Miscarriage Risk in COVID-19 Infection

Abstract

The COVID-19 outbreak, which has its first reported case in Wuhan City, China, has evolved rapidly and was declared as a pandemic by the World Health Organization on 11 March 2020. The novel coronavirus is known officially as SARS-CoV-2. Genomic analysis revealed that SARS-CoV-2 is phylogenetically related to SARS-like bat viruses; therefore, bats could be the possible primary reservoir. Infected individuals have a broad spectrum of manifestations, ranging from asymptomatic and mild symptoms to severe disease with multiorgan involvement. Symptomatic patients commonly presented with fever, cough, shortness of breath and other non-specific symptoms such as muscle ache, headache, confusion and diarrhoea.The implications of COVID-19 infection during pregnancy remain unclear at this moment. Pregnancy is considered high risk as this population remains vulnerable to coronavirus infection. Till date, data regarding SARS-CoV-2 infection amongst pregnant women, their manifestations and outcomes remain limited. Most pregnancies had good outcomes, and transmission of SARS-CoV-2 to infant was uncommon [1].However, the relationship between SARS-CoV-2 infection and risk of miscarriage remains unclear.Sarawak General Hospital is the only tertiary hospital in southern Sarawak, Malaysia, serving a population of around 2.5 million people. We have in total 465 SARS-CoV-2 RT-PCR confirmed COVID-19 cases which were from 12 March 2020 to 25 May 2020. We use nasopharyngeal and oropharyngeal combined swab (NPS/OPS) to collect the samples for SARS-CoV-2 RT-PCR. Seven of these cases were pregnant women, in which at the time of presentation, 2 were in the first trimester, 3 in the second trimester and another 2 in the third trimester of their pregnancies. Two of the cases who were in their first trimester of pregnancies had miscarriages. At the time of writing, the other 5 cases have no reported adverse pregnancy outcomes, in which one of the cases has undergone an uneventful delivery through caesarean section.We would like to highlight 2 cases of first trimester miscarriage in COVID-19 infected pregnant mothers.The first case involves a 34-year-old Malay lady, who was gravida 5, para 4 at a 10-week period of amenorrhea when she was diagnosed to have COVID-19 infection. She first experienced irregular cramping lower abdominal pain, with per vaginal bleeding, associated with blood clots at a 7-week and 1day period of amenorrhea. Three days later, she started to experience non-productive cough and sore throat, which completely resolved after 2 days. She otherwise did not experience any fever, rhinorrhoea, shortness of breath, arthralgia, myalgia, anosmia, dysgeusia or any gastrointestinal symptoms. Her COVID-19 screening was around 2 weeks after a significant contact history with a colleague with COVID-19 infection, and her NPS/OPS for SARS-CoV-2 RT-PCR was positive.Her blood investigations showed absolute lymphocyte count (ALC) 2.4 × 10 3 /μl, with total white cell (TWC) 11.18 × 10 3 /μl, platelet 397 × 10 3 /μl and haemoglobin (Hb) 13.3 g/d...

Vascular Thrombosis in COVID-19: A Potential Association with Antiphospholipid Antibodies

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“… Cerebral infarction in aPL-vs. multiple aPL+ patients (0 vs. 33%, p 0.02). 38%) had a thrombosis, incl 26. DVT, 4 PE, 1 stroke and 1 extensive venous catheter thrombosis.…”

Death from COVID-19 in a Hispanic postpartum woman and review of the literature

“…18 There is also a certain difficulty in ascribing a miscarriage as a consequence of COVID-19 infection that needs to be considered. 19 The gathering of evidence related to vertical transmission is ongoing, with results appearing to support a low risk. 20 A systematic review and meta-analysis that included 86 studies noted that vertical transmission was biologically plausible but appeared to be rare, 21 while a second reported a low risk of neonatal infection.…”

COVID-19 and cause of pregnancy loss during the pandemic: A systematic review

“…respiratory syndrome coronavirus (MERS-CoV) epidemic revealed higher rates of adverse pregnancy outcomes [27,38,39]. Acute or chronic placental insufficiency resulting in subsequent miscarriage or Intrauterine growth restriction (IUGR) was observed in 40% of maternal MERS-CoV and SARS-CoV [29].…”