replacement. The management of the patient in a reference center with early involvement of a multidisciplinary team granted prompt care and adequate protection for all the involved sanitary operators.

Impact of Isolation measures on pregnancy outcome during the COVID-19 pandemic

“…The special psychological and physiological changes during pregnancy make this group more susceptible, which will cause harm to the intrauterine growth and development of the fetus, and should be paid attention to. Most of the previous studies on the impact of COVID-19 on pregnant women have focused on case reports, such as passive immunity in COVID-19 patients during pregnancy ( Toner et al, 2020 ); COVID-19 patients with multiple systems inflammatory syndrome during pregnancy ( Gulersen et al, 2021 ) , and vertical transmission of COVID-19 patients during pregnancy ( Sukhikh et al, 2021 ), acute infection and other reports ( Giavoli et al, 2020 ). Studies have also pointed out the analysis of the status of new coronary pneumonia in pregnant women ( Fox and Melka, 2020 ), the clinical manifestations of COVID-19 patients during pregnancy ( Sabharwal et al, 2021 ), and the study of adverse childbirth outcomes ( Sun et al, 2021 ).…”

Premature birth and COVID-19: an integrative review/ Nascimento prematuro e COVID-19: uma revisão integrativa

“…In our analysis, six pregnant women went into spontaneous premature labor 12,14,[16][17][18][19]22 , two had premature rupture of membranes 18,19 and one had a placenta abruption 20 . Three evolved to spontaneous vaginal delivery 13,17,18 and, among them, only one received intrapartum oxytocin 18 .…”

“…Concerning to neonatal mortality, according to Allotey et al 26 , rates are low in women confirmed or suspected for Covid-19, despite of an increased risk of neonatal ICU admission. A total of eleven newborns remained healthy after delivery 6,16,17,19,20,22,24,25 , and of these, there were triplets with a positive nasopharyngeal swab for SARS-CoV-2 16 .…”