In our study, the most common complication for the mothers who had
confirmed infection in the 3rd trimester was preterm delivery, which
occurred in 7/19 (36.4%) of patients; with a gestation age of 29 weeks
3 days and up to 36 weeks 3 days; Four of these patients were preterm
delivery following preterm pre-labour rupture of membrane (PPROM) prior
to 37 weeks. The other three patients required early delivery with a
gestation age of 30 weeks 4 days to 34 weeks 5 days due to severe
respiratory symptoms.
Two patients had respiratory distress syndrome 2/19 (10.5%), which was
followed by admission to ICU, intubation and ventilation prior to
delivery; and one asthmatic patient developed severe respiratory
symptoms and required early delivery due to fetal growth restriction
following confirmed infection. Antenatal steroids were not administrated
in patients with severe signs of sepsis for the purpose improving
neonatal mortality and morbidity.
Furthermore, pre-eclampsia occurred in 2/19 of patients (10.5%), one of
which progressed to develop coagulopathy accompanied by liver
dysfunction, HELLP and disseminated intravascular coagulation (DIC).
We also had 6/19 (31.6%) of our patients with confirmed COVID-19
infection complaining of reduced fetal movement (RFM), however, fetal
monitoring showed fetal distress in only one of these patients (Table
1).
Amongst 23 confirmed COVID-19 cases with known outcome, there was one
case of maternal death to a 29-year-old Asian lady with a known history
of diabetes. She developed severe infection which was complicated by
diabetic ketoacidosis, right lower lobar pulmonary embolism with
evidence of right heart strain. She was admitted to ICU, intubated and
ventilated. Following ventilation, she had a preterm C-section delivery
at 30 weeks 6 days. Maternal death occurred almost two weeks following
delivery due to basilar artery thrombosis which was confirmed on CT
head.
Out of the 19 pregnant patients who were hospitalised in their 3rd
trimester, the majority had caesarean deliveries 13/19 (68.4%) (Table
1). The indication for C-section varied amongst patients with the
majority being an emergency C-sections 13/16 (81%), and only 3/16
(11.8%) being an elective C-sections and. Indications for C-section
varied (2 fetal distress, 4 failure to progress, 7 maternal
request/PPROM/sepsis) (Table 1).
The clinical characteristics, maternal outcomes of pregnant women with
COVID-19 infection in the second trimester:
We had 4/23 women with confirmed COVID-19 in the second trimester, one
pregnancy to an Asian lady presenting with mild manifestation ended up
with missed miscarriage at 13 weeks. Three women had mild symptoms, and
ΒΌ (25%) had severe sepsis, and was complicated with pyelonephritis.
For all 23 patients, chest radiography showed scattered multiple patchy
infiltrates in both lungs.
Neonatal outcomes of pregnant women with COVID-19 infection:
In total, 20 infants were delivered from 19 pregnant women who tested
positive for COVID-19 (one set of dichorionic diamniotic twins).
The majority of infants 19/20 (95%) had good neonatal outcome with 1
minute Apgar scores of 8 to 9, and 5 minute Apgar scores of 9 to 10. One
infant 1/20 (5%) had an Apgar score at 1 and 5 minutes of 3, and 5
(Table 1). The baby was delivered at 34 weeks 5 days by emergency
C-section under general anaesthetic to black African woman who had
severe COVID-19 symptoms, and was intubated and ventilated. The baby was
resuscitated with positive oxygen pressure using an endotracheal tube,
and admitted to a special care baby unit, however, the infant has been
discharged from hospital with all the test indicators up to standard,
and had good recovery with no serious adverse mother-infant outcomes
have been found.
Four infants 4/19 (21%) with suspected infection were screened for
COVID-19, and were started on broad spectrum antibiotics following
delivery. Indicators for suspected infection included either mildly
raised white cell count, raised inflammatory markers, or temperature.
Neonatal throat swabs and blood samples were tested, all swabs had
negative RT-PCR.
None of the infants presented any symptoms as of 30th April 2020.
In view of the ongoing pregnancy for COVID-19 patients in their 2nd
trimester, no neonatal information is available for these patients.
The compliance in the use of personal protective equipment amongst
healthcare workers when reviewing pregnant women with COVID-19
infection:
All mothers with confirmed COVID-19 infection wore masks, and all
medical staff wore protective suits (including plastic aprons, goggles
and gloves), and surgical masks when reviewing confirmed COVID-19
patients.
PPE was only used in theatre by medical and nursing staff. The infants
were not routinely isolated from their mothers after delivery.
Health care workers did not wear proper PPE when reviewing 80 patients
who presented with suspected COVID-19 infection, out of which 23/80
(28.8%) patients had confirmed infection on nasopharyngeal swabs that
were performed on the same day.