Results:
Our study recorded 45 cases of SARS-CoV-2 infection in pregnant women
over 2.5 years in the gynecology-obstetrics department at HMIMV. The
average age of the patients was 36, and the age group most affected was
20-35 years, accounting for 75% of cases. In terms of comorbidities,
57% of patients had no known comorbidities, 15% had diabetes, and 11%
had obesity. Gestational age at the time of COVID-19 infection was over
28 SA in 35 cases, accounting for 78%, 9 cases were between 28 and 14
SA, accounting for 20%, and only one case was less than 14 SA.
Additionally, 37% of patients had received vaccination against
COVID-19.(Table 1)
In terms of clinical symptoms, 88.8% of patients were symptomatic at
the time of diagnosis, with general symptoms including fever (55.5%),
asthenia (49%), headache (35.5%), myalgia (35.5%), anosmia (28%),
and ageusia (12%). Cough was present in 40% of patients, sore throat
in 13%, and dyspnea in 8.85%. On admission, vital signs were assessed
for all patients, and hemodynamically, all patients had a correct mean
arterial pressure, although tachycardia was noted in 12%. Respiratory
dyspnea with desaturation to room air (Saturation <93%) was
noted in 17.5%. The Glasgow score was 15/15 in all patients.(table 2)
Paraclinical findings from our study revealed that 15.6% of cases
exhibited hyperleukocytosis (WBC > 15000 cells/μL), anemia
was detected in 15% of cases, whereas lymphopenia and thrombocytopenia
in two cases each. CRP was positive (> 10 mg/L) in 36% of
patients, and LDH > 250 IU/l was noted in 22% of cases.
Additionally, creatine kinase levels greater than 170 IU/l were detected
in 4.5% of cases, and ferritin levels greater than 120 mg/l in 6.7% of
cases.
All patients with signs of clinical or biological severity underwent a
thoracic CT scan, with eight patients receiving this evaluation. Of
those, two patients were classified as Corads 2, two as Corads 3, one as
Corads 4, and three as Corads 5.
In terms of management and evolution, the study found that almost 30%
of patients required admission to the intensive care unit, with 60%
requiring oxygen supplementation. Of those patients, 49% received
oxygen via high-concentration mask, 7% via non-invasive ventilation,
and 4% via invasive ventilation. Azithromycin was used as a preventive
antibiotic therapy in 65% of cases, while other antibiotics were
prescribed in the event of signs of superinfection, including
amoxicillin-clavulanic acid (20%), ceftriaxone (13%), and tavanic
(2.2%).
Low-molecular-weight heparin was used as anticoagulation therapy in
51.2% of patients in a preventive dose and 15.5% in a curative dose,
while 33.3% did not receive anticoagulation. The study found that 43
patients had a favorable outcome, but unfortunately, two deaths were
noted. Additionally, two cases did not result in delivery, one due to
abortion and the other due to maternal death before delivery. Of the
deliveries, 20 were Caesarean sections, and 23 were vaginal deliveries.
Over 50% of Caesarean sections were performed due to acute fetal
distress.
Regarding pregnancy outcomes, the study recorded 36 live births (80%),
of which 26 cases (72.2%) required no further care and had a favorable
outcome. Ten cases (27.7%) were hospitalized in a neonatal unit, but
also had a favorable outcome. Unfortunately, there were six cases
(13.3%) of fetal death in utero (FIDU), one case of fetal death
following maternal death, one case of death in a premature newborn, and
one case of early abortion.
Low weight for gestational age was noted in almost 25% of cases. (Table
3)