Case Report: COVID-19 in a Third-Trimester Pregnancy

Monique A. Rainford, MD; Katherine H. Campbell, MD, MPH

Disclosures

May 09, 2020

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Initial Presentation

A 26-year-old pregnant woman (gravida 3 para 1011) at 38 weeks and 3 days' gestation telephoned an acute care service after having a cough for 3 days. She also reported shortness of breath that was worse from baseline when she coughed. She described fatigue but stated that it was no worse than usual during her current pregnancy.

The patient's medical record was reviewed. Five days prior to her telephoning acute care services, the patient canceled a scheduled iron infusion because she felt unwell. At that time, she described having nausea and diarrhea without vomiting. She attributed these symptoms to eating an undercooked meat sandwich. The patient visited her obstetrician at a primary care site the next day. She received iron infusion therapy the day following that visit. Her cough began the day after her infusion therapy, 2 days prior to her telephone call to acute services. The patient had taken her temperature on multiple occasions and remained afebrile.

The patient's obstetric history was notable for a prior spontaneous vaginal delivery and anemia during her current pregnancy, which was being treated with iron infusions. She had a history of a positive purified protein derivative test result 3 years prior but had a subsequent negative QuantiFERON-TB Gold test result. Her social history was significant for known COVID-19 exposure.

Five days prior to the patient phoning acute care services, she attended a religious ceremony. She discovered that one of the attendees tested positive for COVID-19 4 days after that religious event. The patient had subsequent exposures to family members of the individual who tested positive, including a mother and a preschool-aged child. She was within 6 feet of the child and approximately 6 feet from the mother of the child. The patient's husband, who also attended the religious event, developed a cough on the same day as the patient. He developed a fever that reached 100.6° F (38.1° C). Their 20-month-old daughter developed a cough but remained afebrile.

Diagnosis of COVID-19

Upon receiving the patient's call, acute care triage notified the on-call obstetrician. After further consultation with an established COVID-19 hospital hotline and the team at the outpatient facility, the patient and family were recommended to undergo testing for COVID-19 infection. The acute care physician, the pediatrician, and an obstetrician met the family in the ambulance bay at the outpatient facility the following day. All team members donned full personal protective equipment (PPE). Multiple nasopharyngeal and oropharyngeal swabs were taken for each of the three family members. One set was sent to an institutional investigational lab and another was sent to a commercial lab, both for polymerase chain reaction testing. A third set of samples was sent to the commercial lab for a respiratory viral panel.

The obstetrician checked fetal heart tones, which were normal, and verbally assessed the patient. Positive results from the investigational lab for the patient and husband were received the day after the samples were obtained, and the couple was informed. Confirmatory test results were received 5 days later and were also positive. The child's investigational test and confirmatory nasopharyngeal swab results were both negative; however, her oropharyngeal swab was positive. The patient was contacted by telephone and informed of these results.

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