We read with great interest a recent article published in the Journal of Infection, entitled "unfavorable outcome in pregnant patients with COVID-19 by Wenhui Huang et al. 1 The authors analyzed the impact of COVID-19 on pregnancy with severe maternal and neonatal complications. We hereby report a case of miscarriage during the first trimester due to SARS-CoV-2 infection in Pakistan. A pregnant lady in her first trimester who has miscarriage was selected for the present study. Written consent was obtained from the patient before evaluation. The demographic, clinical and laboratory findings were collected from the patient medical record. Nasopharyngeal swab was tested for confirmation of COVID-19 RNA using real-time RT-PCR. Blood sample was screened for other viruses, bacteria and for the analysis of hematological and biochemical markers. The study was approved by the internal review board of National Institute of Health, Islamabad. A 30 years old woman, with no any previous medical history, was presented at 10 weeks and 6 days of gestation to the emergency department of a tertiary care hospital in Rawalpindi with history of fever, dry cough, headache, body pain, sore throat, chest pain and loss of smell and taste. She was provisionaly diagnosed as COVID-19 patient by the attending physician. Laboratory investigations were performed on nasopharyngeal specimen and tested positive for SARS-CoV-2 on June 4, 2020. The patient went into home isolation after confirmation of COVID-19 infection. The attended physician prescribed paracetamol thrice a day for one week. Within 4 to 5 days, the patient recovered with complete absence of fever and body pain. Three days later, she was again presented at the hospital with severe abdominal pain, diarrhea and dry cough. The attending physician prescribed antibiotic (Cefixime 400 mg along with Metronidazole 400 mg for 5 days) and recommended to continue the home isolation. On June 18, 2020 she was presented to the gynaecology department, with severe uterine contraction, persistent cough and minor vaginal bleeding. The results of ultrasound scan showed no urinary bladder lesion or any other abnormality, however the inflammation in the placenta was noted during the scan. She had undergone miscarriage on the same day and re-admitted at the hospital. On the very next day, the patient condition got stable and was discharged from the hospital. Patient nasopharyngeal swabs screened for other respiratory viruses remained negative. Likwise, her blood sample tested for salmonella, toxoplasma, dengue, hepatitis B, hepatitis C, cytomegalovirus (CMV) and rubella virus to rule out other causes of miscarriage turned negative for the above mentioned pathogens.
