ABSTRACT
Case Report: Since the beginning of the Coronavirus Disease 2019 (COVID-19) pandemic, there has been much work to understand the negative effects of SARS-CoV-2 on tissues expressing the Angiotensin Converting Enzyme-2 (ACE2) receptor, including the placenta. However, there is limited information regarding placental pathology findings in mothers with COVID-19 and the effects of SARS-CoV-2 on the placenta. The available research reports effects on the fetus ranging from minimal to intrauterine fetal demise. Case Description: A 4680g baby boy was born at 38+1 weeks of gestation to 36y old G4P1021 female via repeat cesarian section. The pregnancy was complicated by advanced maternal age, chronic hypertension with superimposed pre-eclampsia with severe features, BMI of 80, and SARS-CoV-2 infection. The mother had mild COVID-19 symptoms and did not require hospitalization or oxygen support. Prenatal ultrasounds were limited due to body habitus. At the time of delivery, there was clear amniotic fluid. Upon delivery the infant was cyanotic and limp and was brought to the warmer immediately. Non-invasive positive pressure ventilation was initiated at 5 minutes of life with improvement in infant color and oxygen saturation. He was then admitted to the Neonatal Intensive Care Unit (NICU). APGARs were 2, 3, 5, and 7 at 1, 5, 10, and 15 minutes respectively. Cord gases showed severe metabolic acidosis. The patient was diagnosed with hypoxic-ischemic encephalopathy (HIE) and therapeutic hypothermia was initiated. Both the NICU and obstetric teams were unable to identify a clear perinatal cause of HIE in this patient. Later, the placenta pathology report revealed a large placenta for estimated gestational age corresponding to the 75th percentile, villous parenchyma with focal chorangiosis and thrombi, with unremarkable fetal membrane and three vessel umbilical cord. The cause of HIE was then thought to be due to the placental thrombi likely caused by SARS-CoV-2 infection. Discussion(s): Fetal vascular malperfusion and fetal vascular thrombus have been noted as a common finding in the placentas of pregnant women who test positive for SARS-CoV-2. There are various causes of HIE, from maternal, placental and fetal factors. This patient had no clinically evident hypoxic event, but information was limited due to the lack of monitoring of the fetus in utero. Given the mother's SARS-CoV-2 infection and the placental pathology findings, it is likely that the cause of this patient's HIE was related to the effects on the placenta from SARS-CoV-2. Conclusion(s): As more information comes to light about the effects of SARS-CoV-2 on the placenta, it is important to consider a maternal SARS-CoV-2 infection during pregnancy as a cause of HIE in a newborn.
ABSTRACT
Purpose of Study: Pregnant women are at considerable risk for SARS-CoV-2 infection with adverse maternal and neonatal outcomes. Mother-to-child-transmission can occur, in-utero, perinatally or postnatally with significant complications in the newborn. Little is known on impact of SARS-CoV-2 on newborn infants. Our objectives were to describe maternal and neonatal outcomes among those with SARS-CoV-2 infection since beginning of the pandemic. Methods Used: This was a retrospective review of data from a single center with level III NICU from April 2020 through March 2022 in Los Angeles, CA. The study included pregnant women who were screened at delivery and/or during pregnancy and tested positive with PCR test. Data of these women and their infants were reviewed from medical records. Institutional IRB approval was obtained to review the data. Summary of Results: During the study period 152 mothers were SARs-CoV-2 positive in pregnancy or at delivery. Maternal risk factors included obesity (13.2%), pre-eclampsia (15.1%) and diabetes (19.7%). Fourteen (9.2%) were symptomatic for 0-7 days prior to delivery predominantly with cough, fever and myalgia. Majority (58.7%) delivered vaginally. SARS-CoV-2 exposed infants had a median gestational age of 38.3 weeks;35 (23%) were preterm. Median birthweight was 3120 grams and 32 infants 31 (20.5%) were low birthweight. Thirty-one (20.4%) infants needed resuscitation at delivery. Common symptoms for infants included respiratory symptoms (22.4%), hyperbilirubinemia (15.1%) and hypoglycemia (7.2%). Sixty-eight infants (44.7%) required admission to NICU. Majority of the infants (130) had PCR tests at 24 hours and 48 hours if still hospitalized. Five (3.8%) were PCR+: 4 at 24 hours and 1 at 48 hours. Another 5 infants had positive PCR for SARS-CoV-2 in infancy. Conclusion(s): SARS-CoV-2 infection was present at delivery in a significant number of pregnant women with 3.8 % of their infants. Although a majority of women were asymptomatic at the time of delivery, there was significant morbidity among women with pre-eclampsia and diabetes. Newborn morbidity included prematurity, low birth weight and respiratory distress even in PCR- newborns. These data emphasize the need for screening all pregnant women for SARS-CoV-2 at delivery, and close monitoring of mother-infant dyad if infected. Vaccination of pregnant women should be encouraged.