WITHDRAWN: Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings

Abstract

This report highlights details on a pregnant case of COVID-19 who unfortunately did not survive. This 27-yearold woman at her 30 and 3/7 weeks' gestation was referred to our center with fever, myalgia, and cough. The laboratory investigations showed leukopenia and lymphopenia as well as increased creatinine and CRP levels. The first chest X-ray (faint bilateral patchy opacities) and CT scan (some faint subpleural ground-glass opacities associated with pleural thickening) were not typical for initial COVID-19 pulmonary infection, however, the treatment for COVID-19 was started. Due to respiratory distress, she was intubated and put under mechanical ventilation. After a while, the fetus was born with Apgar score of 0 and did not react to the neonatal cardiopulmonary resuscitation protocol. Finally, due to deterioration in the clinical and imaging findings, the patient was expired as a result of multi-organ failure. Following the death, autopsy was performed and the histopathologic evaluations of the lungs showed evidence of viral pneumonia (viral cytopathic effect and a mild increase in alveolar wall thickness) and ARDS (hyaline membrane). Also, reverse transcription-polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 infection in the lungs. To our knowledge, this is the first report of maternal death with confirmed COVID-19 infection.

Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies

“…The findings of the case of maternal death reported by Zamaniyan et al, 22 where amniotic fluid and neonatal nasal and throat swabs tested positive for SARS-CoV-2, and the case-report by Alzamora et al, 23 The second case of maternal death that was reported by Karami et al underwent autopsy and histopathologic evaluation of paraffin embedded lung tissue that showed alveolar spaces with focal hyaline membrane, pneumocyte proliferation, and metaplastic changes. 21 There was evidence of viral pneumonia (viral cytopathic effect including All rights reserved. No reuse allowed without permission.…”

“…From the case-reports, two maternal deaths among pregnant women with COVID-19 were reported by Karami et al and Zamaniyan et al from Iran. 21,22 The first case was a 27-year-old 30 weeks pregnant woman who complained of fever, cough, and myalgia for 3 days. Her admission laboratory tests showed leukopenia and thrombocytopenia, accompanied with elevated CRP and lactate dehydrogenase levels [R].…”

Pregnancy and Neonatal Outcomes in SARS-CoV-2 Infection: a systematic review

“…8 Among 13 patients, Y. Liu and colleagues (2020) reported that one patient developed Multi Organ Dysfunction Syndrome (MODS) including Acute Respiratory Distress Syndrome (ARDS). 9 Karami et al (2020) also reported a case of pre-partum respiratory distress, which progressed to multi-organ failure post-partum and unfortunately in the eventual death of the patient and the fetus. 10 Thus, out of 164 pregnant women with SARS-CoV-2, 4 (2.44%) developed respiratory distress.…”

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol

“…There are currently limited data on first trimester or early pregnancy COVID-19 infections. One case from Iran reported poor maternal outcomes at 30-week gestation causing maternal and fetal death (17). Data from Intensive Care National Audit and Research Centre in the UK reported a marginal difference in the rate of current/recent pregnancy amongst all individuals admitted to critical care (2.3%) compared to the reported rate for non-COVID viral pneumonia during 2017-19 (3.3%).…”

“…Data from Intensive Care National Audit and Research Centre in the UK reported a marginal difference in the rate of current/recent pregnancy amongst all individuals admitted to critical care (2.3%) compared to the reported rate for non-COVID viral pneumonia during 2017-19 (3.3%). In one study, 47% (15/32) of pregnant women with COVID-19 infections delivered preterm, another study reported 7/15 women delivered preterm by Cesarean section (17). Cesarean section is the most commonly reported mode of delivery for patients confirmed with COVID-19 (17).…”