Coronavirus disease 2019 (COVID-19) manifestations during pregnancy in all three trimesters: A case series

Abstract

Background: Coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the susceptibility amongst different groups of the population. Pregnant women are one such group. This study was conducted to investigate the effect of COVID-19 on pregnancy and maternal/neonatal outcomes.
 Case presentation: This case series was conducted on 16 pregnant women with COVID-19 from March 21 to May 11, 2020. Clinical characteristics, pregnancy complications, medication used, maternal/neonatal outcomes, and fatality rate were investigated through this study. The mean age of the patients was 30.06 yrs. Patients from all three trimesters were included (1 in first, 5 in second, and 10 in the third trimesters). The most common clinical symptoms were shortness of breath (n = 10), dry cough (n = 10), myalgia (n = 8), and chills (n = 7). Also, three cases had papulosquamous skin lesions with fissuring. The most common laboratory results were leukocytosis (n = 8), increased liver enzymes (n = 6), elevated CRP (n = 5), and thrombocytopenia (n = 4). There was one case of maternal mortality, five of premature labor pain (PLP), two of preeclampsia, and two of placenta accreta. Twelve pregnancies were terminated (nine cesarean sections, three vaginal deliveries). Among neonates, we had 6 cases of preterm labor. All neonates had negative PCR results.
 Conclusion: Clinical manifestations and paraclinical results were similar to nonpregnant patients. There was no evidence of vertical transmission. PLP and premature rupture of membranes (PROM) were the most common complications in the second and third trimesters of pregnant COVID-19 women, which can lead to rupture of the uterus. Termination and delivery should be planned individually.
 Key words: Pregnancy, COVID-19, Maternal-fetal infection transmission, Vertical transmission of infectious disease, Papulosquamous skin diseases.

Achados clínicos maternos por infecção do sars-cov-2 na gestação: uma revisão integrativa

“…Enquanto que, as mulheres grávidas de risco habitual sem comorbidades ao adquirir a infecção algumas eram hospitalizadas por problemas respiratórios leves, já outras com condições subjacentes como diabetes gestacional, préeclâmpsia, ou com estado clínico identificado por tomografia computadorizada a pneumonia com quadro grave, necessitando de internação na UTI e até levando a interrupção prematura da gravidez, um caso de uma gestante evoluiu para choque séptico e está foi a óbito (Sattari et al, 2020;Askary et al, 2021). Em muitos estudos observou-se um dado sobre as gestantes com o desenvolvimento da placenta prévia e placenta acreta, essas características de anexo embrionário geralmente o curso das grávidas terminava em aborto espontâneo (Wang et al, 2020;Wastnedge et al, 2021).…”

The Misattributed and Silent Causes of Poor COVID-19 Outcomes Among Pregnant Women

“…It was claimed that increased rates of certain pregnancy complications among SARS-Cov-2 infected women are observed only in symptomatic COVID-19 (33). Those include higher rates of complications to the fetus and/or mother, mainly in the third trimester [88% of pregnancy complications occur in the third trimester, compared to 9 and 3% in the second and first trimesters, respectively (28)], such as premature rupture of membranes, placenta accreta, premature labor, preeclampsia, cesarean section, fetal distress and perinatal death (32)(33)(34)(35)(36)(37)(38). In addition, these pregnant women are at increased risk of severe maternal morbidity (39), specifically the need for hospitalization, intensive care units admission (28,40), and the need of mechanical respiratory support/invasive ventilation/extracorporeal membrane oxygenation (37,(39)(40)(41), and even maternal death (32,42).…”

“…Pro-inflammatory cytokine interleukin-6 (IL-6) and C-reactive protein (CRP) are biomarkers associated with the COVID-19 progression, severity and mortality ( 51 ). Elevated IL-6 ( 52 , 53 ) and CRP ( 36 , 37 , 54 ) circulating levels are closely related to COVID-19 disease severity, and were shown to be higher also among pregnant women ( 55 ) and to predict a need for mechanical ventilation among COVID-19 patients ( 56 ). It is possible that the SARS-CoV-2-induced cytokine storm may result in a more severe inflammatory state mainly in third trimester pregnant women, as they are already in a pro-inflammatory state, which is required for preparation toward childbirth ( 57 ).…”

Empfehlungen zu SARS-CoV-2/COVID-19 in Schwangerschaft, Geburt und Wochenbett – Update November 2021 (Langfassung)

“…Tröpfchenübertragung zustandekommen. Kohorten und Fallserien beschreiben zumeist keine Hinweise für Fälle vertikaler Transmission [296][297][298]. Eine Untersuchung an Plazenta-und Kürettage-Materialproben erbrachten keine Hinweise auf eine vertikale Übertragung von SARS-CoV-2 in der Frühschwangerschaft [299].…”

“…verbunden ist [336]. Die CT ist dabei besser als das Röntgenbild des Thorax zur Diagnostik geeignet [297]. Die Verwendung von Lungenultraschall wurde als prädiktiver für eine SARS-CoV-2-Infektion erachtet als die ausschließliche Verwendung der Symptomatik [337].…”