COVID-19 in Pregnancy

What do we know about COVID-19 in Pregnancy?

Key points:

From small case series on COVID-19 in pregnancy, maternal, fetal, and neonatal outcomes were good in those with mild infections [1]

Yu et al. (2020) reported a series where all patients had mild symptoms (small number of patients) and no ICU admissions

Juusela et al. (2020) reported 2 cases of cardiomyopathy in COVID-19 pregnant patients, viral myocarditis and cardiomyopathy have been reported in non-pregnant COVID-19 patients, not enough is know whether there is an increased risk of cardiomyopathy in pregnancy [2]

Breslin et al (2020) reported 2 pregnant patients with COVID-19, though asymptomatic at presentation, ultimately required unplanned ICU admission for COVID-19 respiratory complications [3]

Characteristics of COVID-19 presented in the same way in pregnancy as in non-pregnant patients, including no symptoms in early stages [1, 3]

However there is still no reliable evidence recommends any specific COVID-19 treatment for pregnant women [1]

WHO guidance does not recommend the use of corticosteroids for COVID-19 [4,5]



Yu et. al. (2020) reported their series of 7 patients from Wuhan, who were diagnosed with COVID-19 during pregnancy. Their average gestation was 39 weeks plus 1 day (range 37 weeks to 41 weeks plus 2 days) at admission.

Maternal presenting symptoms of COVID-19: Average incubation time = 5 days (range 2–9 days)

1) Fever (86%)

2) Cough (14%)

3) Shortness of breath/ breathing difficulty (14%)

4) Gastrointestinal symptoms (14%)

All 7 patients had a C-section delivery, decision made by the multidisciplinary team
Maternal outcomes were good with no intensive care admissions


Adopted the following discharge criteria for postpartum patients:

Normal body temperature >3 days
Improved respiratory symptoms
Chest imaging showing significant improvement in acute exudative lesions
Negative nucleic acid test of respiratory specimens such (sputum and nasopharyngeal swabs) twice in a role when sampled >24h apart

Image Source: Yu et. al. (2020)
Chest CT of 4 pregnant patients admitted with COVID-19, showing bilateral large areas of multiple ground-glass opacities or patchy shadow with an uneven density

References:

1, Nan Yu, Wei Li, Qingling Kang, Zhi Xiong, Shaoshuai Wang, Xingguang Lin, Yanyan Liu, Juan Xiao, Haiyi Liu, Dongrui Deng, Suhua Chen, Wanjiang Zeng, Ling Feng, Jianli Wu (2020), Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study, The Lancet Infectious Diseases, https://doi.org/10.1016/S1473-3099(20)30176-6

2, Juusela A, Nazir M, Gimovsky M, Two Cases of COVID-19 Related Cardiomyopathy in Pregnancy., American Journal of Obstetrics & Gynecology MFM (2020), doi: https:// doi.org/10.1016/j.ajogmf.2020.100113

3, Breslin N, Baptiste C, Miller R, Fuchs K, Goffman D, Gyamfi-Bannerman C, D’Alton M, COVID-19 in pregnancy: early lessons, American Journal of Obstetrics & Gynecology MFM (2020), doi: https://doi.org/10.1016/j.ajogmf.2020.100111

4. WHO (2020), Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance. URL: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf (accessed 6/4/2020)

5.WHO (2020), Novel coronavirus—China. URL: http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/ (accessed 6/4/2020)

Comments

Thank you that was very useful and reassurring to me as a obstetrician

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