A 39-year-old woman, Gravida 3, Para 2 at 29 weeks gestation presented to the emergency department with complaints of fever, chills and dry cough since 3 days. Her past medical history was significant for Rheumatoid arthritis treated with Methotrexate for 5 years, Non-Hodgkin’s lymphoma treated with chemotherapy 10 years ago and is in remission, Sjogren’s syndrome (diagnosed 1 year ago) and Rheumatoid arthritis (relapsed 2 years ago), currently on Hydroxychloroquine. On admission, she was febrile with a temperature of 102.2 degrees Fahrenheit, tachycardic at 126 beats per minute, tachypneic at 24 breaths per minute and mildly hypoxic at 94% on room air. She was mildly hypertensive with a blood pressure of 141/76. Her oxygen saturation improved to 100% after oxygen supplementation with 2 liters via nasal cannula.\nInitial labs were significant for a leukocytosis of 14.75 x 103/µl with neutrophilia, a normal lymphocyte count, elevated C-reactive protein (CRP), lactate dehydrogenase and D-dimer. Procalcitonin was normal. Blood cultures were collected. A nasopharyngeal swab sample was taken and tested positive for COVID-19 by polymerase chain reaction. CT angiogram of the chest revealed extensive severe bilateral focal ground-glass infiltrates () without evidence of pulmonary embolism. Given the patient’s history of autoimmune conditions, current pregnancy, severe imaging findings and overall septic picture, she was admitted to the Intermediate Care Unit for close monitoring despite minimal oxygen requirements. Since the patient meets the criteria for the severe disease defined as requiring supplemental oxygen, as per our institution's policy, Infectious disease (ID) consultation was requested to evaluate if the patient meets the criteria for the use of Remdesivir set forth by the Emergency use authorization (EUA) released by the FDA []. Patient met the criteria and ID physician suggested to initiate Remdesivir after discussing the risks and benefits and obtaining the patient's consent since the teratogenic side effects of Remdesivir are not known. Patient has been provided information regarding the possible side effects including unknown teratogenicity and provided the copy of the patient information released by the Gilead sciences. Patient consented for the use of the Remdesivir. After following the standard of work flow for the use of Remdesivir at our institute which includes approval by hospital pharmacy as per the EUA guidelines for the Remdesivir issued by the FDA, she received 200 mg of IV Remdesivir on Day 1 followed by 100 mg daily for the next 4 days. Since the patient is symptomatic for less than 7 days at the time of admission, she did not meet the criteria to receive the steroid therapy as per the RECOVERY trial.\nShe successfully completed the course of Remdesivir without any side effects and showed steady improvement throughout the hospital stay. Fetal activity was monitored every 8 hours using the external fetal monitor, with no abnormalities detected. As per the obstetrician’s recommendations, supplemental oxygen was provided to maintain saturations >95%. Oxygen saturations were around 98−100% while on 2 L via NC and weaned down to room air with saturations >95% by the time of discharge on day six.
Mrs. M, a 28-year-old pregnant woman at 36 weeks gestation, was diagnosed with confirmed COVID-19 and was referred to our hospital due to worsening clinical symptoms. The patient had been treated in a previous hospital for 2 days with symptoms of cough and fever 4 days before admission. During hospitalization, the patient’s condition worsened as she displayed tachypnea (RR 32×/min, O2 saturation 92%) and fever (102.2 °F).\nA chest X-ray showed no abnormalities in both lungs. A naso-oropharyngeal swab for SARS-CoV-2 was positive (N gene Cq 39.54). Oxygen saturation was 95% using oxygen therapy at 3 Lpm with a nasal cannula. An emergency cesarean section was directly performed due to the worsening of the maternal condition and oligohydramnios seen from ultrasound examination. The cesarean section was performed with no complications. A baby boy was born with a birthweight of 2345 g, a birth length of 45 cm, and AS 7/8. The baby was taken to perinatal isolation for COVID-19 with a negative result for SARS-CoV-2 from a naso-oropharyngeal swab.\nThe patient was taken care of in HCU after surgery on day 1 postoperative (HD 1). Remdesivir was directly given with a dose of 200 mg IV on the 1st day and continued with 1 × 100 mg IV on day 2 until 5. The patient’s postoperative condition was stable, and the RT-PCR result for SARS-CoV-2 was negative on HD 4. Both patient and baby were discharged on HD 7 after Remdesivir therapy was completed.