COVID-19 positive woman presented with major fetal congenital anomalies: A case report with literature review

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Abstract
Rationale: Pregnancy is a special term in life with physiological changes in both cardiorespiratory and immune systems; that is why severe acute respiratory syndrome coronavirus 2 infection in pregnancy may result in an altered response. With this, we present a case report of a young pregnant lady who was exposed to severe acute respiratory syndrome coronavirus 2 infection just before pregnancy and ended up with an affected fetus. The impact of coronavirus disease 2019 (COVID-19) exposure on neonatal outcomes has not yet been fully evaluated; by this article, we aim to find if COVID-19 exposure is linked to congenital anomalies. Patient concerns: A 25-year-old woman who has no history of genetic or chronic diseases applied to our clinic for routine control of pregnancy. She does not have a consanguineous marriage or any other potential risk factors for pregnancy. Diagnoses and interventions: She had a history of COVID-19 polymerase chain reaction positivity 2 days before the first day of the last menstruation period and hospitalization for 7 days. After 7 days of treatment with favipiravir and levofloxacin, enoxaparin sodium, famotidine, paracetamol, budesonide, dornaz alfa, and vitamin C; her general situation gets better, and discharged from the hospital on the seventh day of hospitalization without any further treatment prescription. Outcomes: During her routine controls for pregnancy at first-trimester evaluation ultrasonography; there was right forearm aplasia and deformities at both feet and legs. Lessons: In the literature, there is conflicting evidence about the impact of COVID-19 in pregnancy especially if the patient is confronted with the virus in the first trimester. Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good quality unbiased studies about the issue. Risk factors for COVID-19 overlap with the risk factors for pregnancy complications and the risk factors of the treatment prescribed. The impact of COVID-19 exposure on neonatal outcomes has not yet been fully evaluated; in this article, we aim to find if COVID-19 exposure is linked to congenital anomalies. Further research is needed to ascertain neonatal outcomes.

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