CT characteristics and diagnostic value of COVID-19 in pregnancy
Authors: XiaoMing Gong, Lu Song, Hang Li, Li Li, Wei Jin, KaiHu Yu, Xiaochun Zhang, Hongjun Li, HengNing Ke, ZhiYan Lu
Journal: PLoS One (2020)
MeSH terms: Betacoronavirus / genetics, Coronavirus Infections / diagnostic imaging, Pneumonia, Viral / diagnostic imaging, Pregnancy Complications, Infectious / diagnostic imaging, Tomography, X-Ray Computed / methods, Case Reports, Research Support, Non-U.S. Gov't, Adult, C-Reactive Protein / analysis, COVID-19, Coronavirus Infections / virology, Disease Progression, Female, Fibrin Fibrinogen Degradation Products / analysis, Follow-Up Studies, Humans, Pandemics, Pleural Effusion / diagnostic imaging, Pleural Effusion / virology, Pneumonia, Viral / virology, Pregnancy, Pregnancy Complications, Infectious / virology, Retrospective Studies, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, Fibrin Fibrinogen Degradation Products, fibrin fragment D, C-Reactive Protein

Objective:
To investigate the computed tomography (CT) characteristics and diagnostic value of novel coronavirus pneumonia (NCP or COVID-19) in pregnancy.
Methods:
This study included ten pregnant women infected with COVID-19, treated in the Zhongnan Hospital of Wuhan University from January 20, 2020 to February 6, 2020. Clinical and chest CT data were collected and clinical symptoms, laboratory indicators, and CT images were analyzed to explore CT characteristics and diagnostic value for COVID-19 during pregnancy.
Results:
Laboratory examination showed that white blood cell count was normal in nine patients, and slightly higher in one patient (10.23 × 109). The lymphocyte ratio decreased in two patients by 12% and 14%, respectively. The levels of C-reactive protein was elevated in seven patients (range, 21.16-60.3 mg/L) and the levels of D-dimer was increased in eight patients (range, 507-2141 ng/mL). Six patients had low levels of total protein (range, 35.3-56.5 mg/L). Two patients showed small patchy ground glass opacity (GGO) involving single lung, while eight patients showed multilobe GGO in both the lungs, with partial consolidation. Peripheral and non-peripheral lesion distributions were seen in ten (100%) and four (40%) patients, respectively. There were four patients who had signs of intra-bronchial air-bronchogram, six patients had small bilateral pleural effusions, while none had lymphadenopathy. Dynamic observations were performed in four patients after COVID-19 treatment. Among these four patients, one patient showed normal on the initial examination, and new lesions were observed after 3 days; 1 patient showed progression after 7 days of treatment, with expansion of the lesion area; and the other 2 patients showed improvement after 14 days of treatment, with reduction in the density and area of lesions and appearance of linear opacity.
Conclusions:
The CT characteristics of COVID-19 in pregnancy were mainly observed in early and progressive stages, and multiple new lesions were common. And there were consolidations of varying sizes and degrees within the lesion. Moreover, the original ground glass lesions could be fused or partially absorbed. Six patients had small bilateral pleural effusion. In summary, CT scans can play an important role in early screening, dynamic observation, and efficacy evaluation of suspected or confirmed cases of pregnant women with COVID-19.