COVID-19 infection in first trimester of pregnancy marked by a liver cytolysis in a woman previously treated by hydroxychloroquine for repeated implantation failure: a case report

Abstract

Background In December 2019, a new disease (COVID-19) caused by a novel coronavirus called SARS-CoV-2 emerged in China and spread to many other countries. There is only limited data about the clinical features of COVID-19 during pregnancy, especially in first trimester. Case presentation We report a COVID-19 infection in a 35 years-old patient in first trimester of pregnancy and its consequent medical care. At 7 weeks of pregnancy, the patient, who did not have any pregestational comorbidities, complained of intense nausea and asthenia. An important liver cytolysis was discovered with biological perturbations of transaminases levels. No respiratory symptoms were recorded. Classical viral aetiologies and drug-related toxicity were discarded. Because of the aggravation of the symptoms and the occurrence of the breathlessness, the patient was tested for the COVID-19 in a nasopharyngeal swab. The RTq-PCR assay indicated the presence of SARS-CoV-2 RNA. In the absence of severe symptoms, the patient was monitored at home according to the French government guidelines. After a few days, the symptoms resolved without any complications. The pregnancy is still ongoing without any visible sequelae on the foetus so far. Conclusions This first case illustrated the difficulty of COVID-19 diagnosis in patients with isolated digestive symptoms in first trimester of pregnancy that could be confused with gravida hyperemesis. Monitoring of pregnancy after an episode of COVID-19 should be strengthened with bimonthly foetal growth ultrasounds and doppler assessments because of the risks for intrauterine growth restriction. Comprehensive data on larger numbers of first trimester gravid women with COVID-19 are required to better understanding the overall impact of SARS-CoV-2 on maternal and birth outcomes.

Contracting COVID-19 in the first and second trimester of pregnancy: what we know – a concise qualitative systematic review

“…Only a portion of the studies (9) reported some sort of complication during the span of pregnancy which pertained to 15 patients [ 22 – 27 , 37 , 39 , 40 ]. Disseminated intravascular coagulation (DIC) (20%; 3/15), preeclampsia (13%; 2/15), as well as liver cytolysis, chorioamnionitis, ARDS, hyperemesis gravidarum, pneumothorax and gestational diabetes (each observed in 1/15 of the reported patients) were the most commonly observed complications.…”

“…Out of 223 neonates, the outcomes of 60 infants (31/60: maternal infection during 1 st trimester and 29/60: 2 nd trimester infections) from 20 studies were specified as deceased/terminated, miscarriage, alive/delivered, or still ongoing pregnancy [ 17 , 22 – 33 , 36 , 37 , 39 – 43 ]. While the majority of 1 st trimester infection neonates had a reported status of ongoing pregnancy ( n = 24/31: 77.4%), 4/31 (12.9%) reported miscarriages, 1/31 (3.2%) abortion, 1 (3.2%) stillbirth and 1 (3.2%) chemical pregnancy were also noted.…”

“…Other methodological limitations include short follow-up, with a majority being less than 1 month. Nine studies were of women with still ongoing pregnancy [ 23 , 27 – 30 , 32 , 39 , 41 , 42 ], and only 3 studies had recorded the complete term of pregnancy [ 31 , 37 , 40 ]. Pregnancy-related complications were under-reported, with 9/24 studies mentioning incidence of any complications [ 22 – 27 , 37 , 39 , 40 ].…”

“…Nine studies were of women with still ongoing pregnancy [ 23 , 27 – 30 , 32 , 39 , 41 , 42 ], and only 3 studies had recorded the complete term of pregnancy [ 31 , 37 , 40 ]. Pregnancy-related complications were under-reported, with 9/24 studies mentioning incidence of any complications [ 22 – 27 , 37 , 39 , 40 ]. Overall limited data were available, as 15 studies reported ≤ 2 patients [ 23 , 24 , 26 , 27 , 30 – 34 , 36 , 37 , 39 – 42 ].…”

Impacts of Covid-19 Pandemic on the Early Trimester Pregnancies

“…More specifically, due to the virus's novelty and recent spread, there is a scarcity of data on maternal and perinatal outcomes when the infection occurs in the early trimester of pregnancy. The CDC's frequent report emphasized adverse effects of COVID-19 on pregnancy and prevails on more extensive research to be carried out [14]. Evaluating the liaison of the early gestational trimesters of pregnancy is critical in COVID-19 for an effective counseling and provides vital intuition into pandemic may influence the future pregnancy.…”