A 36 years old pregnant woman (gravida 2, para 1) diagnosed with COVID-19 at 16+ 1 weeks of pregnancy. She worked as a doctor in a hospital of Wuhan, Hubei province. After a range of treatments including antiviral (Arbidol), antibiotic (Azithromycin), Chinese patent medicine (Lianhua qingwen capsule) and oxygen support during 39 days of hospitalization, she recovered from COVID-19 and was discharged home at 21+ 1 weeks of pregnancy. Reviewing her clinical characteristics, we found the pregnant woman had positive results of IgG antibodies of cytomegalovirus and Epstein-Barr virus, which suggests that she had a history of previous infections with these two viruses. She had no history of adverse pregnancy outcomes, history of consanguinity, family history of congenital defects or adverse drug intake, and had regular antenatal care since conception. Down's screening and fetal nuchal translucency screening results were normal. No structural abnormalities were detected in the first trimester ultrasonographic screening. However, four-dimensional color doppler ultrasound examination at 25+ 3 weeks of pregnancy revealed multiple fetal malformation, including multiple cardiac malformations, bilateral renal cystic changes, short nasal bones, accompanied by low amniotic fluid (the maximum depth of amniotic fluid is 3.17 cm, amniotic fluid index is 5.68 cm), and the impedance of the uterine artery blood flow increased. Furthermore, ultrasound measurement of fetal only 23+ 1 weeks of gestation. The woman chose to medically terminate the pregnancy due to severe fetal anomalies. Induction of labor was done with rivanol and delivered a stillbirth (female, 560 g) along with placenta via vaginal route.
Later fetal autopsy was performed; Fig. 1 shows the gross morphology of the dead female fetus. On examination, the fetus was small for gestational age, as observed in the obstetric ultrasound reported above. In terms of gross findings, head facies and limbs of the fetus were normal. The heart measured 3 × 2.5 × 2 cm, but abnormal anatomical structure appeared in the heart, which manifested as ventricular septal defect, oval hole valve missing and pericardial effusion. Moreover, polycystic changes were observed in both kidneys. Placenta measured 11 × 8 × 5 cm, the gross appearance of the placenta was normal, however, maternal neutrophils was noted on microscopy in the connective tissues of the chorionic plate and membranous chorioamnion, which can be defined as maternal inflammatory response, stage 2 (intermediate) acute chorioamnionitis (Fig. 2). No other obvious pathological changes were noted. Using quantitative RT-PCR, the placenta, cord blood, amniotic fluid, and vaginal secretions were found negative for SARS-CoV-2.