Results
Eight of the pregnant women aged at 25-31years, all of them were at the third trimester, two of them were multipara, six of them were primipara. The time from onset to delivery were 2-8 days. Case 3 complicated with mild anemia and thrombocytopenia, the platelet count was 90G/L, case 8 complicated with premature rupture of membranes, case 2 and case 5 complicated with mild anemia(table 1). Three of the eight pregnant women had pneumonia related symptoms, case 1 had dry cough, case 5 had intermittent fever and general weakness on the third day before delivery, the maximum body temperature was 38 degrees, the body temperature was normal at the time of delivery, case 6 had fever and dry cough from a week before delivery, the maximum body temperature was 39 degrees, and she was still febrile at the time of delivery. The oxygen saturation of all eight prenatal pregnant women was higher than 93% in resting state, no one had shortness of breath. According to the 7th edition of New Coronavirus Pneumonia Prevention and Control Program[6], there was no pneumonia changes on lung CT in case 3,7,8, they were mild cases, the rest five cases were normal cases(table 1). Case 6 had a maximum body temperature to 40 degree, with severe cough, needed high flow rate of oxygen to maintain oxygen saturation, and the lowest oxygen saturation was 90% at rest. Her pneumonia aggravated after childbirth and became a severe case. Four days after delivery, her pneumonia gradually started to improve, body temperature and cough were getting relieved, oxygen saturation turned normal at rest. Pneumonia in the rest seven puerperants was not getting worse after childbirth. In laboratory examination, there were 6 cases(case1,2,4,5,6,7) of lymphocytopenia and 2 cases(case5,6) of leukocytopenia. Pregnant women who were hospitalized before March 2020 were not able to carry out the detection of SARS-COV-2 IgM/G when they were in hospital,case 3, case 7 and case 8 were positive for SARS-COV-2 IgM/G(table 1).
In all eight cases labor progressed smoothly. Postpartum hemorrhage was defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process [7]. The amount of bleeding was evaluated by weighing method and comparison of hemoglobin before and after delivery[8]. No postpartum hemorrhage occurred(table 2). In order to deliver the fetuses as soon as possible to reduce the risk of mother to child transmission of the SARS-COV-2, perineum lateral resection was performed in all the patients except the multipara in the second stage of labor.
Case 6 experienced wound healing complication, the incision of perineum was split after the suture was removed, and it healed one week later. To other patients with lateral incisions, sutures were removed on the 5th day postnatal, and healed well(table 2). Hospital discharge standards[6] included patients with no fever for 3 days or more, no obvious self-conscious symptoms, negative SARS-COV-2 PCR twice in a row, obvious absorption of pulmonary inflammation on CT. The hospital stay of all eight patients were 4-23 days(table 2).
Eight livebirths were recorded, no perinatal death, no low birth weight no fetal distress was observed, case 6 had Amniotic fluid stained with feces. All eight livebirths had a 1-min Apgar score of 8 and a 5-min Apgar score of 9 (table 3). Throat swabs and anal swabs of all the newborns were negative for the presence of SARS-CoV-2. Six of the newborns were sent to neonatology department for medical observation, the length of stay were 3-15days. Newborn 5 and newborn 6 had pneumonia during hospitalization(table 3).
Seven of the family accepted follow-up after a month since they gave birth, case 3 accepted follow-up on call only. No maternal and newborn deaths were recorded, case 6 reported to have dry cough occasionally, no abnormal or vaginal bleedings were reported(table 4,5). Detection of SARS-CoV-2 nucleic acid in throat swabs of all the seven parturient women were negative. SARS-COV-2 IgM/G was positive in the venous blood of case 5 and case 6. Case 7 and case 8 had positive results of SARS-COV-2 IgG , the other five were negative(table 4). All the eight infants were gaining weight and no infant was hospitalized again. All the seven infants’ throat swabs and anal swabs were negative for SARS-COV-2 nucleic acid detection, and SARS-COV-2 IgM/G were all negative in venous blood.