Abstract
There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the
literature, most of them with a mild illness course. There is limited evidence about
in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a
history of previous cesarean deliveries and diabetes mellitus presented with a 4-day
history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal
swab was positive for COVID-19, COVID-19 serology was negative. The patient developed
respiratory failure requiring mechanical ventilation on day 5 of disease onset. The
patient underwent a cesarean delivery, and neonatal isolation was implemented immediately
after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal
swab, 16 hours after delivery, was positive for severe acute respiratory syndrome–coronavirus
2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M
and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum
day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during
pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate,
raising the concern for vertical transmission. We suggest pregnant women should be
considered as a high-risk group and minimize exposures for these reasons.
Key Points
-
We report a severe presentation of COVID-19 in pregnancy requiring invasive ventilatory
support.
-
This is a case of positive RT-PCR in first day of life, suggesting possible vertical
transmission.
-
There were no detectable maternal antibodies for COVID-19 until after delivery.
Keywords
COVID-19 - coronavirus - neonate - pregnancy
