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一名感染新冠病毒的孕妇产下早产三胞胎:病例报告及文献综述

A pregnant woman with COVID-19 gives birth to premature triplets: A case report and literature review.

作者信息

Feng Zaili

机构信息

Department of Neonatology, Kunming Medical University (Dehong People's Hospital), Kunming, Yunnan 650500, P.R. China.

Department of Neonatology, Ruili Chinese Medicine and Dai Medical Hospital, Ruili, Yunnan 678600, P.R. China.

出版信息

Med Int (Lond). 2022 Feb 14;2(1):6. doi: 10.3892/mi.2022.31. eCollection 2022 Jan-Feb.

DOI:10.3892/mi.2022.31
PMID:36700154
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9829195/
Abstract

To the best of our knowledge, no case report has been published to date concerning the novel coronavirus disease 2019 (COVID-19) treatment plan for pregnant women with triplets, as well as on the possibility of a vertical transmission to triplets delivered prematurely by a pregnant woman with COVID-19. The present study thus describes such as case. A 29-year-old local resident, a woman with COVID-19, who was pregnant with triplets, had not moved from her residence for the past 6 months. The main symptoms mentioned by the patient on the day of admission were the following: The patient was in the 28th week of pregnancy, 2019 novel coronavirus (2019-nCoV) nucleic acid positive test 13 h prior to admission. Additionally, the patient had a high fever and dyspnea after admission. The patient was treated with convalescent plasma from patients with COVID-19 and methylprednisolone, at the same time her anemia, anxiety and insomnia were treated. Subsequently, the patient's condition improved, and normal body temperature was restored. Cesarean section was performed due to severe intrahepatic cholestasis of pregnancy (ICP), and due to the fetuses being located in three chorionic and amniotic cavities, and due to the fact that each of the three infants was in a different position (cephalic, breech and transverse position). Following delivery, total bile acid values and liver function improved gradually, and the 2019-nCoV nucleic acid test was negative consecutively for two tests, and the woman was then discharged from the hospital. Each premature infant born by caesarean section was individually transported to a neonatal intensive care unit for isolation treatment, with the neonatal escorts and transport teams wearing secondary protective clothing. All three premature infants were transitioned gradually from parenteral intravenous nutrition to full oral feeding. 2019-nCoV nucleic acid test results were negative for all infants. 2019-nCoV IgM test results were negative and IgG were positive for all infants. The pregnant woman and the three premature infants were successfully treated and discharged after they felt no discomfort and were negative consecutively for two 2019-nCoV nucleic acid tests. The three premature infants were monitored for growth and development until December, 2021, and eye, lung, heart, brain, liver, kidney, intestine and other organ functions were normal. The present study reports on the treatment and delivery outcomes of a woman with COVID-19, who was pregnant with triplets. The present case report demonstrated that although the pregnant woman with triplets was suffering from COVID-19, all three premature infants delivered by cesarean section did not present with intrauterine vertical infection, and abnormal growth and development were not observed. The convalescent plasma of patients with COVID-19 and methylprednisolone were effective for the treatment of a continuously high fever, and the timely treatment of complications is helpful for the treatment of patients with COVID-19.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0779/9829195/8b80a2aba13e/mi-02-01-00031-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0779/9829195/1802ffdce4cc/mi-02-01-00031-g00.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0779/9829195/5332348501d4/mi-02-01-00031-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0779/9829195/8b80a2aba13e/mi-02-01-00031-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0779/9829195/1802ffdce4cc/mi-02-01-00031-g00.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0779/9829195/5332348501d4/mi-02-01-00031-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0779/9829195/8b80a2aba13e/mi-02-01-00031-g02.jpg
摘要

据我们所知,迄今为止尚未发表关于新型冠状病毒肺炎(COVID-19)三胞胎孕妇治疗方案以及COVID-19孕妇早产三胞胎垂直传播可能性的病例报告。因此,本研究描述了这样一个病例。一名29岁的当地居民,一名患有COVID-19的孕妇,怀有三胞胎,在过去6个月内未离开过住所。患者入院当天提及的主要症状如下:患者处于妊娠28周,入院前13小时新型冠状病毒(2019-nCoV)核酸检测呈阳性。此外,患者入院后出现高热和呼吸困难。患者接受了COVID-19康复者血浆和甲泼尼龙治疗,同时治疗其贫血、焦虑和失眠。随后,患者病情好转,体温恢复正常。因重度妊娠肝内胆汁淤积症(ICP)、胎儿位于三个绒毛膜和羊膜腔内、三个婴儿各处于不同胎位(头位、臀位和横位)而行剖宫产。分娩后,总胆汁酸值和肝功能逐渐改善,2019-nCoV核酸检测连续两次呈阴性,该女子随后出院。剖宫产出生的每个早产儿均被单独转运至新生儿重症监护病房进行隔离治疗,新生儿护送人员和转运团队穿着二级防护服。所有三个早产儿均逐渐从肠外静脉营养过渡到完全经口喂养。所有婴儿的2019-nCoV核酸检测结果均为阴性。所有婴儿的2019-nCoV IgM检测结果为阴性,IgG检测结果为阳性。该孕妇和三个早产儿在无不适且2019-nCoV核酸检测连续两次呈阴性后成功接受治疗并出院。对这三个早产儿进行生长发育监测至2021年12月,眼、肺、心、脑、肝、肾、肠等器官功能均正常。本研究报告了一名怀有三胞胎的COVID-19孕妇的治疗及分娩结局。本病例报告表明,尽管怀有三胞胎的孕妇患有COVID-19,但剖宫产分娩的所有三个早产儿均未出现宫内垂直感染,也未观察到生长发育异常。COVID-19康复者血浆和甲泼尼龙对持续高热治疗有效,及时治疗并发症有助于COVID-19患者的治疗。

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