Obstetric and intensive-care strategies in a high-risk pregnancy with critical respiratory failure due to COVID-19: A case report

Kolková, Zuzana; Bjurström, Martin F.; Länsberg, John-Kalle; Švedas, Eimantas; Hamer, Maria Andrada; Hansson, Stefan R.; Herbst, Andreas; Zaigham, Mehreen

doi:10.1016/j.crwh.2020.e00240

Cited by 22 publications

(35 citation statements)

References 11 publications

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“…Similar to previous reports, we observed that the clinical condition of the mother improved rapidly after delivery 24,25 . Blood tests taken from the mother on the day of delivery revealed discreet liver injury.…”

Section: Discussionsupporting

confidence: 91%

Intrauterine SARS-CoV-2 infection – a case confirming transplacental transmission followed by divergence of the viral genome

Zaigham

Holmberg

Karlberg

et al. 2020

Preprint

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Pregnant women and their newborns may be at particular risk for poor outcomes due to the coronavirus (COVID-19) pandemic. Intrauterine SARS-CoV-2 transmission has been suggested but most reports have not ruled out postpartum infection. We demonstrate a confirmed case of transplacental transmission of SARS-CoV-2 in a neonate born to a mother infected in the third trimester. Comprehensive virological, pathological and genetic investigations establish that intrauterine SARS-CoV-2 transmission occurred via the following chain of events; I) maternal viremia in a seemingly mildly symptomatic patient, II) high viral load in the placenta with massive perivillous fibrin deposition, acute intervillositis in areas with strong positivity for SARS-CoV-2 and chorangiosis in the areas less affected by infection and inflammation, III) intrauterine fetal distress with pathological cardiotocography and acidemia in validated umbilical cord blood gases and IV) mild neonatal COVID-19. Whole genome sequencing of isolates from the mother and placenta revealed a single variant of the virus. Interestingly, the neonate displayed a mixed SARS-CoV-2 population, harboring both an identical strain to the mother as well as a population with one single-nucleotide polymorphism difference, indicating intrapatient genetic drift.

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Section: Discussionsupporting

confidence: 91%

Intrauterine SARS-CoV-2 infection – a case confirming transplacental transmission followed by divergence of the viral genome

Zaigham

Holmberg

Karlberg

et al. 2020

Preprint

Self Cite

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“…The pregnant woman can be considered to be more at risk of severe form than the non pregnant woman [ 3 ]. Their fragile immunity and frequent comorbidities such as obesity, diabetes mellitus, arterial hypertension, or cardiovascular diseases may expose them at higher risks of developing severe forms of the disease [ 4 ] and to adverse pregnancy outcomes, especially during the third trimester [ 5 ]. COVID-19 causes pneumonia with acute respiratory distress syndrome (ARDS), which can compromise natural delivery, increase maternal morbidity, or even lead to maternal death [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

A case study of the first pregnant woman with COVID-19 in Bukavu, eastern Democratic Republic of the Congo

Birindwa

Mulumeoderhwa

Nyakio

et al. 2021

matern health, neonatol and perinatol

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Introduction Vertical transmission of covid-19 is possible; its risk factors are worth researching. The placental changes found in pregnant women have a definite impact on the foetus. Case presentation We report a case of a 25-year-old woman, gravida 3, para 2 (2 alive children), with a history of two caesarean deliveries, who was infected by the SARS-CoV-2 during the last term of her pregnancy. She gave birth by caesarean at 34 weeks of gestation to a newborn baby also infected with SARS-CoV-2. The peri-operative observations noted several eruptive lesions in the pelvis, bleeding on contact. Microscopic examination of the foetal appendages revealed thrombotic vasculopathy in the placenta and in the umbilical cord vessels. Conclusion This case is one of the first documented cases of COVID-19 in pregnancy in sub-Saharan Africa. We strongly suggest obstetricians to carefully examine the aspect of the peritoneum, viscera and foetal appendages in affected pregnant women.

