key: cord-272553-bcmta2he
authors: Wang, Zhiqiang; Wang, Zhigang; Xiong, Guoping
title: Clinical characteristics and laboratory results of pregnant women with COVID‐19 in Wuhan, China
date: 2020-07-03
journal: Int J Gynaecol Obstet
DOI: 10.1002/ijgo.13265
sha: 
doc_id: 272553
cord_uid: bcmta2he

OBJECTIVE: To evaluate the clinical characteristics and laboratory test results in pregnant women with coronavirus disease 2019 (COVID‐19). METHODS: A retrospective study to review and compare clinical data including electronic medical records and laboratory tests from pregnant and nonpregnant patients admitted the Central Hospital of Wuhan, China from December 8, 2019 to April 1, 2020. RESULTS: A total of 72 women (30 pregnant and 42 nonpregnant) with COVID‐19 were included. No patients developed severe pneumonia during the study. Compared with the nonpregnant group, pregnant patients were admitted to hospital earlier (0.25 vs 11.00 days; P<0.001), presented milder symptoms, had a higher rate of asymptomatic infection (26.7% vs 0%), and shorter length of hospital stay (14.5 vs 17.0 days; P<0.01). Laboratory test results showed that levels of inflammation markers such as white blood cell count, neutrophil count and percentage, C‐reactive protein, procalcitonin, and D‐dimer were significantly higher in pregnant women, whereas mean lymphocyte percentage was significantly lower compared with nonpregnant women. CONCLUSION: In some respects, the clinical characteristics and laboratory test results of COVID‐19 in pregnant patients seems to be distinctive from their nonpregnant counterparts. Appropriate advice and positive treatment might be critical to the prognosis when dealing with these pregnant patients. Pregnant patients with COVID‐19 had their own positive clinical characteristics and special laboratory test results. Responsive medical advice and active treatment for those patients are critical to recovery.

were similar. 2 However, the potential of the virus to cause severe complications for both mothers and newborns requires rigorous screening in pregnancy and long-term follow-up. 3 Although available studies provide vital knowledge, 2, 4 research in this field is limited and the results vary. Therefore, the aim of the present study was to investigate and report the clinical characteristics and laboratory test results of pregnant women with COVID-19 to strengthen the knowledge base.

We conducted a retrospective study at the Central Hospital of Wuhan.

The study received approval from the Medical Ethical Committee of the Central Hospital of Wuhan. Informed written consent was waived owing to the retrospective nature of the study. All patients with suspected COVID-19 admitted to our hospital between December 8, 2019 and April 1, 2020 were screened for the disease. Two authors back to back assessed the all possibly eligible cases for compliance with the inclusion criteria for the study.

Clinical data of epidemiological history, clinical presentation, laboratory test results, and disease outcomes were collected from each patient's electronic medical record and reviewed by designated researchers (ZQW, ZGW). Exclusion criteria were negative results obtained by nasopharyngeal swabs and real-time PCR, and were repeated twice every two days in two different laboratories, male patients, and female patients younger than 20 years or older than 40 years. In addition, patients with a referral history from the local department to another department or from our hospital to other hospitals were excluded owing to the difficulty in obtaining their medical data. The records of two nonpregnant women who died during the study period were also excluded because they had severe underlying health conditions. Patients were discharged from hospital once they had met the following criteria: (1) body temperature returned to normal and remained consistent for more than 3 days; (2) respiratory symptoms improved; (3) computed tomography (CT) of the chest showed decreased exudative lesions; and (4) for pregnant patients, there were no puerperal complications and they had fully recovered from any perineum or abdominal incision. Considering the limited performance of the nucleic acid test for the detection of COVID-19, 5 patients with typical manifestations of COVID-19 on chest CT were also included as diagnosed patients.

Typical CT manifestations of COVID-19 such as bilateral ground-glass opacities, consolidation, an occasionally rounded morphology, and peripheral lung distribution were consistent with the guidelines of the Fleischner Society. 6 The treatment strategy in the present study fol- The clinical characteristics of pregnant patients extracted from medical records were gestational age; time interval between symptom onset and admission; time interval between hospitalization and delivery; delivery mode; length of hospital stay; initial symptoms (fever, cough, abdominal pain, blood-tinged mucus, ruptured membranes at term, chest tightness, asthma, fatigue, poor appetite, headache, nausea, and vomiting); and maternal comorbidities (gestational diabetes, gestational hypertension, intrahepatic cholestasis of pregnancy, premature rupture of membranes, and obesity). Reviewed laboratory tests included white blood cell (WBC) count, neutrophil count and percentage, lymphocyte count and percentage, platelet count, coagulation indicators (D-dimer), and liver and kidney function markers (e.g. aminotransferase and creatinine). The demographic and clinical characteristics of the two groups are shown in Table 1 

