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).