Case presentation
A 29-year-old primigravida at 16 weeks of gestation was diagnosed with a
COVID-19 infection. Her dating scan was done at 10+4weeks gestation. She did not have medical or surgical co-morbidities.
At 16 weeks of gestation on 17th August 2020, she was
tested for COVID-19 as one of the primary contacts of Mini Dry Port
(MDP) loaders who tested positive. Her reverse transcriptase-polymerase
chain reaction (RT-PCR) test was confirmed positive. She was admitted to
Royal Institute for Governance and Strategic Studies (RIGSS) isolation
hospital on 18th August 2020. She was asymptomatic on
admission; her vital parameters were unremarkable. Her chest x-ray
showed the normal study. Vitamin supplementations were continued during
her pregnancy.
She was followed up daily for signs and symptoms of COVID-19 and
obstetrical complications. Repeat RT-PCR was done as per the testing
protocol of the country. On day-7 of isolation, she developed a mild
fever with shortness of breath and a loss of smell. Vital signs got
slightly deranged; Temperature 40-degree Celsius, respiratory rate 28
breaths/min, SpO2 dropped to 94%, pulse rate 96 beats/min, and BP
slightly raised (Figure 1). Oxygen was administered by face mask at 6-8
L/min and conservatively managed. After 4-6 hours of oxygenation, all
the vital signs were restored to normal and her symptom of shortness of
breath subsided. From day-8 onward the patient was clinically stable and
biochemically normal.
On day-35 RT-PCR test for COVID-19 was negative and confirmed on day-36
with a repeat RT-PCR. The patient was shifted to the de-isolation
facility on day-37 and kept for two weeks. The repeat RT-PCR was
performed at the end of de-isolation and sent for home quarantine for
another week and kept under COVID-19 surveillance by the ministry of
health, Bhutan.
From 24 weeks of gestation, she was followed up at the Maternal and
Child Health (MCH) care unit, Phuentsholing hospital. She had made six
antenatal visits. Her pregnancy was uneventful until 36 weeks of
gestation where she was diagnosed to have polyhydramnios with an
Amniotic Fluid Index (AFI) of 29 cm (Figure 2).
The patient was evaluated for the cause of polyhydramnios: Oral glucose
tolerance test with 75g glucose done, FBS 5.0 mmol/L and 2 hours after
glucose 7.5 mmol/L; Viral markers all negative; detailed anatomical scan
showed no significant fetal anomalies seen. Pregnancy was terminated at
39 weeks of gestation by cesarean section for failed induction. A live
healthy female baby weighing 3550g was delivered with the Apgar score of
8 in 1 minute and 10 in 5 minutes. At birth no gross anomaly or birth
defects were present. After 48-hours of delivery, an ultrasound scan of
the newborn was done and ruled out gastrointestinal tract anomalies. The
baby was feeding well and perfectly normal.