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.