妊娠合并新型冠状病毒肺炎九例临床分析  

Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases

作　　者：雷帝 王晨[2] 李春燕[1] 方聪聪[3] 杨文兵[1] 程苾恒[1] 魏敏[1] 徐晓宇[1] 杨慧霞[2] 王素青 范翠芳[1] Lei Di;Wang Chen;Li Chunyan;Fang Congcong;Yang Wenbing;Chen Biheng;Wei Min;Xu Xiaoyu;Yang Huixia;Wang Suqing;Fan Cuifang(Department of Obstetrics,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China;Department of Pediatrics,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Nutrition and Food Hygiene,School of Health Sciences,Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院妇产科,430060 [2]北京大学第一医院妇产科,100034 [3]武汉大学人民医院儿科,430060 [4]武汉大学健康学院,430060

出　　处：《中华围产医学杂志》2020年第3期159-165,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的评估妊娠合并新型冠状病毒肺炎(COVID-19)患者的临床特征及母婴妊娠结局。方法回顾性分析武汉大学人民医院2020年1月22日至2月1日收治入院的9例COVID-19孕妇的病例资料,包括流行病学史、临床症状、实验室检查、胸部CT影像学表现、治疗方案、分娩方式和新生儿结局的相关资料。并对其中6例孕妇的阴道分泌物标本和4例分娩孕妇的羊水、脐带血、新生儿鼻咽拭子、母乳标本进行新型冠状病毒核酸检测。对数据资料进行描述性统计分析。结果(1)9例孕妇中,5例为妊娠晚期,4例为妊娠中期。潜伏期中位数为8(1~14)d。9例孕妇均出现发热症状,7例出现咳嗽,5例出现腹泻症状。其他症状包括气短或气促、肌肉疼痛、乏力(各4例),鼻塞、咽痛、胸痛、头痛或头晕(各3例),皮疹(2例),以及寒战和咳痰(各1例)。7例孕妇合并淋巴细胞减少,6例C-反应蛋白升高。7例孕妇行胸部CT检查,均见肺部多发斑片状毛玻璃影。1例孕37周+5孕妇在确诊7 d后,超声提示羊水过少。(2)所有患者均给予经验性抗生素治疗、抗病毒治疗和中成药物辅助治疗。8例患者接受吸氧及激素治疗,6例接受免疫治疗。(3)9例孕妇中,4例分娩,1例于孕26周引产。分娩的4例中3例行剖宫产术终止妊娠;1例胎膜早破自发性早产并经阴道分娩,产后2 d出现急性呼吸窘迫综合征,转入重症监护病房治疗。4例新生儿中2例为足月儿;2例为早产儿,其中1例为低出生体重儿。所有新生儿出生时均无窒息。其余4例继续妊娠孕妇病情均稳定。羊水、脐带血、新生儿鼻咽拭子、母乳及母亲阴道分泌物行新型冠状病毒核酸检测均为阴性。结论妊娠合并COVID-19患者的临床特征与非妊娠期成人患者相比无特异性,尚无证据表明妊娠合并COVID-19可导致更严重不良母儿结局或垂直传播。Objective To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19.Methods This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1,2020.Their clinical data,including epidemiological history,clinical symptoms,laboratory examinations,chest CT,treatment,delivery mode,and pregnancy outcomes,were analyzed retrospectively.Specimens of maternal vaginal swab were collected in six pregnant women,and the specimens of amniotic fluid,cord blood,neonatal throat swab and breast milk samples were collected in four pregnant women who had a delivery during our study.All samples were tested for the existence of COVID-19.Descriptive analysis was applied in this study.Results(1)Among the nine cases,five were admitted in the third trimester and four in the second trimester.The median incubation period of COVID-19 was 8(1-14)d.Fever was presented in all cases on admission,and the other commonly seen symptoms were cough(seven cases)and diarrhea(five cases).Other signs and symptoms were also reported,including shortness of breath,myalgia and fatigue(four cases in each),nasal obstruction,pharyngalgia,chest pain,and headache/dizziness(three cases in each),rash(two cases),and chills and expectoration(one case in each).The most common laboratory abnormalities were a decreased number of lymphocytes(seven cases)and elevated C-reactive protein(six cases).Chest CT scans were performed in seven women,and all showed patchy areas or ground-glass opacity in both lungs.Oligohydramnios was detected in only one case at 37+5 weeks,which was seven days after the diagnosis of COVID-19.(2)All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment.Eight patients required oxygen inhalation,and eight were treated with glucocorticoid.Six cases received immunotherapy.(3)Four of the nine cases had delivered,including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of

关 键 词：冠状病毒感染 新型冠状病毒肺炎 肺炎 病毒性 妊娠 垂直传播 

分 类 号：R714[医药卫生—妇产科学]