Interpretation
Coronaviruses (CoV) are a large family of viruses that cause a variety of diseases, from the common cold to more serious diseases such as the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Human beings can also be infected by inhalation of droplets scattered from the respiratory tract of the sick individuals or by contact with the surfaces contaminated with these aeroceles(7). Eighteen of our patients (45%) had a contact with people whom had a history of the disease. Current evidence suggests that the severity of disease among pregnant women after COVID-19 infection is similar to non-pregnant adult COVID-19 cases, and there is no data showing that infection with COVID-19 during pregnancy has a negative effect on the fetus. So far, there is no evidence that vertical transmission from mother to baby during pregnancy (8).In our study, no vertical transition was detected as no Infant had positive PCR test.
In 2002-2003, there was a high maternal mortality rate in the SARS-CoV-1 outbreak (9). However, there has not been a similar situation in SARS-CoV-2 yet. However, more studies are needed on this subject. Looking at the current studies, it seems difficult to make clear comments. (10-12). In Turkey, as of June 2, the overall mortality rate of the disease is 2.76 %, and there are no published articles showing maternal mortality rates in pregnant women with COVID-19 (6). Similarly, no maternal and fetal death has been observed in our hospital too.
In terms of clinical findings in patients, the common symptoms at baseline were cough, fever, and difficulty breathing, and the rate of asymptomatic patients was 22 (13, 14). Similar to current studies, laboratory tests were observed as low lymphocyte count, increased CRP and D-dimer (15, 16).
The relatively high mortality of COVID-19 is making people feel anxious. Most of the women had c-section in our study similar to the literature(17). The most common c-section indication was maternal request. This was followed by difficulty breathing and anxiety.
Lung CT findings are important for the diagnosis of pneumonia in pregnant women with COVID-19. In patients who had mild involvement in CT, multiple patchy frosted glass areas are peripherally located rather than parenchyma, and lesions increased as the disease progresses. According to the study conducted by Li M et al., extensive pulmonary consolidations are observed in cases of severe involvement, ”white lungs” may appear on the radiogram, but pleural effusion is rare(18).
In treatment, hydroxychloroquine is usually used in combination with a second-generation macrolide. There is not enough data to know if it has a role in treatment, but it is widely used. It can also cause QT prolongation and ventricular arrhythmias, which may pose a certain risk for critical patients (19). Among the 40 patients we studied, no cardiac side effects related to drug use were observed. In addition, heparin has been suggested to be added into treatment by some specialized consensus due to the risk of disseminated intravascular coagulation and venous thromboembolism. Heparin treatment has been related to well prognosis, mostly in severe COVID-19 cases with high D-dimer concentrations (20). Lopinavir, another treatment option, is a protease inhibitor used to treat HIV in combination with ritonavir. In one of the randomized study with 199 patients by Bin Cao et al., 99 of these patients were evaluated in the group receiving lopinavir-ritonavir and 100 in the standard care group. According to this study, it was observed that there was no additional benefit of lopinavir-ritonavir treatment beyond standard care in adult patients diagnosed with heavy Covid-19 (21).Oseltamivir is an approved neuraminidase inhibitor for the treatment of influenza. Since the epidemic in China occurred during the peak season of influenza, oseltamivir was added to the treatment of patients. In fact, this agent has no role in the treatment of COVID-19 after influenza has been excluded (22). We applied LMWH and hydroxychloroquine to pregnant women as standard treatment. We observed one of our patients without treatment because she was asymptomatic and laboratory values were normal. Initially, we added oseltamivir to the treatment of 7 patients due to the seasonal period. We used lopinavir/ritonavir treatment in patients who needed oxygen therapy and had severe involvement findings on lung CT. We have created our treatment algorithm according to the ”COVID-19 guide”, which is updated regularly by our health ministry since the disease first appeared in our country. Changes in treatments arise from this. (23).