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COVID-19 and Women’s Health

Case Reports of Fetal Skin Edema and COVID-19

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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)

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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

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