Case report
A 36-year old woman, para 3, and pregnant in gestational week 26+5 presented to the Emergency Department with shortness of breath and vomiting. She tested positive for SARS-CoV-2 by a pharyngeal swab and was admitted. She was a non-smoker, obese, and treated with Levothyroxine for hypothyroidism.
She had previously contacted the antenatal ward with vaginal bleeding in gestational week 24+5, and again at 25+1 with bleeding, in addition to headache, shortness of breath, and calf tenderness. Deep vein thrombosis of the left femoral vein was confirmed by ultrasound, and she started treatment with daily injections of Tinzaparin. The vaginal bleeding was from a varicose vein in the left labium minus. She had a negative pharyngeal swab for SARS-CoV-2 and as symptoms improved shortly thereafter she was discharged.
Eleven days later (26+5) she contacted the Emergency Department due to coughing, shortness of breath, and vomiting and was subsequently admitted to the Department of Cardiology, where she tested positive for SARS-CoV-2 in a pharyngeal swab. Her respiration rate was 22 breaths per minute, pulse 130 per minute, saturation of 97% without oxygen, and a temperature of 37.6 degrees Celsius. The following day (26+6) the obstetrician was asked for a consult and decided to do a vaginal swab for SARS-CoV-2, in case of need for urgent delivery. During admission there were normal fetal movements, a normal cardiotocography, and no signs of preeclampsia. Two vaginal swabs both came back positive. Cycle threshold values for all swabs can be seen in Table 1. Temperature had increased to 38.0 degrees Celsius, but as pulse decreased to 87 per minute and saturation increased to 99%, and there were no signs of severe COVID-19 infection or pulmonary embolism, she was discharged from the Department of Cardiology to recuperate at home. A couple of days thereafter, her partner and daughter tested positive for SARS-CoV-2. The patient had had coitus three or four days prior to testing positive for SARS-CoV-2 in the vaginal swab. A serum antibody test (VITROS Anti-SARS-CoV-2 total serology assay by Ortho Clinical Diagnostics) performed at week 26+6 gestation was negative for SARS-CoV-2 antibodies.
We followed up with the patient, with complete remission of symptoms in gestational week 28+0. A repeat pharyngeal swab in gestational week 29+0 was still positive but two vaginal swabs were negative. However, the serum antibody test had turned positive. In week 32+0 both pharyngeal and vaginal swabs were negative and serum antibody test still positive. The patient was clinically well with no signs of preeclampsia and with normal biophysical profile and growth of the fetus.