Virginia Research Day 2021

Medical Resident Research Case Reports

21 COVID-19 Postpartum

Andrew Doyle, DO; Leonard Beaver, MD; Fatima Guzman-Gawel, MD Corresponding author: michael.moore1@LPNT.net

SOVAH Health Family Medicine Residency Program

Context: Maternal infections carry serious risk for the mother and the unborn child. The Covid-19 pandemic has added further to pregnancy risk. Case Report: A G1,P0 morbidly obese 27-year-old African American female presented to Labor and Delivery at 38 4/7 weeks gestation with gestational hypertension to rule out pre-eclampsia. Pertinent Review of Symptoms: Several days reduced taste, leg swelling, ample fetal movement, but no cough, shortness of breath, fever, chills. Past Medical History (Hx): Gestational hypertension and anemia, pre- diabetes, morbid obesity, asthma, eczema, & fibroids. No allergies or medications. Social Hx: Lives at home with her partner. Her mother and grandmother had been admitted to hospital for Covid-19. Smoked in the past. Denied alcohol and illicit drug use. Pertinent Physical Exam: Vitals: (Admission) BMI 55.5 kg/ m2, Temp 101.8, pulse 102, respirations 25, blood pressure 168/71, lungs clear, uterine fundus palpable at xiphoid process, 3+ bilateral pedal edema, fetal heart tones 150s with moderate variability. Pertinent Labs: Group B Streptococcus positive, UA: +1 protein, +3 blood, WBC 9.46, Hct 36.1%, D-dimer post-partum 2.98.

Treatment: She was found to be Covid-19 positive incidentally on admission and underwent a C-section the following day (due to a non-reassuring fetal heart tracing) with no complications. Four days post-partum, she developed hypoxia; seven days post-partum, she required ICU ventilator support. She received Covid convalescent plasma, intravenous remdesivir, ceftriaxone, piperacillin/ tazobactam and enoxaparin for with concern for thromboembolism. After 7 ventilator days, she was extubated and subsequently discharged on aspirin 81mg, ferrous sulfate 300mg BID, and daily rosuvastatin 10 mg, amlodipine 5mg, zinc sulfate 220 mg, hydrochlorothiazide 25 mg, ascorbic acid 500 mg, cholecalciferol 5,000 units, and to complete an oral course of cefdinir 300 mg BID, and azithromycin 500mg daily. Baby initially had respiratory distress and required oxygen for 72 hours before successful weaning. Its chest x-ray had transient tachypnea of a newborn. Ampicillin and gentamycin were initially begun but stopped at discharge. Baby’s tested Covid negative x 2.

coronavirus that has yet to be fully understood. Covid risk factors for poor outcome include increased age, obesity, cardiovascular disease, lung disease, diabetes, and smoking. In pregnant women, the most prevalent symptoms are cough, headaches, myalgias, fever, throat soreness, and dyspnea. Pregnant women have an increased risk of complications from Covid-19 compared to their non-pregnant counterparts, and are more likely to require ICU admission, require mechanical ventilation, and to die. Covid treatment during pregnancy include maintaining oxygen saturations above 95% to ensure fetal oxygenation, placing the mother in the left lateral decubitus position with proper padding above and below the uterus, and remdesivir. Hydroxychloroquine has not shown to be efficacious in Covid 19 pregnancy infections, and it has been shown to cross the placenta.

Diagnosis: Postpartum maternal covid-19 pneumonia. Comment: Covid-19 is a novel

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