Am J Perinatol
DOI: 10.1055/s-0041-1726428
Short Communication

Complicated Monochorionic–Diamniotic Twins in a Pregnant Woman with COVID-19 in the Second Trimester

1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Deisy Contreras
2  Division of Infectious Disease, Department of Pediatrics, University of California, Los Angeles, California
,
Ramen H. Chmait
3  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine–University of Southern California, Los Angeles, California
,
Jeffrey Goldstein
4  Department of Pathology, University of California, Los Angeles, California
,
Ilina D. Pluym
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Khalil Tabsh
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
2  Division of Infectious Disease, Department of Pediatrics, University of California, Los Angeles, California
,
1  Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
› Author Affiliations
Funding This work was funded by an Iris Cantor-UCLA Women's Health Center pilot award (Y.A.).

Abstract

Objective A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester.

Study Design We present a patient with monochorionic–diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation. The pregnancy is further complicated by stage II twin–twin transfusion syndrome. She undergoes laser ablation, which is complicated by development of a subchorionic hematoma. The patient then develops Escherichia coli bacteremia, resulting in septic shock and preterm labor followed by previable delivery at 21 weeks of gestation. Amniotic fluid and placenta were negative for SARS-CoV-2 by real-time polymerase chain reaction.

Conclusion This case of SARS-CoV-2 argues against transplacental transmission after a second-trimester infection but brings attention to the possible downstream complications that may arise following early infection.

Key Points

  • Vertical transmission of SARS-CoV-2 is not evident after a second-trimester infection.

  • Antepartum coronavirus disease 2019 may cause vascular placental changes and placental insufficiency.

  • SARS-CoV-2 is associated with a maternal hypercoagulable state with adverse perinatal outcomes.



Publication History

Received: 18 August 2020

Accepted: 12 February 2021

Publication Date:
14 April 2021 (online)

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