Second-Trimester Miscarriage in a Pregnant Woman With SARS-C
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A 28-year-old obese, primigravida woman presented at 19 weeks’ gestation with fever, myalgia, fatigue, mild pain with swallowing, diarrhea, and dry cough for 2 days. A nasopharyngeal swab was positive for SARS-CoV-2. She was given oral acetaminophen and discharged home.

Two days later, she presented with severe uterine contractions, fever, and no improvement of her symptoms. Physical examination did not reveal any signs of pneumonia. Vaginal examination demonstrated bulging membranes through a 5-cm dilated cervix. Active fetal movements; fetal tachycardia (180/min); and normal fetal morphology, growth, and amniotic fluid were detected on ultrasound. Prophylactic amoxicillin–clavulanic acid and regional anesthesia were started. The patient wore a mask throughout her labor, as did 2 health care professionals who both tested negative for SARS-CoV-2. Amniotic fluid and vaginal swabs sampled during labor tested negative for SARS-CoV-2 and bacterial infection (Table).

A stillborn infant was delivered vaginally after 10 hours of labor. Swabs from the axillae, mouth, meconium, and fetal blood obtained within minutes of birth tested negative for SARS-CoV-2 and bacterial infection. Fetal autopsy showed no malformations, and fetal lung, liver, and thymus biopsies were negative for SARS-CoV-2.

Within minutes of placental expulsion, the fetal surface of the placenta was disinfected and incised with a sterile scalpel, and 2 swabs and biopsies (close to the umbilical cord and peripheral margin) were obtained. All were negative for bacterial infection but were positive for SARS-CoV-2. At 24 hours, the placenta remained positive for SARS-CoV-2. At 48 hours, maternal blood, urine, and vaginal swab were all negative for SARS-CoV-2, whereas a nasopharyngeal swab remained positive. Placental histology demonstrated mixed inflammatory infiltrates composed of neutrophils and monocytes in the subchorial space and unspecific increased intervillous fibrin deposition (Figure). Funisitis (inflammation of the umbilical cord connective tissue suggesting fetal inflammatory response) was also present. Gram and periodic acid–Schiff staining of the placenta, PCR, and culture did not identify any bacterial or fungal infections.

Source: https://jamanetwork.com/journals/jama/fullarticle/2765616
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