VP45.33: A 41‐year‐old multigravida pregnancy with COVID‐19 infection in third trimester: a case of transient deterioration after Caesarean

Abstract

Caesarean section in mothers infected with COVID-19 may linked to clinical deterioration. Physiological changes in the cardiovascular, respiratory, and coagulation systems may lead to increased risk of morbidity. Our case had a transient deterioration after Caesarean. A 41-year-old multigravida (G6P5), without any underlying medical disease, was refered to our centre at 36 weeks of gestation with complaints of fever, dry cough, shortness of breath and myalgia on 19 March 2020. Her husband's nasopharynx swab test became SARS-COVID positive and had mild symptoms. He was isolated at home. She was admitted due to suspected COVID-19 pneumonia. She was normotensive, febrile, and tachypneic on admission. Her chest CT on admission had bilateral patchy ground-glass features, nasopharyngeal swab for SARS-COVID had a positive result. The laboratory investigation showed lymphocytopenia, increased liver function tests and CRP levels. Antepartum monitoring was reassuring. Treatment with diphenhydramin, azithromycin and kaletra was initiated. Within 24h of admission, she developed acute hypoxemia, tachypenea and decreased O2 saturation and non-reassuring fetal heart rate tracing. An emergency Caesarean section was performed, leading to birth of a liveborn girl weighing 3,100g, Apgar score was 8/10 and 9/10 at 1st and 5th minute, her neonate was isolated and referred to neonatal centre and nasopharyngeal swab was SARS-CoV2 negative. Our patient was transferred to ICU after delivery and continued on oxygen support. 24h later, she decompensated and was intubated. Mechanical ventilation was continued for 6 days and then she was extubed and was managed by NIV for 48h, then on Day 11 she was transferred to ward. On Day 13 her general condition improved and was discharged from hospital on outpatient orders. The mother and her neonate remained healthy during follow-up.