The virus causing COVID-19 is believed to have originated from a local seafood market in Wuhan, which is surrounded by many residential buildings. 8, 9 This may be one reason that the pandemic spread so quickly at The present study also found that the typical symptoms of COVID-19 may have been milder in pregnant patients than in nonpregnant patients, which was also reported in an earlier study. 11 Carriers of SARS-CoV-2 often presented with milder or no symptoms in the incubation period, the duration of which could be as long as 14 days, which increased the risk of infecting others before diagnosis and implied that positive treatment monitoring might be delayed. 12 Medical personnel should be alert that they run a high risk of becoming infected when performing a physical examination on these patients.

T A B L E 2 Laboratory test results of patients with COVID-19 (n=72).

White blood cell count, ×10 9 /L 3.5-9. Among the 30 pregnant patients, 25 delivered at full term, three were delivered by cesarean because of premature rupture of membranes, one had hypothyroidism, and one had intrahepatic cholestasis of pregnancy. Pregnant patients seemed more likely to undergo cesarean delivery during the emergence of COVID-19. In the present study, rate of cesarean delivery was higher than that of vaginal delivery (76.7% vs 23.3%, respectively), given that the main concern might be neonatal infection. 13 Consistent with an earlier report, 16 the present study showed that peripheral lymphocyte count and lymphocyte percentage were normal or decreased in pregnant patients in the early stages of COVID-19.

Although lymphocyte count varied in pregnancy, it often returned to levels in the postpartum period that were equal to those in nonpregnant patients. 13 This may indicate a poor prognosis as lymphocyte percentage was correlated with the severity of COVID-19. 17 Except for the deaths of two nonpregnant women who had severe underlying conditions, all enrolled patients had recovered by the end of the study.

Patients with mild symptoms could have increased levels of C-reactive protein but normal procalcitonin. 17 Procalcitonin is a biomarker with higher diagnostic accuracy than C-reactive protein for bacterial infection. 18 However, procalcitonin levels were slightly higher in pregnant patients in the present study and, further considering the higher neutrophil count in this group, clinicians should be well-informed of the risk of puerperal infection in these patients. D-dimer is an indicator of fibrinolysis and is widely used as a criterion for thromboembolism. The correlation of high levels of this indicator with the occurrence of severe COVID-19 in adult patients has been reported previously. 19 The present study showed that pregnant patients with COVID-19 had higher levels of D-dimer;

however, its application in these patients may be restricted because it This study has several limitations. The first is that we included 13 pregnant women whose SARS-CoV-2 nucleic acid test results were positive, but who had typical manifestations of COVID-19 on chest CT based on the evidence that CT could be an auxiliary diagnostic tool for the disease. 20 The second is that we did not make a comparison between pregnant women with and without COVID-19, therefore some of the conclusions drawn from current data might be limited.

The third weakness is the relatively small sample size. Results and conclusions from the present study need to be validated by multiple center trials in the future.

In conclusion, this study included 72 patients with COVID-19, 

All authors contributed to writing the manuscript and approval of the final version. GPX designed the study, ZQW and GPX collected the data, ZQW and ZGW analyzed and interpreted the results.

The authors have no conflicts of interest.

Successful containment of COVID-19: The WHO-report on the COVID-19 outbreak in China

What are the risks of COVID-19 infection in pregnant women?

Management of pregnant women infected with COVID-19

COVID-19 in pregnant women

Detection and analysis of nucleic acid in various biological samples of COVID-19 patients

The role of chest imaging in patient management during the COVID-19 pandemic: A multinational consensus statement from the Fleischner Society

The 5th edition of diagnosis and treatment program of COVID-19 pneumonia from the National Health Commission

Coronavirus infections-more than just the common cold

A new coronavirus associated with human respiratory disease in China

Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China

Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing

COVID-19: What is next for public health?

Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records

Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection

Characteristics of peripheral blood leukocyte differential counts in patients with COVID-19

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study

Procalcitonin-guided antibiotic therapy in patients with fever in a general emergency department population: A multicentre non-inferiority randomized clinical trial (HiTEMP study)

Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19

Chest CT manifestations of new coronavirus disease 2019 (COVID-19): A pictorial review