妊娠合并新型冠状病毒肺炎28例临床特征及预后分析

Clinical characteristics and prognostic analysis of COVID-19 infection in 28 pregnant women

目的探讨妊娠合并新型冠状病毒肺炎(COVID-19)患者的临床特征及其预后。方法回顾性分析2020年1月30日-2020年3月14日,由新疆援鄂医疗队负责在武汉大学人民医院东院产科收治的28例妊娠合并COVID-19肺炎患者的临床资料,总结其临床特征及预后。结果28例患者中,18例确诊病例,10例临床诊断病例,所有病例均为普通型。平均年龄(29.75±3.5)岁。有明确流行病学接触史者占17.9%。早期妊娠组4例,中期妊娠组4例,晚期妊娠组20例。晚期妊娠组平均住院天数为(13.4±9.1)d。有症状者占46.4%,其中早、中、晚期妊娠组分别占75%、75%、35%。临床症状以发热、咳嗽多见,少见症状包括胸闷、呼吸困难、腹泻、肌痛等。妊娠合并COVID-19肺炎患者,白细胞升高者占25%,中性粒细胞升高者占42.9%,淋巴细胞下降者占39.3%,降钙素原升高者占11.5%,谷丙转氨酶升高者占8%,谷草转氨酶升高者占12%。所有妊娠晚期患者胸部CT检查均有不同程度的斑片状磨玻璃影,呈间质性改变,符合病毒性肺炎改变。所出生的17名新生儿均为咽拭子筛查COVID-19病毒阴性,其中3例早产。14名新生儿中的13名1 min、5 min、10 min的Apgar评分分别为9、10、10分,另1名为7、9、9分。结论妊娠合并COVID-19肺炎患者中重症率及死亡率均不高。妊娠合并COVID-19肺炎患者的临床症状与非妊娠成年人相似。在晚期妊娠合并COVID-19肺炎患者中目前没有母婴垂直传播的证据。仍需继续追踪研究早中期妊娠合并COVID-19肺炎患者的临床结局。

Objective To investigate the clinical characteristics and prognostic analysis of Coronavirus Disease 2019(COVID-19)infection in 28 pregnant women.MethodsThe clinical data and prognosis of the 28 pregnant woman with COVID-19 admitted to Department of Obstetrics,East Hospital of People′s Hospital of Wuhan University from January 30,2020 to March 14,2020 were analyzed retrospectively.ResultsAmong the 28 cases,18 cases were confirmed,10 cases were clinically diagnosed,and all cases were normal type.The median age was(29.75±3.5)years.The proportion of patients with clear epidemiological history of exposure was 17.9%.There were 4 cases in the early pregnancy period,4 cases in the middle pregnancy period and 20 cases in the late pregnancy period.The average length of stay in the third trimester period was(13.4±9.1)days.The proportion of patients with symptoms was 46.4%,of which the early,middle and late pregnancy groups accounted for 75%,75%and 35%,respectively.The clinical symptoms were fever and cough,and rare symptoms included chest tightness,dyspnea,diarrhea,and myalgia.In the pregnant women with COVID-19 pneumonia,the elevation of white blood cell(WBC)was 25%,neutrophil was 42.9%,lymphocyte was 39.3%,procalcitonin was 11.5%,alanine transaminase was 8%,and aspartate transaminase was 12%respectively.All the patients in the third trimester of pregnancy had different degree of patchy ground-glass shadow on chest CT,showing interstitial changes,which was consistent with viral pneumonia changes.All of the 17 newborns were negative for the virus screening with throat swabs,of which 3 of them were premature.Among the 14 newborns,13 had a Apgar score of 9,10,10 for 1 minute,5 minutes and 10 minutes,and 1 had a score of 7,9,9.ConclusionThe severe illness and mortality rates of the pregnant women with COVID-19 pneumonia were not high.The clinical symptoms of the pregnant women with COVID-19 pneumonia were similar to those of non-pregnant adults.There is no evidence of mother-to-child vertical transmission in the late pregnancy patients with COVID-19 pneumonia.Follow-up studies on clinical outcomes in patients with COVID-19 pneumonia during the early and mid-term pregnancy are still necessary.