key: cord-336057-tj9qcuf8
authors: Lv, Yantian; Gu, Binbin; Chen, Ying; Hu, Siming; Ruan, Ting; Xu, Guopeng; Ding, Jian; Xu, Xiao; shen, Xinghua
title: No intrauterine vertical transmission in pregnancy with COVID-19: a case report
date: 2020-08-05
journal: J Infect Chemother
DOI: 10.1016/j.jiac.2020.07.015
sha: 
doc_id: 336057
cord_uid: tj9qcuf8

Abstract The coronavirus disease 2019(COVID-19)has been a worldwide pandemic diseases, nearly 400,000 people died at now. The data of status of pregnant women and neonates after infection of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is limited. We report a case of pregnant woman in her third trimester with critical COVID-19, and amniotic fluid, umbilical cord blood, placenta, and neonatal gastric fluid were retained during cesarean section. The SARS-COV-2 nucleic acid test results of these specimens were negative. there is no evidence of intrauterine vertical transmission during delivery in the third trimester, but the data are limited and need to be further explored.

Since the SARS-COV-2 virus was discovered in China in December 2019, as of June 05, 2020, WHO confirmed 6535354 cases of (SARS-COV-2) infections worldwide, and nearly 400000 deaths were declared 1 . As a special population, pregnant women have attracted much attention, and the presence of intrauterine vertical transmission is critical to the outcome of newborns. Here, we report a pregnant woman with critical COVID-19 to provide some help for the treatment of pregnant women.

A 28-year-old 31-week pregnant woman was admitted to the Fifth People's Hospital of Suzhou on February 6,2020 for recurrent fever and cough in 2 weeks. Epidemiological history showed that the patient went to Wuhan to visit relatives on January 4, and returned to Suzhou on January 23. She developed fever on January 25, with a maximum body temperature of 38.3℃.

She went to the fever clinic of Suzhou Municipal Hospital on February 2. The blood test showed a normal white blood cells, lymphopenia and elevated CRP J o u r n a l P r e -p r o o f (Table). The result of the SARS-COV-2 nucleic acid test was negative,   however, given her epidemiological history, the possibility of SARS-COV-2 infection remained to be considered. A chest CT scan on February 4 revealed multiple peripheral ground-glass exudates with partial consolidation in bilateral lungs ( Figure) . On February 6, after the 4th SARS-COV-2 nucleic acid test returned to be positive, she was transferred to the Fifth People's Hospital of Suzhou for treatment.

Blood test showed 10.60×10 9 /L of WBC, 0.85×10 9 /L of lymphocytes, 124.1mg / L of CRP, 0.288 ng/ml of PCT. ABG analysis showed that PO 2 was 120.6mmHg, PCO 2 was 38.2mmHg, and PO 2 /FiO 2 index was 294.According to the SARS-COV-2 pneumonia protocol (5th edn) 2 , the pregnant woman was classified as critical type of COVID-19. We gave her high flow oxygen, Lopinaviri/Rionavir for antiviral, cefoperazone Tazobactam for anti-infection, dexamethasone for fetal maturation, and symptomatic management.

On February 8, the fetal heart rate was 100 beats/min, the patient's ABG analysis showed that PF index was 208, and CT scan indicated pulmonary lesions deteriorated. The cesarean section was performed under lumbosacral combined anesthesia immediately, and a 1830g live-born male infant was delivered successfully. Amniotic fluid, umbilical cord blood, placenta, and neonatal gastric fluid were collected during the operation and tested for the SARS-COV-2 nucleic acid, and the mother and infant were separated after the operation.

J o u r n a l P r e -p r o o f On February 9, a blood test showed an increase in PCT of 1.63 ng/ml, linezolid was added to enhance anti-infection. Lopinaviri/Ritonavir was replaced by abidol because of nausea and vomiting. On February 12, CT scan indicated that the lesions absorbed than before and her clinical symptoms improved continually. On February 18, chest CT showed that the lesions almost disappeared. In addition, the sputum SARS-COV-2 nucleic acid test was negative for the fourth time, and the anal swab SARS-COV-2 nucleic acid was also negative. The patient was discharged on February 20.

As for the newborn, his Apgar scores were 8, 8 and 10 at 1, 5, and 10 minutes after birth, with weight of 1830g, blood pressure of 77/48mmHg, and pulse oxygen 95%.He was admitted to the negative pressure isolation ward after birth, NCPAP breathing support, given sulbenicillin sodium, azithromycin for anti-infection treatment. In addition, not only SARS-COV-2 nucleic acid test results were negative in 4 times pharyngeal swabs, but also the anal swab, amniotic fluid, umbilical cord blood, placenta, and neonatal gastric fluid were negative. On March 28, the neonatal weight had grown to 2530g, with no difficulties of breathing and pulse oxygen of 99%, he was discharged.

The common syndrome of COVID-19 are fever, dry cough, sore throat, muscle soreness, shortness of breath, occasional diarrhea and other symptoms [3] [4] [5] . There was no significant difference in symptoms between J o u r n a l P r e -p r o o f pregnant women and non-pregnant women 6 . It should be noted that this case was diagnosed based on multiple nucleic acid tests. For nucleic acid testing, sputum specimens are recommended because the positive rate of sputum(74.4%~88.9%) is higher than that of the nasopharynx swap (53.6%~73.3%) 7 .In treatment, Lopinavir/Ritonavir has been shown to be safe in HIV-infected pregnant women, but due to adverse reactions, we used arbidol instead, which was proven to be safe and effective.

Another important question is whether there is a possibility of intrauterine vertical transmission. Chen 6 .reported the delivery of 9 cases of pregnant women with COVID-19. SARS-CoV-2 tests were performed on amniotic fluid, umbilical cord blood, neonatal throat swabs and breast milk samples from six of these patients. The results were negative. Zhu 8 described 10 neonates in pregnant women with COVID-9, including two cases of vaginal delivery. 9 cases had pharyngeal swab specimens taken 1-9 days after birth for SARS-CoV-2 nucleic acid tests, all of which were negative. Li 9 also reported a 35-week pregnant woman with COVID-19, whose amniotic fluid, cord blood and placenta, breast milk samples as well as neonates swab SARS-COV-2 nucleic acid were all negative. However, Dong 10 reported a case of a neonate by cesarean, whose SARS-COV-2 IgG and IgM were positive 2 hours after birth. Before her born, her mother had been infected SARS-COV-2 for more than 20 days. It is known that IgM antibodies are not transferred to the fetus via the placenta. It seemed that the elevated IgM in the neonate indirectly Thank you very much for giving us an opportunity to revise our manuscript. We appreciate the editor and reviewers very much for their constructive comments and suggestions on our manuscript entitled" No intrauterine vertical transmission in pregnancy with COVID-19：a case report".

Those comments are very helpful for revising and improving our paper.We have studied the comments carefully and made corrections which we hope meet with approval. The main corrections are in the manuscript and the responds to the reviewers' comments are as follows (the replies are highlighted in blue).

Kind regards.

Situation report-1

New coronavirus pneumonia prevention and control program

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

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