COVID-19 during pregnancy
Following the WHO interim guidance criteria, three cases were diagnosed
with COVID-19: Case A was 24 weeks (+3), while Case B was 26 weeks (+1)
when they were diagnosed with COVID-19. They had no chronic disease.
Both presented with fever, fatigue, and dry cough. The descriptions are
listed in Table 1. Case A had respiratory distress and dyspnoea; Case B
presented with stuffy nose and respiratory distress. Case C had no
dyspnoea. All three cases had moderate anaemia. Case B had lymphopenia
(0.54 G/L), leukopenia (3.21 G/L), and neutropenia (1.65 G/L). Case C
presented with moderate leukopenia. Cases A, B, and C had elevated
C-reactive protein and IL-6 (Case A:CRP 6.9ng/L, IL-6 67.98 pg/ml,Case B
CRP 31.88mg/L, IL-6 not available; Case C: CRP 26.8 ng/L, 7.49 pg/ml);
and had decreased albumin and total protein (TP). Case A (TP 55.8 g/L,
ALB 27.9 g/L , ALT 510 U/L, AST 246U/L) , Case B (TP 57.1 g/L, ALB:31.4
g/L, AST 21 U/L, ALT 14 U/L) , Case C: (TP: 57.6 g/L, ALB:31.4 g/L, ALT
38U/L, AST 104U/L). Case A and C had positive nucleic acid tests. Case B
had two consecutive negative nucleic acid tests, however, she presented
with viral pneumonia. On readmission after 70 days, SARS-CoV-2 IgG was
positive confirming previous COVID-19 infection. Case A had a severe
type of infection and was admitted for 12 days. Case B and C were normal
type infections and were treated for 6 days and 10 days, respectively.
According to chest CT imaging, they all had viral pneumonia. CT imaging
of Case A showed multiple, membranous, ground-glass-patterns or dense
shadows surrounding the parenchyma of both lungs. The pulmonary lesions
showed resolution post-treatment. Case B and C show similar chest CT
findings (Fig. 1).
All cases received oxygen therapy using a nasal catheter. Case A had
severe dyspnoea, fatigue, and desaturations (SPO2 90%
on room air). Case B and C had moderate distress (SPO295-96%) (Table 1).
Case A received antiviral treatment, interferon (Recombinant human
interferon a-2b 5 million IU daily), atomisation inhalation for 7 days,
oral umifenovir tablets (200 mg three times daily for 7 days), and
azithromycin (0.25g bid for 3 days). Polyene phosphatidyl choline (458
mg thrice daily) and reduced glutathione (1.8 g daily) were used to
decrease the ALT and AST for 7 days. All cases were given antibiotic
treatment (Table 2.) They were discharged improved and stable. CT scan
showed resolution of pulmonary lesions, and the SARS-CoV-2 throat swab
showed two consecutive negative results. After discharge, Case A and C
were prescribed oral liver supplements and was quarantined for 14 days.
Repeat antibody testing before delivery showed positive serum IgG and
negative IgM antibodies in all three cases (see Table 2).