Department of Obstetrics and Gynecology, Elena Doamna Obstetrics and Gynecology University Hospital, 700398 Iasi, Romania.
Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.
Medicina (Kaunas). 2021 Nov 1;57(11):1186. doi: 10.3390/medicina57111186.
: The multiple pregnancies associated with COVID-19 is a new and difficult condition to manage. The prognosis for rapid deterioration after the cesarean delivery is difficult to assess and needs close interdisciplinary follow-up due to pregnancy and postpartum-related changes. : We report the case of a 37-year-old primigesta primipara patient who was admitted to "Elena Doamna" Clinical Hospital of Obstetrics and Gynecology at 33 weeks and 3 days of gestation with high-grade multiple pregnancies (triplets) for threatened premature birth associated with COVID-19. The patient had a history of surgically corrected atrial septal defect during childhood and currently is known to have paroxysmal supraventricular tachycardia. Tocolysis was ineffective and the decision to perform a cesarean operation was made. The diagnosis was established: primigesta, primipara, at 34 weeks of gestation, high-grade multiple pregnancy with triplets, intact membranes, threatened premature birth, surgically corrected atrial septal defect, paroxysmal supraventricular tachycardia, infection with COVID-19. The patient underwent a cesarean intervention and treatment for COVID-19 pneumonia. The intervention took place at 33 weeks and 4 days of gestation resulting in four newborns with weights between 1400 g and 1820 g and Apgar scores between 6-8. All newborns were transferred to a third-degree Neonatology ICU service due to their prematurity. The fourth newborn was not identified in any of the ultrasounds performed during pregnancy. During the postpartum period, the patient had a fulminant evolution of COVID-19 pneumonia, with rapid deterioration, needing respiratory support and antiviral treatment. : Managing high-risk obstetrical pregnancies associated with COVID-19 requires a multidisciplinary team consisting of obstetricians, anesthesiologists, neonatologists, and infectious disease doctors. : Our case is the first to our knowledge in Romania to present an association of high-grade multiple pregancy with COVID19 moderate form, rapidly evolving postpartum, needing rapid intensive care admission, and specific treatment with Remdesivir, with good post-treatment evolution.
与 COVID-19 相关的多胎妊娠是一种新的、难以处理的情况。由于妊娠和产后相关变化，剖宫产术后迅速恶化的预后难以评估，需要密切的跨学科随访。
我们报告了一例 37 岁初产妇患者的病例，她在 33 周零 3 天因 COVID-19 相关的早产高危多胎妊娠（三胞胎）而入院。该患者在儿童时期曾接受过心脏房间隔缺损的手术矫正，目前患有阵发性室上性心动过速。宫缩抑制剂无效，决定行剖宫产术。诊断为：初产妇，初产妇，妊娠 34 周，高级别三胞胎妊娠，胎膜完整，早产先兆，心脏房间隔缺损手术矫正，阵发性室上性心动过速，COVID-19 感染。患者接受了剖宫产干预和 COVID-19 肺炎治疗。干预发生在妊娠 33 周零 4 天，导致 4 名新生儿体重在 1400 克至 1820 克之间，阿普加评分在 6-8 之间。所有新生儿均因早产而转至三级新生儿重症监护病房。在怀孕期间进行的任何超声检查中均未发现第四个新生儿。在产后期间，患者 COVID-19 肺炎迅速恶化，需要呼吸支持和抗病毒治疗。
管理与 COVID-19 相关的高危产科妊娠需要一个多学科团队，包括产科医生、麻醉师、新生儿科医生和传染病医生。
据我们所知，我们的病例是罗马尼亚首例报告的高级别多胎妊娠与 COVID19 中度形式相关，产后迅速恶化，需要快速入住重症监护病房，并接受 Remdesivir 的特异性治疗，治疗后病情好转。
