Patel Priya, Kulkarni Sayali, Guerrero Manrique, Persaud Clive, Zuberi Jamshed, Rebein Benjamin
St. George's University School of Medicine, True Blue, Grenada.
Department of Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA.
Am J Case Rep. 2020 Dec 19;21:e926591. doi: 10.12659/AJCR.926591.
BACKGROUND Up to 47% of pregnant women with COVID-19 have preterm deliveries. A severe, symptomatic COVID-19 infection in close-to-term pregnancies can have a poor prognosis. Early identification of COVID-19 in pregnant women can prevent the progression of the disease. Currently, there is very little guidance on treating pregnant close-to-term women with COVID-19; this case report suggests changes to current management to maximize positive maternal and fetal outcomes. CASE REPORT A pregnant woman (37 weeks of gestation) presented to the Emergency Department with a chief complaint of fever with an associated cough for 2 days. She was diagnosed with COVID-19 in the Emergency Department, and discharged in a stable condition. She returned 5 days later in preterm labor with severe respiratory distress. After an emergency cesarean section, she remained intubated in the Surgical Intensive Care Unit; she was persistently hypotensive and hypoxic despite maximal ventilator and medical treatment. She died after a cardiac arrest and unsuccessful resuscitation, 15 days after the delivery. We discuss the possible benefit of a planned C-section for close-to-term pregnancies prior to the onset of COVID-19 symptoms. The patient's next of kin gave informed consent for this case report. Approval from the Institutional Review Board or Ethics Review Board was not required as this is a case report. CONCLUSIONS Currently, asymptomatic pregnant women are not tested for COVID-19 infection until hospitalization for delivery. It could be beneficial to have a protocol in place to screen asymptomatic pregnant women so they can be identified early and monitored, as COVID-19 symptoms can escalate quickly.
感染新冠病毒的孕妇中，高达47%会出现早产。临近足月妊娠时发生严重的、有症状的新冠病毒感染，预后可能较差。尽早识别孕妇感染新冠病毒可预防疾病进展。目前，对于感染新冠病毒的临近足月孕妇的治疗，指导意见非常少；本病例报告建议改变当前的管理方式，以实现最佳的母婴结局。病例报告：一名孕妇（妊娠37周）因发热伴咳嗽2天为主诉就诊于急诊科。她在急诊科被诊断为新冠病毒感染，出院时情况稳定。5天后，她因早产伴严重呼吸窘迫再次就诊。紧急剖宫产术后，她在外科重症监护病房仍需插管治疗；尽管接受了最大程度的通气和药物治疗，她仍持续低血压和低氧血症。分娩后15天，她因心脏骤停且复苏失败而死亡。我们讨论了在出现新冠病毒症状之前，对临近足月妊娠进行计划性剖宫产的可能益处。患者的近亲已对本病例报告给予知情同意。由于这是一份病例报告，无需机构审查委员会或伦理审查委员会的批准。结论：目前，无症状孕妇直到住院分娩时才进行新冠病毒感染检测。制定一套方案来筛查无症状孕妇可能有益，这样她们可以被早期识别并监测，因为新冠病毒症状可能迅速加重。
