- Three days post admission, a category III-fetal heart rate was observed and thus a category II-Caesarean section was performed
- C-section was performed with intact amniotic membranes, in complete isolation and under anesthesia due to the mother’s respiratory issues
- During the C-section, clear amniotic fluid was collected before the membranes ruptured; the fluid tested positive for both the E and S genes of SARS-CoV-2 
- A 5 lbs, 9.6 oz (2540 g) male neonate was delivered 
- Newborn resuscitation was administered in accordance with current international guidelines
- Mother was discharged 6 days post delivery 


Smith College

In a comprehensive case study, Vivanti et al. report the first transplacental transmission of SARS-CoV-2 with clinical manifestation in the newborn, consistent with neurological signs and symptoms of the virus. 

Transplacental Transmission of COVID-19

Vivanti, A.J., Vauloup-Fellous, C., Prevot, S. et al. (2020). Transplacental transmission of SARS-CoV-2 infection. Nat Commun 11, 3572 

https://doi.org/10.1038/s41467-020-17436-6

https://www.nature.com/articles/s41467-020-17436-6

Transplacental transmission of SARS-CoV-2
infection

- 23-year-old female
- Admitted to the hospital during 35th week of gestation 
- Symptoms: fever (38.6°C), severe cough, and expectoration 
- RT-PCR detected both E and S genes of SARS-CoV-2 in blood and nasopharyngeal and vaginal swabs
- Normal pregnancy until diagnosis of COVID-19
- Hospital tests revealed the following: thrombocytopenia (54 × 109/L), lymphopenia (0.54 × 109/L), prolonged APTT (60 s), transaminitis (AST 81 IU/L; ALT 41 IU/L), elevated C-reactive protein (37 mg/L) and ferritin (431 μg/L)


Mother’s Diagnosis 

- Sedative and analgesic drugs were not administered
- Vital parameters were at normal levels
- Newborn was extubated after 6 hours
- Blood and nonbronchoscopic bronchoalveolar lavage fluid samples were collected before extubation and RT-PCR revealed the presence of both E and S genes of SARS-CoV-2 
- Nasopharyngeal and rectal swabs were collected at 1 hr of life, 3 days and 18 days; RT-PCR revealed the presence of both SARS-CoV-2 genes in each sample 
- Routine blood tests on the 2nd day revealed normal results
- Formula milk was used to feed the newborn

Newborn Care in the Neonatal Intensive Care Unit (NICU)

- On day 3, newborn experienced irritability, poor feeding, axial hypertonia and opisthotonos; however cerebrospinal fluid tested negative for SARS-CoV-2 
- Symptoms gradually improved over the course of 3 days, but mild hypotonia and feeding difficulty remained
- MRI on day 11 revealed bilateral gliosis of the deep white periventricular and subcortical matter, with slightly left predominance
- Newborn recovered slowly and was discharged after 18 days without antiviral treatments 
- A follow-up after 2 months revealed improved hypertonia, normal motricity, and MRI showed reduced white matter injury 


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