key: cord-0923423-4kyrpnax authors: Wu, Xiaoqing; Sun, Ruihong; Chen, Jianpu; Xie, Yuanliang; Zhang, Shutong; Wang, Xiang title: Radiological findings and clinical characteristics of pregnant women with COVID‐19 pneumonia date: 2020-06-03 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13165 sha: 11db3f4da74fe4203a07efbfa98f12363e7c1601 doc_id: 923423 cord_uid: 4kyrpnax OBJECTIVE: To study chest CT images and clinical characteristics of COVID‐19 pneumonia in pregnant patients to examine any correlation. METHODS: Between December 31, 2019 and March 7, 2020, 23 hospitalized pregnant patients with confirmed COVID‐19 were enrolled in the study. Clinical presentations were collected retrospectively from records, including laboratory testing, chest CT imaging, and symptoms. Descriptive analysis and correlation of patients’ clinical and CT characteristics were performed. Laboratory results from time of first admission and CT absorption (defined as reduction in lesion area, decrease in density, and absorption of some solid components) were compared between symptomatic and asymptomatic patients. RESULTS: Fifteen (65.2%) patients were asymptomatic with patchy ground‐glass opacity in a single lung lobe. Eight (34.8%) patients were symptomatic with multiple patchy ground‐glass shadows, consolidation, and fibrous stripes. Differences in lymphocyte percentage and neutrophil granulocyte rate between first admission and CT absorption were significant (P<0.001). Median absorption time was shorter in the asymptomatic group compared with the symptomatic group (5 vs 10 days; P<0.001). Median hospitalization time between asymptomatic and symptomatic patients was 14 vs 25.5 days; P>0.001. Median absorption time and length of hospitalization for all patients was 6 days (IQR 5–8) and 17 days (IQR 13–25), respectively. CONCLUSION: Radiological findings and clinical characteristics in pregnant women with COVID‐19 were similar to those of non‐pregnant women with COVID‐19. Median absorption time and length of hospitalization in asymptomatic patients were significantly shorter than in symptomatic patients. Lymphocyte percentage and neutrophil granulocyte rate may be used as laboratory indicators of CT absorption. symptoms similar to acute respiratory distress syndrome (ARDS), acute respiratory failure, and other serious complications that pose a huge threat to public health globally. [3] [4] [5] [6] COVID-19 is highly contagious and transmits from person to person. As of April 7, 2020, 1214 466 patients worldwide have been diagnosed, 7 including pregnant women. Pregnancy may trigger important changes in respiratory functions, both anatomical and physiological, making pregnant women prone to respiratory disease. 8 Pregnant women with COVID-19 pneumonia are more difficult to manage than nonpregnant patients, because drug therapy and intrapartum risk also need to be considered. Past studies have indicated that SARS/MERS infections were found to be associated with severe maternal illness, maternal death, and spontaneous abortion. [9] [10] [11] Many current studies focus on the impact of COVID-19 on the general population, with few analyzing its impact on pregnant women. The aim of the present study was to assess the radiological characteristics and clinical presentations of pregnant patients with COVID-19, as well as their correlation. The present study was approved by the Ethics Committee of the Low-dose CT scanning was performed using Somatom Definition FLASH (Siemens, Erlangen, Germany) or Philips Ingenuity Core128 (Philips Medical Systems, Best, the Netherlands) CT scanners following the chest protocol, where the patient adopted a supine position with arms raised. Each patient was instructed to hold their breath during image acquisition, which included whole lung volume. The slice thickness for reconstruction was 1.25 mm, and other parameters were set to 120 kV, 30 mA, display field of view (DFOV) 36.0 cm, and matrix 512 × 512. CT absorption was defined as: (1) reduction in lesion area, (2) decrease in density, and (3) absorption of some solid components. Based on previously published articles, four stages of lung involvement were defined based on CT imaging at the lung window 14 : (1) early stage, (2) progressive stage, (3) peak stage, and (4) absorption stage. All CT image analyses were performed by two experienced thoracic radiologists (YX, 20 years of experience; XW, 22 years of experience) who were blinded to the clinical information. The image findings were determined according to a consensus. Statistical analysis was performed using SPSS version 22 (IBM, Armonk, NY, USA). Categorical variables were expressed as numbers (percentages). Continuous variables were expressed as median and interquartile range (IQR) and were compared using the Mann-Whitney U test. P<0.001 was considered statistically significant. Table 1 . Based on the staging definition of CT images, 15 (65.2%) patients were classified as early stage and 8 patients (34.8%) were classified progressive stage. Three (13.0%) patients demonstrated groundglass opacity in a single lobe (Fig. 1A) , with the smallest lesion diameter at approximately 5 mm. One (4.3%) patient showed ground-glass opacity embodying a symmetrical sphere (Fig. 1B) . Twenty (87.0%) patients presented with patchy, wedge-shaped ground-glass shadows mainly along the bronchovascular area and lung field with subpleural area (Fig. 1C,D) . One (4.3%) patient had intralobular interstitial thickening with consolidation (Fig. 1E) , and 2 (8.7%) patients had fibrous stripes (Fig. 1F) Table 3 ). Median absorption time in the asymptomatic group was 5 days (IQR 4-6), while in the symptomatic group it was 10 days (IQR 8-12) days, which was statistically significant (P<0.001). In the present study, most pregnant patients were asymptomatic but had clinically threatened or premature rupture of membranes. Three such patients were examined due to their close contact history with ; (B) 28-y-old, 39 + 1 wk: bilateral, circular ground-glass opacity in the lower lobes; (C) 30-yold, 35 + 4 w: single peripheral ground-glass shadow with air bronchograms in the right upper lobe; (D) 29-y-old, 37 + 6 wk: multiple patchy, wedge-shaped ground-glass shadows mainly along the bronchovascular area and lung field with subpleural area; (E) 33-y-old, 38 + 6 wk, day 5 after onset of symptoms: focal ground-glass shadow associated with smooth interlobular and intralobular septal thickening in the right lower lobe; (F) 28-y-old, 38 + 5 wk, day 6 after onset of symptoms: patchy consolidation and fibrous stripes in the lower lobes. 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