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.