A Case of 2019 Novel Coronavirus.txt

On 2 February 2020, a 28-year-old female, who was 30 weeks pregnant, presented to a fever clinic of Suzhou Municipal Hospital with intermittent fever for 1 week. She disclosed that she had returned to Suzhou on 24 January after traveling to visit family in Wuhan 3 weeks previously. Given the patient’s travel history and fever, 2 throat-swab samples were collected and tested negative for SARS-CoV-2 with the Chinese Center for Disease Control and Prevention–recommended kit (BioGerm, Shanghai, China), following World Health Organization guidelines for quantitative RT-PCR. Chest computed tomography (CT) scan on 4 February demonstrated left-sided subpleural patchy consolidation and right-sided ground-glass opacities (Figure 1A). The patient then went into isolation at that hospital. On 6 February the second SARS-CoV-2 RT-PCR results of her sputum came back positive, so she was then transferred to the intensive care unit (ICU) in a negative-pressure isolation room of the Affiliated Infectious Hospital of Soochow University, the designated medical center for COVID-19 in Suzhou. On admission, the physical examination revealed a body temperature of 36.2°C, blood pressure of 95/64 mm Hg, pulse of 92 beats per minute, respiratory rate of 22 breaths per minute, and oxygen saturation of 97% with a facial mask at 5 L per minute of oxygen. Other laboratory findings included a leukocyte count of 10.60 × 109 /L, neutrophils of 9.14 × 109 /L, lymphocytes of 0.86 × 109 /L, albumin of 24.6  g/L, C-reactive protein of 19.6 mg/L, D-dimer of 840 μg/L, procalcitonin (PCT) of 0.288 ng/mL, lactate dehydrogenase (LDH) of 544 U/L, and N-terminal probrain natriuretic peptide (NT-proBNP) of 318 pg/mL. Levels of creatinine and aminotransferase were within normal limits. A  fetal ultrasound revealed a normal intrauterine fetus with normal anatomy of approximately 30 weeks of gestational age. Since SARS-CoV-2 is a newly identified virus, it remains unknown whether viral shedding during delivery occurs or vertical transmission exists. Several multidisciplinary consultations were performed, concluding that given the current situation, in particular the CT scan and low levels of lymphocytes and albumin, the patient’s condition might deteriorate at any time, and she was at risk of preterm birth. After emergency scenarios for the patient, treatment with Arbidol tablets (Suzhou Pharmaceutical Factory) (0.2  g administered orally every 8 hours), lopinavir and ritonavir tablets (400/100  mg administered orally every 8 hours), cefoperazone sodium and sulbactam sodium (3.0  g administered intravenously every 8 hours), and human serum albumin (20  g administered intravenously every day) were initiated; dexamethasone and magnesium sulfate as prophylaxis for the fetus were given; and an emergency cesarean section was prepared. On hospital day 3 morning (8 February), a repeated chest CT scan showed bilateral multiple ground-glass opacities (Figure 1B), a finding consistent with severe atypical pneumonia. In the afternoon, fetal movement and variability in fetal heart rate monitoring were not detected, and no improvement was shown on noninvasive ventilation for 4 hours. After a multidisciplinary consultation was performed and informed consent was obtained, an emergency cesarean section under combined spinal-epidural anesthesia was performed, with an estimated blood loss of 200  mL, in a designated negativepressure isolation room; all personnel involved wore protective gear, including gown, a N95 mask, eye protection, and gloves. A preterm male infant weighing 1.83 kg was delivered uneventfully, with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively. He was kept in the isolation ICU of the neonatal nursery for observation without any contact with his mother after birth. The newborn was given formula instead of breast milk. During the delivery, samples of amniotic fluid, placenta, umbilical cord blood, gastric juice, and throat swabs of the infant were obtained for SARS-CoV-2 RT-PCR tests, and all results were negative. On day 3 after cesarean section (11 February), RT-PCR analyses of the neonatal throat swab and stool samples were negative. On 15 and 17 February, throat swab RT-PCR tests of the mother and the infant were negative. Three chest CT scans of the mother on 12, 15, and 18, respectively, demonstrated resolution of infiltrates of both lung fields (Figure 1D, E). All healthcare workers in contact with the infant during his delivery and subsequent care remained asymptomatic. The patient and her infant had an uneventful postpartum and neonatal course.