REPORT CASE
A 29-years-old woman, 37 weeks of third gravida, two living children,
has been referred to the Department of Gynecology, Obstetrics and
Oncological Gynecology in Bytom due to diagnosed fetal effusion in right
pleural cavity. The pregnancy was complicated by insulin-requiring
gestational diabetes and cervical insufficiency requiring assumption
suture. Due to Rh-negative blood type anti-D immunoglobulin was
administered at the 28th week of pregnancy. At the gestational age of 34
weeks the woman developed a fever (38.0˚C) and general weakness.
Naso-oropharyngeal swab testing for SARS-CoV-2 (RT-PCR) was positive.
As a standard on admission, COVID-19 rapid antigen test was performed
and was positive. A negative RT-PCR test result excluded an active
infection. The ultrasound showed fluid in the right pleural cavity in
fetus with the dimensions of 7.6 x 4.9 cm (Figure 1). Common laboratory
tests showed no significant deviations from the norm. Similarly,
C-reactive protein (CRP) and procalcitonin (PCT) levels were within the
normal range. The patient was negative for antibodies of TORCH
(toxoplasmosis, cytomegalovirus, parvovirus B19, herpes, syphilis,
rubella and HIV). The fetal condition was systematically monitored by
cardiotocography and ultrasound. The patient was asymptomatic throughout
most of this period. At 38+2 weeks of pregnancy a spontaneous vaginal
delivery has occurred and a full-term male newborn was born with a
birthweight 3650g and 6/7/8/9 points Apgar score. The rapid antigen test
for SARS-CoV-2 performed on a newborn was negative. Due to single,
shallow breaths nCPAP breathing support with FiO2 0,40-0,45 was
administered. The ultrasound showed a collapse of the right lung
compressed by fluid in the pleural cavity, heterogeneous echogenicity,
with dominant B-line artifacts. The maximum fluid thickness was 1.7cm at
the base of the lung. A thymus with a heterogeneous structure was also
revealed. The laboratory tests showed negative parameters of
inflammation. The right pleural cavity was drained and 150 ml of the
yellow, cloudy liquid fluid was evacuated. Thereby improvement in
respiratory efficiency was achieved. The microbiological examination
indicated a fluid of a lymphatic nature. The computed tomography (CT)
scan of the chest excluded pathological changes in the mediastinum.
Serological tests ruled out congenital TORCH infection. Diagnostics was
extended to group B Coxackie virus infection, which was negative. The
karyotyping ruled out genetic disorders. On day 7, a continuous infusion
of octreotide was ordered and reduction in lymphorrhea was observed,
until it resolved. RT-PCR tests for COVID-19 were performed twice at
16th and 19th days of life with negative results. After 19 days of
hospitalization and total evacuation of approximately 850 ml of lymph,
the newborn was discharged in good general condition.