Original article: Dehan Liu, Lin Li, Xin Wu, Dandan Zheng, Jiazheng Wang, Lian Yang, Chuansheng Zheng, Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis, 18.03.2020, AJR Am J Roentgenol.
Author of Summary: Gabriella Assante; Reviewer: Caroline Benski
Original Article Published on March 18th, 2020
This study describes the clinical manifestations and the CT of 15 pregnant women with COVID 19 pneumonia, by monitoring the changes before and after the delivery between January 20 to February 10, 2020, in order to provide some guidelines for the treatment.
Basing on the WHO guidelines, chest CT was performed on a commercial MDCT scanner by using a tube voltage 120kVp with automatic tube modulation for the CT acquisition. In order to evaluate pulmonary involvement along with all the abnormalities, a semiquantitative CT scoring system was using. Each of the five lung lobes was scored according to the following parameters:
- 0 = no involvement;
- 1= less than 5% involvement;
- 2= 25% involvement;
- 3= 26–49% involvement;
- 4= 50–75% involvement;
- 5= more than 75% involvement.
The total CT score was the sum of the five individual lobar scores and ranged from 0 (no involvement) to 25 (maximum involvement). Furthermore, the disease progression according to CT images was divided into four stages:
- early stage (stage 1)
- progressive stage (stage 2)
- peak stage (stage 3)
- absorption stage (stage 4)
At the time of admission, all the women between 23 and 40 years old and 12 and 38 gestational weeks, were positive for SARS-CoV-2 and presented a mild pneumonia.
Three patients had underlying diseases such as thalassemia and gestational diabetes, mitral and tricuspid valves replaced ten years earlier or complete placenta previa. All the women were given oxygen support from admission and achieved good recovery without mechanical ventilation.
The most common onset symptoms were fever and cough as also lymphocyte count reduction. Two patients showed no clinical symptoms but SARS-CoV-2 infection was suspected of contact history. In these two patients and lesions were detected on subsequent chest CT despite of a suspicious laboratory test for COVID19.
One patient delivered vaginally and 10 patients delivered by cesarean section. Three patients delivered by cesarean section at 34– 36 weeks because of the belief that antiviral treatment was needed as early as possible in the disease course. Apgar scores of all neonates were 8 or greater, and there were no cases of neonatal asphyxia or neonatal death. All the data are presented in the following table.
Furthermore, the fact that only the patient with really high temperature was able to deliver naturally is evidence that there is a potential role for natural delivery in pregnant women with mild COVID-19. During the treatment of all patients in this study, no aggravation of pneumonia symptoms due to childbirth or pregnancy was found. After treatment, the quantitative RT-PCR result for SARS- CoV-2 was negative, clinical symptoms disappeared, and laboratory values returned to normal levels.
Chest CT plays an important role in the diagnosis and treatment of COVID-19 pneumonia. Because pregnant patients could be particularly sensitive to exposure dose, some patients in our study underwent only one CT examination. Before CT examinations, the patient’s lower abdomen and pelvis were covered with a lead blanket. The low-dose imaging mode was used for all 25 CT examinations, and the dose for a single examination was kept safe (mean ± SD, 4.1 ± 0.9 mGy) .
With the progression of disease course, chest CT showed GGOs, crazy paving pattern, and consolidations, followed by gradual absorption. Most of the lesions were seen in the lower lobes of both lungs.
Patient 7 had no change in CT scores before and after delivery, but the CT scans showed stage 3 and stage 4 of the disease phases, respectively, and the lesions were partially absorbed during treatment. For patient 11 with an elevated CT score after delivery, the first CT study showed findings that matched the characteristics of stage 1, whereas the second CT study showed findings that were rated as stage 4 instead ; these CT findings are consistent with the time course of the disease according to the Table 3.
Overall, the pregnant women with COVID-19 pneumonia presented with clinical manifestations and CT features of mild pneumonia. No SARS-CoV-2 infection was found in the neonates. Pregnancy and delivery did not aggravate the severity of COVID-19 pneumonia.