Critically ill pregnant patient with COVID‐19 and neonatal death within two hours of birth

Short abstract

COVID‐19 may lead to a sharp decline in blood oxygen, can cause sudden changes in the fetal intrauterine environment, and could possibly result in neonatal death.

While most pregnant women with coronavirus disease 2019 (COVID‐19) appear to experience a milder clinical course, ¹ , ² the present report describes a critical case of COVID‐19 in a pregnant woman. We discuss the identification, diagnosis, disease progression, and treatment outcome in a 31‐year‐old pregnant woman admitted to Xiaolan People’s Hospital of Zhongshan at 35+2 weeks of pregnancy with no known comorbidity or history of chronic illness. Onset of symptoms in the patient began with a sore throat and dry cough for 4 days, followed by fever and dyspnea for half a day. The timeline of the patient’s disease history and illness progression is shown in Figure 1. The patient experienced rapid aggravation of the disease. Emergency cesarean delivery was performed at the bedside, but the neonate died within two hours of birth (Fig. 2).

Figure 1.

Timeline of disease history and illness progression in a critically ill pregnant patient with COVID‐19.

Figure 2.

Fetal heart monitoring results and neonatal information on February 1, 2020.

Although the patient had no history of chronic disease, the severity of COVID‐19 increased rapidly—from dyspnea to acute respiratory distress syndrome and septic shock within 12 hours. The patient’s condition worsened, with persistent decreases in white blood cell and lymphocyte counts. Inflammation indicators of C‐reactive protein, procalcitonin, and interleukin 6 all increased significantly, whereas peripheral oxygen saturation level decreased progressively. Given these circumstances, white blood cell and lymphocyte counts of COVID‐19 patients should be monitored closely. Changes in lymphocyte counts and oxygen saturation, blood gas analysis, and pulmonary inflammation imaging should be assessed as early biomarkers for predicting the prognosis of critically ill patients with COVID‐19.

Infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) caused this pregnant patient to suffer multiple organ dysfunction, including heart, liver, and kidneys. Although the patient was managed using timely systematic treatment and salvage therapies, the neonate died within 2 hours of birth. This may be due to the rapid deterioration in maternal condition, which eventually led to the death of the neonate. This case may also suggest that COVID‐19, which leads to a sharp decline in blood oxygen, can cause sudden changes in the fetal intrauterine environment and possibly result in neonatal death.

The possible severe complications of SARS‐CoV‐2 infection may cause neonatal death because the inflammatory storm caused by the infection triggers a systemic immune response, ³ which may also attack fetal organs. Biochemical examination of umbilical cord blood at birth revealed a marked increase in myocardial enzymes, suggesting that the fetal myocardium was severely damaged. Considering the severe hypoxia, the possibility of immune damage cannot be ruled out, which may have led to difficulty in resuscitation and eventual death of the newborn. Critical cases due to maternal hypoxia and unstable circulation may endanger the fetus for a short period of time and may cause fetal death in utero.

AUTHOR CONTRIBUTIONS

JL, YW, BL, SH, DC designed the study. JL, YW, TS, XP, MW, FH, LH were responsible for data collection and interpretation. YZ drafted the manuscript. JL, YW, BL, SH, DC made essential revisions.

CONFLICTS OF INTEREST

The authors have no conflicts of interest.