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Askary, E., Tahereh, P., Shiravani, Z., Ali Ashraf, M., Hashemi, A., Naseri, R., Moradialamdarloo, S., Karimi, Z., Izanloo, E., & Sadat Najib, F. (2021). Coronavirus disease 2019 (COVID-19) manifestations during pregnancy in all three trimesters: A case series. International Journal of Reproductive BioMedicine (IJRM), 19(2), 191–204. https://doi.org/10.18502/ijrm.v19i2.8477
https://doi.org/10.18502/ijrm.v19i2.8477
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- Cited by 5 articles
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Elham Askary
Elham Askary
Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Poordast Tahereh
Poordast Tahereh
Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Zahra Shiravani
Zahra Shiravani
Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Mohammad Ali Ashraf
Mohammad Ali Ashraf
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Atefeh Hashemi
Atefeh Hashemi
Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Razieh Naseri
Razieh Naseri
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Shaghayegh Moradialamdarloo
Shaghayegh Moradialamdarloo
Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Zinat Karimi
Zinat Karimi
Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Elham Izanloo
Elham Izanloo
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Fatemeh Sadat Najib
Fatemeh Sadat Najib
Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Published Date
- Feb 21, 2021
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.
References
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[22] Wu J, Liu J, Zhao X, Liu Ch, Wang W, Wang D, et al. Clinical characteristics of imported cases of coronavirus disease 2019 (COVID-19) in Jiangsu Province: A multicenter descriptive study. Clin Infect Dis 2020; 71: 706–712.
[23] Guan WJ, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in china. New England Journal of Medicine 2020; 382: 1708–1720.
[24] Lapinsky S. Management of acute respiratory failure in pregnancy. Semin Respir Crit Care Med 2017; 38: 201–207.
[25] Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RTPCR. Radiology 2020; 296: e115–e117.
[26] Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time Course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020; 295: 715–721.
[27] Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; 296: E32–E40.
[28] Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18: 844–847.
[29] Yang Y, Yang M, Yuan J, Wang F, Wang Zh, Li J, et al. Laboratory diagnosis and monitoring the viral shedding of SARS-CoV-2 Infection. The Innovation 2020; 1: 100061: 1– 7.
[30] Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A, et al. Myocardial localization of coronavirus in COVID−19 cardiogenic shock. Eur J Heart Fail 2020; 22: 911–915.
[31] Berri F, Rimmelzwaan GF, Hanss M, Albina E, Foucault- Grunenwald M, Lê VB, et al. Plasminogen controls inflammation and pathogenesis of influenza virus infections via fibrinolysis. PLoS Pathog 2013; 9: e1003229.
[32] Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14: 72–73.
[33] Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020; 30: 269–271.
[2] Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020; 91: 157–160.
[3] Silasi M, Cardenas I, Kwon J, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. American Journal of Reproductive Immunology 2015; 73: 199–213.
[4] Somerville LK, Basile K, Dwyer DE, Kok J. The impact of influenza virus infection in pregnancy. Future Microbiol 2018; 13: 263–274.
[5] Yang H, Wang C, Poon LC. Novel coronavirus infection and pregnancy. Ultrasound Obstet Gynecol 2020; 55: 435– 437.
[6] Schwartz DA, Graham AL. Potential maternal and infant outcomes from coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human coronavirus infections. Viruses 2020; 12: 194.
[7] Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191: 292–297.
[8] Lam CM, Wong SF, Leung TN, Chow KM, Yu WC, Wong TY, et al. A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome. Br J Obstet Gynecol 2004; 111: 771–774.
[9] Zhang JP, Wang YH, Chen LN, Zhang R, Xie YF. Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome. Zhonghua fu chan ke za zhi 2003 38: 516–520.
[10] Maxwell C, McGeer A, Tai KF, Sermer M. No. 225- management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory Syndrome (SARS). J Obstet Gynaecol Can 2017; 39: e130–e137.
[11] Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle east respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect 2019; 52: 501–503.
[12] Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet 2020; 395: 809–815.
[13] Yu N, Li W, Kang Q, Xiong Zh, Wang Sh, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: A retrospective, single-centre, descriptive study. Lancet Infect Dis 2020; 20: 559–564.
[14] Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019- nCoV pneumonia. Translational Pediatrics. 2020; 9: 51– 60.
[15] Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; 71: 844–846.
[16] Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in hubei province. Zhonghua fu chan ke za zhi 2020; 55: 166–171.
[17] World Health Organziations. Coronavirus disease 2019 (COVID-2019): Situation report–54. Geneva. World Health Organization March 2020 [cited June 16, 2020]. Available at: https://reliefweb.int/report/china/coronavirus-disease -2019-covid-19-situation-report-54-14-march-2020.
[18] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in wuhan, China. JAMA 2020; 323: 1061–1069.
[19] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
[20] Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382: 1199–1207.
[21] Lansbury LE, Rodrigo Ch, Leonardi-Bee J, Nguyen-Van- Tam J, Lim W. Corticosteroids as adjunctive therapy in the treatment of influenza. An updated cochrane systematic review and meta-analysis. Crit Care Med 2020; 48: e98– e106.
[22] Wu J, Liu J, Zhao X, Liu Ch, Wang W, Wang D, et al. Clinical characteristics of imported cases of coronavirus disease 2019 (COVID-19) in Jiangsu Province: A multicenter descriptive study. Clin Infect Dis 2020; 71: 706–712.
[23] Guan WJ, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in china. New England Journal of Medicine 2020; 382: 1708–1720.
[24] Lapinsky S. Management of acute respiratory failure in pregnancy. Semin Respir Crit Care Med 2017; 38: 201–207.
[25] Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RTPCR. Radiology 2020; 296: e115–e117.
[26] Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time Course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020; 295: 715–721.
[27] Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; 296: E32–E40.
[28] Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18: 844–847.
[29] Yang Y, Yang M, Yuan J, Wang F, Wang Zh, Li J, et al. Laboratory diagnosis and monitoring the viral shedding of SARS-CoV-2 Infection. The Innovation 2020; 1: 100061: 1– 7.
[30] Tavazzi G, Pellegrini C, Maurelli M, Belliato M, Sciutti F, Bottazzi A, et al. Myocardial localization of coronavirus in COVID−19 cardiogenic shock. Eur J Heart Fail 2020; 22: 911–915.
[31] Berri F, Rimmelzwaan GF, Hanss M, Albina E, Foucault- Grunenwald M, Lê VB, et al. Plasminogen controls inflammation and pathogenesis of influenza virus infections via fibrinolysis. PLoS Pathog 2013; 9: e1003229.
[32] Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14: 72–73.
[33] Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020; 30: 269–271.