Vertical Transmission in Severe COVID-19 Pregnant Patients

According to the literature extracted, few cases of pregnant women with COVID 19, most of them had a mild illness. There is limited evidence about in utero infection and early positive neonatal infection. However, one case has come to light about a 41-year-old woman with a history of previous cesarean deliveries and a known case of Diabetes Mellitus with the clinical presentation of malaise, low-grade fever, and progressive shortness of breath.

A nasopharyngeal swab was positive for COVID-19 while COVID-19 serology was negative. The patient developed respiratory failure requiring ventilation on day 5 of disease onset. The patient underwent cesarean delivery and neonatal isolation was implemented immediately after birth without delayed cord clamping and skin-to-skin contact.

The neonate was tested after 16 hours of delivery and was positive for SARS CoV-2, Real-Time- Polymerase Chain Reaction (RT-PCR). Also, IgM and IgG for SARS CoV-2 were negative whereas maternal IgM and IgG were tested positive on postpartum day 4. This case was reported as a severe presentation of COVID 19 in pregnancy. As per the evidence, this is the earliest positive PCR in this neonate which is raising the concern of vertical transmission during pregnancy.

Also, it is important to note, that this severe presentation of COVID 19 in pregnancy required ventilatory support and intervention. This is a case of positive RT- PCR in the neonate, on the first day of life which suggests possible vertical transmission.

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