Azathioprine/prednisolone

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 31-year-old woman developed COVID-19 infection during treatment with prednisolone and azathioprine for systemic lupus erythematosus during pregnancy.

The pregnant woman, who had hypertension and systemic lupus erythematous, had been receiving prednisolone and azathioprine [dosages and routes not stated]. In March 2020, she was scheduled for labour induction at 38 weeks and 1 day of gestation. Concomitantly, she had been receiving methyldopa for hypertension, and aspirin [acetylsalicylic acid] for pre-eclampsia prophylaxis till 36 weeks of gestation. Antenatal ultrasound scans at 28, 34 and 36 weeks of gestation revealed normal fetal biometry with an estimated fetal weight of the 16 percentile. However, she developed progressive cough. The PCR of oropharyngeal sample confirmed COVID-19 infection before the scheduled delivery. The diagnosis of COVID-19 infection secondary to immunosuppressive therapy was confirmed.

In order to avoid the risk of maternal respiratory distress, the woman was admitted to an isolated zone in delivery ward for scheduled delivery. The results of physical examinations were as follows; temperature 37.2°C, HR 82 beats/min, BP 141/88mm Hg, RR 12 breaths/min and transcutaneous saturation 99% by a FiO₂ 0.21. Laboratory findings were normal. She received unspecified epidural anaesthesia and oxytocin to assist labour. Also, she received unspecified corticosteroid 100mg in 30 minutes as a part of corticosteroid stress dose scheme. PCR samples during different stages of labour revealed no signs of vertical transmission. Eventually, she delivered a healthy female neonate with a birth weight of 2880g (13 percentile), arterial-umbilical pH 7.19 and Apgar score of 9/10 at 5 and 10 minutes, respectively. There were no signs of congenital abnormalities and neonatal COVID-19 infection. Anti-Sjogren's antigen A/B tests were negative. Twelve hours following the delivery, she was discharged. At a follow-up after one week, she continued to experience coughing and mild dyspnoea. Four weeks following the delivery, all her symptoms resolved.