妊娠中の重症コロナウイルス感染症：挑戦的な症例報告

Severe coronavirus infection in pregnancy: challenging cases report.

• Helena Lucia Barroso Dos Reis
• Neide Aparecida Tosato Boldrini
• João Victor Jacomele Caldas
• Ana Paula Calazans da Paz
• Carolina Loyola Prest Ferrugini
• Angelica Espinosa Miranda

抄録

妊娠中のCOVID-19の影響に関するデータは少ないが、これらのデータを解析することは、早期予防、発見、患者の隔離、疫学的調査、診断、早期治療に至るまで、臨床の指針となる重要なものである。本報告は，ブラジルEspirito Santo州Vitoria市の妊婦から採取した綿棒中の鼻咽頭分泌物をリアルタイム逆転写-ポリメラーゼ連鎖反応（RT-PCR）で確認したCOVID-19の3例を報告するものである．3例では、いずれも発熱を呈し、1例は息切れ、1例は下痢、2例は腹痛、2例は咳嗽を呈した。3例はCOVID-19の重篤な臨床経過をたどって進行した。集中治療室（ICU）での入院期間は10日以上であった。そのうち2名は回復し、1名は不可逆的な難治性ショック、多臓器不全でICUに残り、死亡した。分娩モードは産科適応と母体感染の重症度に基づいて個別化され、良好に進展した2例の重症母体COVID-19では帝王切開が適応となった。これらの新生児は未熟児であり，RT-PCR による COVID-19 の検査では陰性であった．

There are few data on the impact of COVID-19 in pregnancy, however, analyzing these data is important to guide the clinical practice, covering the early prevention, detection, patients' isolation, epidemiological investigation, diagnosis and early treatment. This is a report of three cases of COVID-19 confirmed by real-time reverse transcription - polymerase chain reaction (RT-PCR) of nasopharyngeal secretions collected in swabs from pregnant women in the city of Vitoria, Espirito Santo State, Brazil. In the three cases, all the patients presented with fever, one had shortness of breath, one had diarrhea, two of them reported abdominal pain and two of them had cough. The three patients progressed with a severe clinical evolution of COVID-19. The permanence in the intensive care unit (ICU) was more than 10 days. Two of them recovered and one remained in the ICU with irreversible refractory shock, multiple organ failure and died. The mode of delivery was individualized and based on the obstetric indication and severity of the maternal infection, and the cesarean section was indicated in the two severe maternal COVID-19 cases that evolved favorably. These newborns were premature and tested negative for COVID-19 by RT-PCR.