妊娠不同时期感染新型冠状病毒肺炎的随访研究

Follow-up study of Corona Virus Disease 2019 in different periods of pregnancy

目的通过研究不同妊娠时期感染新型冠状病毒患者的妊娠结局,分析新型冠状病毒对孕妇及新生儿出生后近期体格生长发育的影响,了解武汉地区COVID-19孕产妇及新生儿在后期的随访情况及需要解决的问题。方法收集2020年1月30日至2020年4月30日在武汉大学人民医院住院治疗的妊娠合并新型冠状病毒肺炎确诊病例共25例,总结早期(5例)、中期(5例)、晚期妊娠(15例)患者感染SRAS-CoV-2的临床特征、治疗、妊娠结局以及母婴随访等。结果5例早期妊娠合并COVID-19患者中,4例治愈出院后选择放弃妊娠,1例住院期间生化妊娠。5例中期妊娠合并COVID-19的患者中,活产儿4例,引产1例(胎儿心脏多发异常,双肾多发囊性病变,鼻骨偏短,羊水少)。新生儿出生后首次SRAS-CoV-2核酸鼻咽拭纸检测阴性。2020年10月随访结果显示,新生儿身长、体重及神经系统发育未见明显异常,1例患儿溶血性黄疸,1例患儿心脏室间隔缺损,卵圆孔未闭,二尖瓣反流,拟近期手术。15例晚期妊娠合并COVID-19患者中,早产3例,足月产12例。新生儿出生后首次SRAS-CoV-2核酸鼻咽拭纸检测阴性,2020年10月随访结果显示,新生儿身长、体重未见异常,1例小肠坏死伴高胆红素血症,4例细菌性肺炎,2例患儿肌张力过高。选取6例患者的胎盘行SARS-CoV-2检测均为阴性,病理检查中有1例胎盘胎膜未见明显异常,1例胎盘局灶可见散在的中性粒细胞,4例胎盘表现为急性绒毛膜炎(母体反应1级)。结论早期妊娠感染新型冠状病毒患者治愈后均选择终止妊娠。中、晚孕期感染新型冠状病毒肺炎孕妇分娩的新生儿近期随访身长、体重未发现明显异常,但仍有流产、胎儿畸形、绒毛膜炎、新生儿细菌性肺炎、肌张力增高等。因此,孕期新型冠状病毒感染可能导致不良围产期结局,这有待更大样本的流行病学研究调查证实。

Objective:To study the pregnancy outcome of patients infected with the novel coronavirus in different pregnancy periods,and to analyze the impact on pregnant women and the recent physical growth as well as development of newborns after birth.To understand the follow-up situation of COVID-19 pregnant women and newborns in Wuhan area and the problems that need to be solved.Methods:A total of 25 confirmed cases of pregnancy complicated with novel coronavirus pneumonia who were hospitalized in Renmin Hospital of Wuhan University from January 30,2020 to April 30,2020 were collected to summarize the clinical features,treatment,pregnancy outcomes and follow-up of mother and baby in patients with SRAS-CoV-2 infection in early,middle and late pregnancy.Results:Among the 5 patients with COVID-19 in early pregnancy,4 patients chose to abandon pregnancy after being cured and discharged from hospital,and 1 patient had a biochemical pregnancy during hospitalization.Among the 5 patients with COVID-19 in the second trimester,there were 4 cases of live births and 1 case of induction(multiple fetal heart abnormalities,multiple cystic lesions in both kidneys,short nasal bones,and oligohydramnios).The first SRAS-CoV-2 nucleic acid nasopharyngeal swab test of the newborn after birth was negative.In October 2020,follow-up of the above newborns showed no obvious abnormalities in the length,weight,and nervous system development.However,one child had hemolytic jaundice.1 case of heart ventricular septal defect,patent foramen ovale,mitral valve regurgitation planned for short-term surgery.Among the 15 patients with COVID-19 in late pregnancy,3 were premature,and 12 were full-term.The first SRAS-CoV-2 nucleic acid nasopharyngeal swab test of the newborn after birth was negative.In October 2020,follow-up of the above newborns showed no abnormalities in length and weight,but there was 1 case of small intestinal necrosis with hyperbilirubinemia,4 cases of bacterial pneumonia,2 cases of children with hypertonia.The placenta of 6 patients were tested negative for SARS-CoV-2.In pathological examination,1 case of placenta and fetal membrane showed no obvious abnormality,1 case of placenta showed scattered neutrophils,and 4 cases of placenta showed signs of acute chorionitis(maternal reaction grade 1).Conclusions:All patients who were infected with the novel coronavirus in the early pregnancy chose to terminate their pregnancy after they were cured,while the newborns who were born with the novel coronavirus pneumonia in the second and third trimesters were not found to have any significant abnormalities in their length and weight.However,there were still miscarriages,fetal malformations,chorionitis,neonatal bacterial pneumonia,increased muscle tone,etc.Therefore,SARS-CoV-2 infection during pregnancy may cause adverse perinatal outcomes to be confirmed by a larger sample of epidemiological research investigation.