Considerations on COVID-19 pregnancy: a cases series during outbreak in Bergamo Province, North Italy

Abstract

Background: COVID-19 has rapidly spread worldwide, with severe complications affecting particularly elderly and compromised subjects. Less information about COVID-19 in pregnancy has been reported so far in the literature. Methods: Case series on pregnancies complicated by COVID-19. All cases were diagnosed at Bolognini Hospital, Seriate, Italy. These cases are presented to clarify the features of COVID-19 occurring in pregnancy. Results: Four women had symptoms of COVID-19 during pregnancy or immediately after delivery. All cases were confirmed by oropharyngeal swab. All patients presented with fever and low saturation levels at the diagnosis. One case was transferred after diagnosis to a tertiary referral center and delivered the day after for worsening clinical conditions. In the other three cases, bilateral pneumonia was documented at the admission. Antithrombotic therapy was used in most cases. No cases of the infected neonate was reported. At 2 month follow-up, all patients were alive, three were asymptomatic while one presented neurological complication. One more case was described because suspicious for COVID-19, however, it was not confirmed by oropharyngeal swab. Conclusions: In pregnant women, the peripheral nervous system could be affected. No case of trans-placental passage was reported. The swab could be helpful in diagnosis. The antithrombotic therapy could play a role in the positive course of COVID-19 also in pregnant women.

A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection

“…In total, the studies reported findings from 325 women whose pregnancy outcome was known following SARS-CoV-2 infection, seven of which were twin pregnancies [ 25 , [31] , [32] , [33] , [34] , [35] ], six pregnancies were terminated (one for maternal health reasons [ 18 ], one for personal reasons [ 19 ], three for “personal choice” [ 21 ] and one where the reason was unclear [ 17 ]). Of the remaining pregnancies, 83 births (58%) were by Caesarean section and no information was provided in 16 cases.…”

“…# cases only included if specified as spontaneous preterm birth. Maternal Medical Condition Number of women Percentage of total cases examined (%) References Gestational diabetes 7 2 [ 19 , 20 , 28 , 33 , 60 ] Pre-existing diabetes 2 0.6 [ 21 , 57 ] Hypertensive disorders of pregnancy 18 5 [ 18 , 19 , 21 , 24 , 25 , 28 , 31 , 53 , 60 ] Obstetric cholestasis 1 0.3 [ 28 ] Acute cholecystitis 1 0.3 [ 52 ] Cardiovascular disease 1 0.3 [ 21 ] Metabolic acidosis 1 0.3 [ 51 ] Respiratory failure 2 0.6 [ 24 , 25 ] Preterm prelabour rupture of membrane …”

“…Four women were admitted for delivery, but it is unclear when they were diagnosed [ 31 , 51 ]. Seven women were diagnosed postnatally [ 33 , 37 , 42 , 52 ]; although one woman's swab tested negative, the CT scan indicated that she had COVID-19 [ 52 ]. The timing of diagnosis was unclear for 85 women.…”

“…Corticosteroids were administered to a total of 43 women (in 15 reports) [ 16 , 17 , 19 , 20 , 32 , 33 , [37] , [38] , [39] , 41 , 45 , 46 , 49 , 51 , 53 ]. Four studies reported that the corticosteroids were primarily given for prophylaxis against fetal lung disease [ 32 , 38 , 49 , 51 ].…”

“…There were six terminations of pregnancy including one at 22 weeks' gestation [ 18 ]. In another case the outcome of the pregnancy was unclear [ 17 ] Two infants were described as small-for-gestational-age (SGA), but no definition was provided [ 31 ], three infants had FGR or SGA, but no definitions were provided [ 24 ] and 11 birthweights were recorded as <2500 g, with no comment on whether the weights were appropriate for gestational age [ 19 , 21 , 32 , 33 ]. The birthweight of 5 stillborn infants were provided: 1070 g, 329 g, 2895 g, 680 g, and 1430 g at 28, 21, 38, 23 and 30 weeks’ gestation, respectively [ 30 ].…”