SARS-CoV-2-induced emergency cesarian section

ABSTRACT

INTRODUCTION: Novel coronavirus disease 2019 (COVID-19) caused by acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a nondiscriminatory highly contagious virus. Although many studies have not concluded vertical transmission of SARS-CoV-2;the high rate of preterm Caesarian section (C-section) is of concern. Presenting symptoms of COVID-19 such as fever, cough, malaise, diarrhea and severe complications of SARS are also apparent in pregnancy. They also demonstrate leukocytosis, lymphopenia and high levels of C-reactive protein (CRP), which is notably higher during pregnancy. Due to minimally reported studies on the effects of SARS-CoV-2 in pregnant patients or their fetuses, we hope to describe events in this case to help guide research towards therapy and complications of pregnancy as a result of COVID-19. METHODS: We present a 25-year-old G2P0010 at 37 weeks gestation, requiring emergency C-section due to complications of acute hypoxic respiratory failure caused by COVID-19. She had complaints of fevers, chills, shortness of breath and feeling less fetal movements over 48 hours. she was febrile, tachycardic with a gravid abdomen. Imaging demonstrated patchy bilateral lung airspace opacities due to multifocal pneumonia. Fetal heart tones were monitored by 1 hour non-stress tests 4 times per day and were within normal limits. Labs were significant for elevated CRP, leukocytosis with lymphopenia and positive for COVID-19. She was started on hydroxychloroquine, azithromycin and ceftriaxone. On hospital day 2, she developed sudden shortness of breath, fever and tachypnea and was intubated for respiratory failure. Shortly after, fetal tachycardia and decelerations were noted on the monitor. Repositioning failed to improve fetal vitals and patient was taken for emergent C-section. The neonate was delivered healthy and tested negative for COVID-19. The patient completed treatment and successful recovered. RESULTS: The complications of COVID-19 in pregnancy has led to miscarriages, premature rupture of membranes, preterm labor and emergency C-sections. Additionally, concerns for vertical transmission of the virus is still being studied as reports are limited. Our case illustrated outcomes of complications, assessments and management of COVID-19 during pregnancy.