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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The COVID-19 coronavirus infection&#44; first identified in December 2019 in Wuhan &#40;China&#41;&#44; is an emerging disease that has seen a rapid increase in the number of infected patients worldwide&#46; Not much data are available on how it affects pregnancy&#46; However&#44; there is information on infection by other highly pathogenic coronaviruses&#44; such as severe acute respiratory syndrome &#40;SARS&#41; or Middle East respiratory syndrome &#40;MERS&#41;&#44; during pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Thus&#44; it is known that the mortality rate of SARS infection was 10&#37; in the general population and up to 25&#37; in pregnant women&#44; with no intrauterine transmission demonstrated&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our 44-year-old patient was 29<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>2 weeks pregnant&#44; did not have any pathological medical history of interest&#44; and had had no recent travel or contact with known infected patients&#46; She came to the center for symptoms that had been ongoing for 12 days that consisted of odynophagia&#44; dry cough&#44; and&#44; in recent days&#44; fever of 39&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The obstetric examination was normal&#46; A COVID-19 PCR was performed&#44; which was positive&#46; On the blood test&#44; of note were leukocytes 20&#44;900 &#40;98&#37; PMN&#41;&#44; lymphopenia with lymphocytes 200&#44; <span class="elsevierStyleSmallCaps">d</span>-dimer 578<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; CRP 28<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; LDH 223<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; and procalcitonin 5&#46;33<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; From a respiratory point of view&#44; with oxygen via nasal cannula at 3<span class="elsevierStyleHsp" style=""></span>L&#44; she had a PO<span class="elsevierStyleInf">2</span> of 140<span class="elsevierStyleHsp" style=""></span>mmHg&#46; On the chest X-ray&#44; multilobar bilateral pulmonary infiltrates with an interstitial-alveolar pattern were observed&#44; with alveolar consolidation in the left upper lobe&#44; blunting of the costophrenic angles&#44; and right fissural thickening due to a small amount of pleural effusion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment was started with lopinavir&#47;ritonavir&#44; chloroquine&#44; ceftriaxone&#44; and azithromycin&#46; At 48<span class="elsevierStyleHsp" style=""></span>h&#44; the patient was more tachypneic and&#44; in a few hours&#44; her mechanics of breathing worsened with respiratory acidosis and severe hypoxemia&#46; She required orotracheal intubation and connection to mechanical ventilation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In light of the clinical deterioration&#44; the gynecology department was contacted&#44; which decided to start fetal lung maturation by means of two 12-mg doses of betamethasone separated by 12<span class="elsevierStyleHsp" style=""></span>h&#46; At 24<span class="elsevierStyleHsp" style=""></span>h&#44; a cesarean section was performed in the ICU box without complications for the mother or the child&#46; COVID-19 infection was ruled out in the child&#46; In the following days&#44; there was a progressive improvement in oxygenation and the weaning process was begun&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This patient had satisfactory progress&#44; which is also corroborated by various studies on COVID-19 published during this pandemic&#46; A study of 38 pregnant women infected with the virus demonstrated that maternal prognosis was much better than in previous coronaviruses&#59; none died nor were there any cases of intrauterine transmission to the fetus&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> In another study on nine pregnant patients with pneumonia due to COVID-19&#44; the authors described the clinical similarity to cases reported in nonpregnant adult patients&#46; No cases of vertical transmission were found&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In another study on 15 patients&#44; it was observed that pregnancy and birth did not worsen the course of symptoms&#44; which was mild with a satisfactory recovery in all cases&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Lastly&#44; another study on 16 pregnant women recommended that if there is an indication for obstetric surgery or if there is critical COVID-19 disease&#44; the voluntary interruption of the pregnancy will not increase the newborn&#39;s risk of premature birth or anoxia and is beneficial for the treatment of the mother&#39;s pneumonia&#46; Like the above authors&#44; they found no cases of COVID-19 among the neonates&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore&#44; to date&#44; there is no evidence that this coronavirus behaves differently in pregnant women than in the general population nor is there evidence of maternal-fetal transmission&#46; With all of these studies&#44; on February 5&#44; 2020&#44; a meeting of Chinese and North American experts was held in which they drafted a series of specific recommendations for the management of pregnant women and neonates born to mothers with suspected or confirmed coronavirus &#40;COVID-19&#41; infection&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> As a result of that meeting&#44; a set of recommendations&#44; supported by a greater or lesser degree of clinical evidence&#44; was published&#46; Of these&#44; the following are of note&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Pregnant women with suspected COVID-19 infection may undergo lung imaging tests &#40;X-ray&#44; CT scan&#41; and COVID-19 diagnostic testing as soon as possible&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Pregnant women who have suspected or confirmed COVID-19 must be hospitalized&#44; if possible&#44; in negative-pressure rooms&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">The time of the birth must be decided on an individual basis based on maternal-fetal well-being&#44; gestational age&#44; and other concomitant conditions&#44; not just because the pregnant patient is infected&#46; In addition&#44; vaginal birth must be permitted when possible and cesarean section must be reserved for when it is obstetrically necessary&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">It is reasonable to consider regional anesthesia in pregnant women with COVID-19 infection who need a cesarean section&#44; provided that respiratory function allows for it&#46; If not&#44; general anesthesia is much safer&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Currently&#44; it cannot be affirmed if there is vertical transmission from the mother to the fetus&#44; although there have been some published cases that have not shown evidence of vertical transmission in patients with COVID-19 infection in the last trimester of pregnancy&#46; In any case&#44; it is recommended that the newborns be isolated for at least 14 days and&#44; 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Correspondence
Pregnancy and perinatal outcome of a woman with COVID-19 infection
Pronóstico perinatal y de la paciente embarazada con infección por COVID-19
D. González Romero, J. Ocampo Pérez, L. González Bautista, L. Santana-Cabrera
Corresponding author
lsancabx@gobiernodecanarias.org

Corresponding author.
Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain

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