Clinical course of COVID‐19 in Pregnancy
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The published literature to date indicates that pregnant women may be more vulnerable to COVID-19. The disease may be associated with an increased risk of premature rupture of membranes, preterm delivery, fetal tachycardia, and fetal distress. Lymphocytopenia and elevated C-reactive protein (CRP) levels were observed in the majority of the COVID-19 pregnant women. A recently published systematic review suggested that there is a higher risk of severe maternal morbidity and perinatal death associated with COVID-19 infection, although maternal-fetal transmission was not detected. The aim of this study is to report clinical experience in the management of pregnant women infected with Severe Acute Respiratory Syndrome Coronavirus 2 during the first thirty days of the Coronavirus disease pandemic.

A total of 60 pregnant women were diagnosed with COVID‐19. The most common symptoms were fever and cough (75.5%, each) followed by dyspnea. Forty‐one patients required hospital admission of whom 21 patients underwent pharmacological treatment, including hydroxychloroquine, antivirals, antibiotics and tocilizumab. Lymphopenia (50%), thrombocytopenia (25%), and elevated C‐reactive protein (CRP) (59%) were observed in the early stages of the disease. Median CRP, D‐dimer and the neutrophil/lymphocyte ratio were elevated. High CRP and D‐dimer levels were the parameters most frequently associated with severe pneumonia. The Neutrophil/lymphocyte ratio was found to be the most sensitive marker for disease improvement. During the study period, 18 of the women delivered vaginally. All newborns tested negative for SARS‐CoV‐2 and none of them were infected during breastfeeding. No SARS‐CoV‐2 was detected in placental tissue.

Most of the pregnant COVID‐19 positive patients had a favorable clinical course. However, one‐third of them developed pneumonia, of whom 5% presented a critical clinical status. CRP and D‐dimer levels positively correlated with severe pneumonia and the neutrophil/lymphocyte ratio decreased as the patients improved clinically. Seventy‐eight percent of patients had a vaginal delivery. No vertical or horizontal transmissions were diagnosed in the neonates during labor or breastfeeding.