Discussion
This case report highlights evidence of severe outcomes of COVID-19
infection on the mother and infant. We describe lessons pertaining to
the early management of pregnant women with COVID-19 infection. Pregnant
women are susceptible to COVID-19, and are therefore likely experience
severe adverse pregnancy outcomes. Pregnant women have a highly
sensitive inflammatory response to viral respiratory infection.
Infections during pregnancy rapidly progresses, especially in the middle
and late stages of pregnancy, rendering pregnant women more likely to
develop complications or even severe cases. This points to high risk of
serious damage to the mother and/or infant. Thus, timely and appropriate
management is crucial for pregnant women with COVID-19 infection.
For pregnant women suspected of COVID-19 infection, immediate chest CT
examination is recommended before nucleic acid testing is performed.
This is because chest CT examination can effectively perform early
detection and evaluation of lung injury, which are early symptoms of
COVID-19 pneumonia.6 Notably, this should be performed
after obtaining the patient’s sufficient informed consent and
implemented under necessary radiation protection measures for pregnant
women.
Managing pregnant women in the context of COVID-19 epidemic remains
extremely complex and challenging.4 Given that viral
pneumonia in pregnancy cause complications with potential to rapidly
deteriorate, it is recommended that pregnant patients be isolated in a
designated unit and co-managed by anti-infection teams, obstetrics, ICU
and other related departments. Although treatments of COVID-19 pneumonia
are similar for pregnant and
non-pregnant patients, the
condition of fetus should be carefully and closely monitored, as the
clinical signs and symptoms may worsen along disease progression. In
case the healthy condition of the pregnant woman becomes critical, her
life should always be given priority, and possible termination of
pregnancy should be considered. In this report case, the patient showed
progressive decline in blood oxygen, and hypoxemia seemed difficult to
correct even with progressive increase in oxygen therapy support. Her
anoxic state improved after timely cesarean section. However, the sharp
decrease in blood oxygen concentration due to severe maternal
respiratory complication resulted in acute fetal hypoxia leading to
neonatal death. (see Supplementary material, Table S2)
Laboratory tests performed at admission revealed leukopenia and
lymphopenia. However, the number and proportion of lymphocytes decreased
sharply as the disease progressed. This implies that lymphocytopenia is
a prominent feature of critically ill patients with COVID-19 infection,
and may reflect the severity of this disease.7 Other
biochemical markers that were increased include serum levels of
procalcitonin, IL-6 and serum amyloid A and thus may also indicate
severity of COVID-19 infection. It worth noting that these inflammatory
biomarkers are non-specific, thus they should be applied with caution
when assessing pregnant patients with COVID-19. Given the lack of large
cohorts of pregnant women with COVID-19 infection, we believe that
lessons learnt from the present case are useful in guiding future
management of such women.