Severe COVID-19 in a pregnant patient
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A 35 year old woman at 34 weeks of pregnancy was admitted to hospital with clear vaginal fluid discharge that had been ongoing for 3 hours. Labor occurred spontaneously that day and a healthy female neonate was delivered that tested negative for SARS -CoV-2 on throat swab.

The patient presented with a persistent low fever and dry cough 1 day later. Laboratory investigations showed increased neutrophil ratio, reduced lymphocyte count, and increased C-reactive protein levels. Throat swabs from the patient tested positive for SARS-CoV-2 by real time RT-PCR assays. Chest CT scan showed multiple infiltrations of different sizes in both lungs. The patient had no history of comorbidities. She was treated with antibiotics and hormones and administered oxygen through a nasal catheter. The patient experienced dyspnea and cyanosis on the following day. Given her critical condition, she was transferred to the intensive care unit (ICU) for further treatment. After transfer to the ICU she quickly developed severe acute respiratory distress syndrome. CT scan showed a density shadow and large scale ground-glass opacity in both lungs. Tracheal intubation (supine) was given, and relevant drugs were used.

The patient’s condition significantly improved after 11 days. Tracheal intubation was removed and replaced by a noninvasive ventilator, and she was transferred to the general ward for treatment. During treatment, the patient developed second-degree bedsores, which gradually improved by regularly turning the patient over and use of an air mattress.

The present case describes a pregnant woman with COVID-19 that rapidly developed into severe respiratory infection following vaginal delivery. Due to increased oxygen consumption and pulmonary load during pregnancy, cesarean delivery may help to avoid adverse events caused by pulmonary insufficiency during vaginal delivery. For critically ill pregnant women, tracheal intubation should be used as early as possible, and sedative drugs should be used to reduce oxygen consumption. Broad-spectrum antibiotics and antiviral drugs are needed, based on experience in treating community-acquired pneumonia, as well as protective treatments for the heart, liver, and kidneys.