key: cord-0727064-kc8tjujx
authors: Panichaya, Punika; Thaweerat, Wajana; Uthaisan, Juthaporn
title: Prolonged viral persistence in COVID-19 second trimester pregnant patient
date: 2020-05-18
journal: Eur J Obstet Gynecol Reprod Biol
DOI: 10.1016/j.ejogrb.2020.05.030
sha: aae8c7aca20ee0fa32202dfaa656eec2bf0f571a
doc_id: 727064
cord_uid: kc8tjujx

nan

We reported a 43-year-old gravida 3 para 2 pregnant woman without underlying disease at 18 weeks' gestation who presented with fever and chest discomfort. She contacted her husband who visited the boxing stadium where the COVID-19 outbreak occurred and was diagnosed with COVID-19 infection 2 days before she developed symptoms. Her vital signs were normal without fever and physical examination was unremarkable. Nasopharyngeal and throat swabs were positive for SARS-CoV-2 by reverse transcriptase polymerase chain reaction (RT-PCR) assays. Her investigations including complete blood count, renal function, serum electrolyte, liver function and urinalysis were within normal limits. Chest radiograph did not reveal any obvious active cardiopulmonary lesion. Rapid tests for influenza viruses and respiratory syncytial virus were negative.

She did not receive any specific treatments due to mild symptoms. Daily fetal heart rate was measured between 120-170 beats per minute. Nasopharyngeal and throat swab were conducted every two days. Her past antenatal history and ultrasonography from another hospital were unremarkable and amniocentesis was done one week before this admission due to high risk of aneuploidy by maternal age. Karyotype results which reported on the 10th day of admission demonstrated 47;XY,+21 and was diagnosed as fetal Down syndrome. Most published studies of COVID-19 in pregnancy are reported in the third trimester [1] . Currently, only two briefed cases of mild infection in the late second trimester [2] and one case of miscarriage in the early second trimester [3] were reported. In our report, the clinical characteristics of COVID-19 in this early second trimester pregnancy are indifferent from reports of non-pregnant patients [4] . There are no obvious immediate effects to the fetus after prolonged maternal SARS-CoV-2 infection for three weeks in the second trimester which demonstrated by positive fetal heartbeat and unchanged ultrasonographic result. Pregnancyrelated adverse events did not occur during infection of this patient such as premature labor or premature rupture of membrane. Therefore, we observed that pregnancy did not aggravate COVID-19 and the prolonged infection did not cause pregnancy complications in this patient J o u r n a l P r e -p r o o f as well. To eradicate infection, specific treatment was not essential in pregnant patients with mild symptoms similarly to non-pregnant patients with only addition of fetal monitoring.

Unfortunately, our report cannot exclude vertical transmission since no fetal specimen was collected during infection period but placental pathology reported no morphological change related to infection which is similar to previous report [5] . However, the recent study detected SARS-CoV-2 at placenta with inflammatory histological changes [3] . Hence, further studies are required to provide more evidence about infection during second trimester pregnancy and its maternal and fetal consequences.

COVID19 during pregnancy: a systematic review of reported cases

Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy

Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection

Clinical Characteristics of Coronavirus Disease 2019 in China

Pregnant Women With New Coronavirus Infection: A Clinical Characteristics and Placental Pathological Analysis of Three Cases

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.J o u r n a l P r e -p r o o f