PURPOSE:

• Garcia-Manau et al. (Obstetrics and Gynecology, 2020) report on transient fetal skin edema in COVID-19 positive pregnancies

METHODS:

• Case Reports  
  • Two cases of unexplained fetal skin edema
  • Pregnant women, positive for SARS-CoV-2 during the second trimester of pregnancy
  • Both patients still pregnant at time of publication

RESULTS:

Case 1

• 50-year-old primigravid woman
  • Previous smoker and no other comorbidities
  • IVF pregnancy
  • Received aspirin to prevent early onset preeclampsia
  • No genetic testing done
  • No fetal anomalies seen on ultrasound | Normal Dopplers and AFV
• 22w6d: Presented at emergency department with COVID-19 symptoms
  • 7 day history of dry cough and fever
  • Pulse oximetry 93% | Elevated IL-6 and D-dimer levels | Bilateral ground glass opacities on CT
  • Positive for SARS-CoV-2
• 23w1d: Transferred to ICU | Mechanical ventilation | Azithromycin, lopinavir- ritonavir, and hydroxychloroquine
• Care plan: Expectant management with antenatal surveillance
  • Daily FHR
  • Weekly MFM assessment for fetal growth, Dopplers, AFV, anomalies
• 23w5d (Day 6)
  • Generalized fetal skin edema with greatest thickness around scalp and trunk
  • No ascites or other signs of hydrops  
  • Persisted to day 10
• Other fetal testing normal and included
  • Dopplers | Maternal indirect antiglobulin | Serology (e.g. CMV, varicella, parvo B19, Toxoplasma, HSV and rubella) | STD screening
• 25w2d (Day 17)  
  • Mother clinically improved
  • SARS-CoV-2 (oropharyngeal and nasopharyngeal swabs) now negative  
  • At the same time, fetal edema resolved

Case 2

• 30-year-old primigravid woman
  • No associated medical comorbidities aside from BMI of 32
• 20w1d:  Presented at emergency department with COVID-19 symptoms
  • 2 day history of cough and fever in the previous 48 hours
  • Positive for SARS-CoV-2
  • Pulse oximetry 99% on room air
  • Discharged home with mild COVID-19 with monitoring of maternal wellbeing via daily phone calls
• 21w2d (day 8): Fetal skin edema identified
  • No other fetal or maternal abnormalities detected | Amniocentesis performed and negative for SARS-CoV-2 or other viral infections
• 23w7d (day 22)
  • Fetal edema resolved
  • SARS-CoV-2 test now negative

CONCLUSION:

• Authors report on 2 cases with fetal skin edema concordant with positive maternal SARS-CoV-2 testing that resolved spontaneously at the same time that the RT-PCR test became negative
• The authors acknowledge that firm conclusions cannot be drawn from two cases
• However, the authors also suggest that fetal skin edema may be related to COVID-19 infection in pregnant women and furthermore

Given these findings and the lack of reports of COVID-19 in the first and second trimesters, a close follow-up of these pregnancies may help to understand the effect on the fetus

Learn More – Primary Sources:

Fetal Transient Skin Edema in Two Pregnant Women With Coronavirus Disease 2019 (COVID-19)

Related ObG Topics:

SMFM Guideline Update on COVID-19 in Pregnancy

ACOG COVID-19 FAQs for Obstetrical Care

Labor and Delivery During COVID-19: Management Highlights