Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: Human chorionic gonadotropin normal, Injection site pain, Laboratory test normal, Occupational exposure to SARS-CoV-2, Ultrasound antenatal screen abnormal
Clinical narrative: I was 9 weeks and 2 days pregnant with my first pregnancy (no history of miscarriages) when I received my first dose of the Moderna vaccine on 1/9/2021. I had a routine appointment with my OB-GYN the day prior, 1/8/2021, during which they completed a routine ultrasound. At that time, the ultra sound was completely normal with a healthy fetus and heart rate, and my due date was estimated to be 8/13/2021. Also at that time, I was advised by my OB-GYN to get the COVID vaccine, when offered to me, given my higher risk of contracting COVID due to my job as a healthcare worker with direct patient contact, and my higher risk for more severe illness if I contracted COVID due to pregnancy. I received the vaccine the next day with no immediate adverse reactions/events aside from some considerable arm soreness at the site of the vaccine and fatigue. Then 2 weeks and 6 days later I had another routine appointment with my OB-GYN (1/29/2021) at which point in time I was 12 weeks and 1 day pregnant. During this visit they conducted a second routine ultrasound. From this ultra sound they identified multiple abnormalities including an increased nuchal translucency of 3.5 mm, absent nasal bone, and presence of fluid around the fetus?s abdomen. These abnormalities were concerning for a chromosomal/genetic abnormality. Given these concerns I had labs drawn for maternal carrier screening (the Panorama and the Horizon 274), and I was referred to maternal fetal medicine for further imaging and testing. The results of the lab work took approximately 2 weeks to receive, but they came back normal without increased risk identified for any of the chromosomal/genetic conditions tested. I was seen by a high risk doctor and a genetic counselor within the maternal fetal medicine department on 2/2/2021. At this appointment I had a third ultrasound completed which confirmed the presence of an increased nuchal translucency now 4.3mm, and also found the presence of a cystic hygroma. These findings were again consistent with concerns for a chromosomal, genetic or other anatomical/structural condition and as such I had a chorionic villus sampling done that same day to assess the DNA of the fetus. These results also came back all normal without concern for any of the chromosomal or genetic conditions tested. I then had a follow up appointment and ultrasound with the maternal fetal medicine department on 2/19/2021, at which point I was 15 weeks and 1 day pregnant. This early anatomical scan revealed even more concerning findings with the fetus?s humerus measuring in the 1st percentile for gestational age and the fetus?s femur measuring in the 3rd percentile for gestational age. Per consultation with our genetic counselor this was indicative or some severe condition; however, it was not clear exactly what condition. Given the severity of the findings it was recommended to terminate the pregnancy. As such I had to undergo a dilation and evacuation procedure on 2/24/2021. We are currently still awaiting results of further genetic testing (exome testing), the results of which can take 2-3 months from the time of sending out the labs (sent out around 2/24/2021).