Case 1
A 35-year-old woman, gravida 4, para 3, with a history of 3 previous cesarean sections, was hospitalized at 39 weeks of pregnancy due to uterine contractions. The patient had no history of underlying diseases and no contact with infected cases with COVID-19. She did not have a fever or any symptoms such as cough, sore throat or muscle weakness on admission. She also did not complain of gastrointestinal disorders such as diarrhea and vomiting. On the first patient’s visit, blood pressure (BP): 110 /70 mm Hg, Heart Rate (HR): 130 beats/min, Temperature (T): 37.5 °c, Respiratory Rate (RR): 26 breaths/min and oxygen saturation (SpO2): 96% were recorded. According to the laboratory results, lymphocyte count were lower than normal (lymphocyte count: 1× 109/L) and platelet count, hepatic enzymes and creatinine level were within the normal range while, C-reactive protein levels (CRP) were significantly increased. (Table 1). Coagulation function and blood biochemistry were normal. Due to the high level of C-reactive protein and the probability of COVID-19 infection, a GeneXpert COVID-19 RNA polymerase chain reaction (RT-PCR) test was performed which turned positive. Computed Tomography (CT) images of the lungs revealed the bilateral involvement of the lungs and multifocal rounded consolidations with surrounding ground-glass opacities (GGO) (Fig. 1). The pregnant patient underwent a cesarean section due to the onset of uterine contractions and a history of previous cesarean sections. One full-term female infant was born with a birth weight >3000 gr. She had a 1-min Apgar score of 8 and a 5-min Apgar score of 9. The throat swab sample was tested within 24 hours after birth and positive result confirmed that the baby was infected with SARS-CoV-2. She suffered from transient tachypnea of the newborn (TTN) and needed nasal-Continuous Positive Airway Pressure (nCPAP) after birth. CT-chest was carried out and it showed no abnormal opacities (Fig. 2). Breathing became normal 3 days after birth and the infant was discharged from neonatal intensive care unit (NICU) 6 days later. It should be noted that the mother was discharged from the hospital with a satisfying general condition a week after delivery.
Case 2
A 31-year-old patient, gravida 2, para 1, with a gestational age of 39 weeks and a history of cesarean section referred to hospital because of the increase in uterine contractions. She had no underlying diseases and her vital signs were recorded as BP: 120 /70 mm Hg, (SpO2):96%, HR: 110 beats/min, T: 39 °c and RR: 26 breaths/min. She had experienced coughing and sore throat during the previous week and complained of muscle weakness. She mentioned that her husband had experienced the same symptoms. Laboratory tests showed an increased level of CRP and lymphopenia (lymphocyte count: 1.0 × 109/L) (Table 1). Since the infection of COVID-19 was probable, Chest X-ray and RT-PCR test were carried out in the first 24 hours. Lung appearance was normal and it had no signs of typical viral pneumonia (Figure 3). COVID-19 test was done for the patient and the positive result of RT-PCR assay confirmed that the pregnant woman was infected with SARS-CoV-2. The patient underwent a cesarean section due to the onset of uterine contractions and a history of previous cesarean section. She gave birth to a male infant with a birth weight of 3400 g, a 1-min Apgar score of 2 and a 5-min Apgar score of 6. The baby was intubated due to severe respiratory distress and transferred to the NICU. His arterial blood gas (ABG) showed a pH of 6.86, pCO2 of 97 mm Hg, pO2 of 49 mm Hg, HCO3 of 16 mEq/L, and a base excess (BE) of −18.5 mmol/L. Since a decrease in oxygen saturation was observed and the respiratory distress exacerbated, echocardiography and chest radiography were performed. The echocardiogram was normal but the chest radiography suggested severe lung involvement (Fig. 4). The positive result of COVID-19 testing confirmed that the newborn was infected with 2019-nCoV. Despite the supportive and resuscitation attempts, the infant died. Fortunately the mother discharged from the hospital 5 days after delivery with a good general condition.
Table 1. Clinical and laboratory characteristics of mothers
Signs and symptom
|
Case1
|
Case2
|
Fever
|
No
|
Yes
|
Cough
|
No
|
Yes
|
Fatigue
|
No
|
Yes
|
Headache
|
No
|
No
|
Dyspnea
|
Yes
|
No
|
Heart rate(per min, at arrival)
|
130
|
110
|
White blood cell count ×109/L
|
17.2
|
9.2
|
Lymphocyte count×109/L
|
1.0
|
1.0
|
Hemoglobin,g/L
|
12.8
|
11
|
Platelet count×109/L
|
158
|
120
|
C-reactive protein, mg/L
|
79
|
50
|
Alanine aminotransferase U/L
|
15
|
30
|
Aspartate aminotransferase U/L
|
25
|
35
|
Creatinine,mmol/L
|
0.6
|
0.8
|