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“…Pregnant women are not spared by COVID-19. Although they are not considered as a vulnerable group for COVID-19, their fragile immunity and frequent comorbidities such as obesity, diabetes mellitus, arterial hypertension, or cardiovascular diseases may put them at higher risks of developing severe forms of the disease (3) and to adverse pregnancy outcomes, especially during the third trimester (4). causes pneumonia with acute respiratory distress syndrome (ARDS), which can compromise natural delivery, increase maternal morbidity, or even lead to maternal death (5).…”

Section: Introductionmentioning

confidence: 99%

“…causes pneumonia with acute respiratory distress syndrome (ARDS), which can compromise natural delivery, increase maternal morbidity, or even lead to maternal death (5). Knowledge about coronavirus disease during pregnancy is still limited (4), and vertical transmission in utero is not yet well established (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…There are no established guidelines about the best timing nor the best mode of delivery in COVID-19 infected pregnant women to optimize foetal and maternal well-being (10). While a study on the association between mode of delivery and maternal and neonatal outcomes in COVID-19 patients in Spain, has shown that caesarean section was associated with an increased risk for maternal clinical deterioration which remained signi cant after adjustment for confounders (11), a few case-reports have shown a bene t of a caesarean section on the improvement of respiratory distress in severely affected patients (4,10). Studies Only a few studies investigating the intraoperative ndings in women undergoing caesarean delivery (12), or changes in the foetal appendages that may explain the risk of maternal-foetal transmission (13).…”

Section: Introductionmentioning

confidence: 99%

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A case study of the first pregnant women with COVID-19 in Bukavu, Eastern DR Congo.

Birindwa

Mulumeoderhwa

Nyakio³

et al. 2020

Preprint

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Introduction: Vertical transmission of covid-19 is possible; its risk factors are worth researching. The placental changes found in pregnant women have a definite impact on the foetus.Case presentation: We report a case of a 25-year-old woman, gravida 3, para 2 (2 alive children), with a history of two caesarean deliveries, who was infected by the SARS-Cov-2 during the last term of her pregnancy. She gave birth by caesarean after 34 weeks of gestation to a new-born baby also infected with SARS-Cov-2. The per-operative observations noted several eruptive lesions in the pelvis, bleeding on contact. Microscopic examination of the foetal appendages revealed thrombotic vasculopathy in the placenta and in the umbilical cord vessels.Conclusion: This case is one of the first documented cases of COVID-19 in pregnancy in sub-Saharan Africa. We strongly suggest obstetricians to carefully examine the aspect of the peritoneum, viscera and foetal appendages in affected pregnant women.

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Obstetric and intensive-care strategies in a high-risk pregnancy with critical respiratory failure due to COVID-19: A case report

Cited by 22 publications

References 11 publications

Intrauterine SARS-CoV-2 infection – a case confirming transplacental transmission followed by divergence of the viral genome

Intrauterine SARS-CoV-2 infection – a case confirming transplacental transmission followed by divergence of the viral genome

A case study of the first pregnant woman with COVID-19 in Bukavu, eastern Democratic Republic of the Congo

A case study of the first pregnant women with COVID-19 in Bukavu, Eastern DR Congo.

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Obstetric and intensive-care strategies in a high-risk pregnancy with critical respiratory failure due to COVID-19: A case report

Cited by 22 publications

References 11 publications

Intrauterine SARS-CoV-2 infection – a case confirming transplacental&nbsp;transmission followed by divergence of the viral genome

Intrauterine SARS-CoV-2 infection – a case confirming transplacental&nbsp;transmission followed by divergence of the viral genome

A case study of the first pregnant woman with COVID-19 in Bukavu, eastern Democratic Republic of the Congo

A case study of the first pregnant women with COVID-19 in Bukavu,&nbsp;Eastern DR Congo.

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Product

Resources

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Intrauterine SARS-CoV-2 infection – a case confirming transplacental transmission followed by divergence of the viral genome

Intrauterine SARS-CoV-2 infection – a case confirming transplacental transmission followed by divergence of the viral genome

A case study of the first pregnant women with COVID-19 in Bukavu, Eastern DR Congo.