妊娠晚期合并新型冠状病毒肺炎的影像及临床特点分析

Imaging and clinical characteristics of third trimester of pregnancy with corona virus(COVID-19)pneumonia

目的:探讨妊娠晚期合并新型冠状病毒肺炎(COVID-19)的影像及临床特征。方法:回顾性分析12例经临床及核酸检测确诊为COVID-19妊娠晚期患者的临床及影像资料,包括患者的基本孕产资料、就诊症状、实验室检查、肺部影像学特征及转归。结果:患者年龄为26~33岁(中位年龄28岁),孕35+4~40周,因临产或先兆临产入院;12例均于本院足月分娩,3例为阴道产,9例为剖宫产,均未出现严重产后并发症,分娩结局良好。7例(7/12)伴有低热、咳嗽为主的呼吸道感染症状,5例(5/12)无明显产内科症状。实验室检查以白细胞计数正常、淋巴细胞计数降低及C-反应蛋白增高为主要特征。首次CT检查2例为阴性,余10例阳性者中3例为单肺叶单病灶,1例为单肺叶多病灶,6例为多肺叶多病灶;病灶主要分布于下叶胸膜下,以磨玻璃密度影(4/10)合并铺路石征及部分实变(6/10)为主。进展期CT病变范围增大、数目增多、密度增高,部分实变,吸收期病灶总体吸收,部分病灶纤维化,吸收早期可出现病灶缓解与进展交替发生。肺外表现:早期3例出现少量心包积液,2例出现单侧少量胸腔积液;进展期胸腔积液例数明显增多(11/12),吸收期减少。结论:妊娠晚期合并COVID-19患者的呼吸道感染症状较轻,分娩结局良好;胸部CT提示肺内病变特征与普通人群相似,但胸腔积液发生率较高,具有一定特征性。

Objective:To investigate the imaging and clinical features of the third trimester of pregnancy with novel coronavirus pneumonia(COVID-19).Methods:The clinical and imaging data of 12 pregnant women patients in the third trimester diagnosed with COVID-19 by clinical and nucleic testing were retrospectively analyzed,including the basic data of maternal,clinic symptoms,laboratory examination,pulmonary imaging characteristics and outcome.Results:The average onset age of 12 pregnant women was 26~33(median 28)years old and their gestation was 35+4~40 weeks.They were hospitalized due to labor and pre-labor.All the 12 cases were delivered to term in our hospital,3 cases delivered vaginally,9 cases delivered by cesarean section.No serious postpartum complications were found,and the delivery outcome was good.7 cases(7/12)were accompanied by respiratory symptoms characterized low-grade fever and cough,and 5 cases(5/12)had no obvious obstetrical symptoms.Laboratory tests were characterized by normal leukocyte count,decreased lymphocyte count and increased C-reactive protein.The baseline CT examination was negative in 2 cases.Among the remaining 10 positive cases,3 cases were solitary lesion in single pulmonary lobe,1 case was multiple lesions in single pulmonary lobe,and 6 cases were multiple lesions in multiple pulmonary lobes.The lesions were mainly distributed in the subpleura of inferior lobe,and mainly multiple ground-glass opacity(4/10)with crazy paving pattern or partial consolidation(6/10).The range,number and density of progressive CT lesions were increased,and partial consolidation was achieved.The lesions in the absorption stage were generally absorbed,while some lesions were fibrotic.Remission and progression of lesions occurred alternately at the early stage of absorption.Extrapulmonary manifestations:a small amount of pericardial effusion was found in 3 cases and a small amount of pleural effusion was found in 2 cases;the number of cases of pleural effusion in the progressive stage increased significantly(11/12)and decreased in the absorption stage.Conclusion:Patients with COVID-19 in the third trimester had mild respiratory symptoms and a good delivery outcome.Chest CT indicated that the characteristics of intrapulmonary lesions were similar to those of the general population.However,the incidence of pleural effusion was higher,with certain characteristics.