Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

Abstract

Background Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. Findings All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8-9 and a 5-min Apgar score of 9-10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus.Interpretation The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy.

Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children

“…Therefore, there is no doubt that the CT study did a big favor in structuring the clinical treatment strategy for the pregnant women as we hoped. Fortunately, the infants were all normal without any evidence of vertical transmission from women with COVID-19 pneumonia in late pregnancy, which was consistent with the prior research by Chen et al 16 While compared between the two pregnant groups, the consolidation were more frequent in the clinically-diagnosed group with a relatively higher TSS of 4 ·8 (SD 3 ·5), indicating relatively more severe lung involvement resulting from delayed treatment prior to a laboratory confirmation. Cases with initial negative RT-PCR for SARS-CoV-2 but high clinical suspicion were also reported in previous studies, and the SARS-CoV-2 was positive after repeated tests.…”

Novel coronavirus infection and pregnancy

“…In the study by Chen et al 9 , of nine pregnant women with COVID-19 in the third trimester, no fetal death, neonatal death or neonatal asphyxia was observed 9 . In the study by Chen et al 9 , of nine pregnant women with COVID-19 in the third trimester, no fetal death, neonatal death or neonatal asphyxia was observed 9 .…”

“…In 2009, pregnant women accounted for 1% of patients infected with influenza A subtype H1N1 virus, but they accounted for 5% of all H1N1-related deaths 6 . Chen et al 9 reported the clinical characteristics of nine pregnant women with laboratory-confirmed COVID-19 in the third trimester, which comprised mainly fever and cough. Interestingly, the impact of COVID-19 infection on pregnant women appears to be less severe.…”

“…It has been reported that the youngest patient with COVID-19 infection was diagnosed 36 h after birth 9 . It is unclear whether, for the safety of both baby and healthcare professionals, a pregnant woman with COVID-19 infection should be allowed to deliver vaginally, which can be a rather long process.…”

Experience of different upper respiratory tract sampling strategies for detection of COVID-19

“…To analyze the positive rates of throat swabs and lingual swabs to detect COVID-19, we conducted a cohort study of two groups of suspected patients at two COVID-19 fixed-point hospitals (Wuhan No.7 Hospital and Zhongnan Hospital of Wuhan University). Zhongnan Hospital is one of the largest hospitals in the area, and has admitted a large number of COVID-19 patients 3,4 . Two groups of consented patients were sampled using both sampling methods; all swabs were tested using a real-time reverse transcription-polymerase chain reaction (RT-PCR) assay for SARS-CoV-2.…”