13 pregnant patients with COVID-19 ,including four health care workers and five others infected by contacting their families or covid-19 patients, 4 patients with no explicit contacting history just performing obstetrical examinations in hospital during covid-19 outbreak, had a positive result for SARS-COV-2 RT-PCR test at the time of admission. The mean gestational age of the pregnant women who requested to terminate pregnancy is 13.3±5.4 weeks (range from 5.1 weeks to 21.5 weeks), and that is 17±9.2 weeks (range from 5.1 weeks to 31.5 weeks) in those pregnant patients who kept pregnancy (Table 1). Except one patient with hyperthyroidism which were controlled with drugs well, other patients had no underlying medical diseases. Among the 13 patients, most common clinical manifestations were fever (84.6%), cough (61.5%), secondly fatigue (30%) and shortness of breath (23%). One patient (7.7%) had diarrhea with transit disappear of smell. Other 5 patients(38.5%)had no clinical symptoms of COVID-19 pneumonia. In the patients with pregnancy termination, there was no recurrent fever, or aggravative infection symptoms after surgery. The symptoms in all patients completely disappeared 7 days after SARS-COV-2 infection.
As shown in Table 2, only one patient (7.7%) had lower leukocyte count after pregnancy termination surgery. Lymphopenia (<1.0) was observed in five patients (38.5%), and subsequently developed to normal. The level of C-reactive protein is increased in three patients (23.1%) keeping pregnancy. Only one patient (7.7%) had a slight increase in the levels of liver alanine aminotransferase and aspartate aminotransferase at admission. After treatment, leukocyte counts, lymphocyte counts, and c-reactive protein levels returned to normal state in all patients. The abortion patients have no fever and infection. The patients could not discharge from the hospital until they have twice SARS-COV-2 negative tests in row. The course of disease in patients keeping pregnancy is 28.4±9.0 days, while that is 10.7±4.5 days in patients with pregnancy termination, indicating that termination pregnancy reduced the course of disease in patients with COVID-19. 10 patients (76.9%) still have positive results with Ig-G antibody and 4 patients (30.7%) with Ig-M antibody against SARS-COV-2. All patients had no infection with other respiratory virus. Some CT imagines similar to atypical pneumonia, such as “crazy paving sign” “segmental pulmonary consolidation” and “ground glass shadow”, were found in patients’ Lung periphery(see figure 1). Lesions of the lunge infection were all absorbed by CT examination at time of discharge.
All patients received combination therapy(8),including empirical antibiotic treatment, oxygen and symptomatic support therapy. The antiviral treatment was only given to those who demanded to terminate pregnancy. The drugs were used as follows: oseltamivir (75mg every 12h orally), ribavirin(0.25g every 12 hours intravenously), Abidor tablets (200mg three times a day orally). Traditional Chinese medicine, such as Jinyebaidu granules and Lianhuaqingwen capsules, were also administrated to patients keeping pregnancy.
As for maternal and neonatal outcomes, all patients have no intensive care unit admissions during the study period. They were allowed to discharge with following criteria: body temperature returned to normal for more than 3 days, respiratory symptoms improved significantly, pulmonary imagine showed a significant improvement and twice negative nucleic test of SARS-covs-2 in a row. Patient one, whose gestational age was 36 days, had positive pregnancy tests during hospital admission, and exclude a fleshy tissue from the vagina 3 days later. Serial serum human chorionic gonadotrophins rapidly decreased and she was considered to have a very early pregnancy loss. we also investigated the current situation of pregnant patients keeping pregnancy by a telephone follow-up visit. Maternal and fetal outcomes were presented as follow (table 3). All patients were quarantined in designated place for 28 days after discharge, and they have a negative nucleic test of SARS-COV-2 after quarantining. Then, they were followed for 28 to 78 days. We found that two patients were carried by induced abortion, one of whom conducted for social reasons at 13 weeks. Another patient’s fetal was found to have multiple heart and kidney abnormalities. A study was under way on whether abnormal ultrasound signs is related to SARS-COV-2 infection. There were no abnormalities presented in four pregnant women with selective examination such as routine labor examination, systematic ultrasound screening, Non-invasive Prenatal Testing and CMA (Fetal chromosome microarray). Two patients had vaginal delivery successfully two neonates looked vital without respiratory symptoms or fever and tested negative results for SARS-COV-2 infection.