Complicated Monochorionic-Diamniotic Twins in a Pregnant Woman with COVID-19 in the Second Trimester

Am J Perinatol. 2021 Jun;38(7):747-752. doi: 10.1055/s-0041-1726428. Epub 2021 Apr 14.


Objective: A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester.

Study design: We present a patient with monochorionic-diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation. The pregnancy is further complicated by stage II twin-twin transfusion syndrome. She undergoes laser ablation, which is complicated by development of a subchorionic hematoma. The patient then develops Escherichia coli bacteremia, resulting in septic shock and preterm labor followed by previable delivery at 21 weeks of gestation. Amniotic fluid and placenta were negative for SARS-CoV-2 by real-time polymerase chain reaction.

Conclusion: This case of SARS-CoV-2 argues against transplacental transmission after a second-trimester infection but brings attention to the possible downstream complications that may arise following early infection.

Key points: · Vertical transmission of SARS-CoV-2 is not evident after a second-trimester infection.. · Antepartum coronavirus disease 2019 may cause vascular placental changes and placental insufficiency.. · SARS-CoV-2 is associated with a maternal hypercoagulable state with adverse perinatal outcomes..

Publication types

  • Case Reports

MeSH terms

  • Adult
  • COVID-19* / complications
  • COVID-19* / diagnosis
  • COVID-19* / physiopathology
  • Escherichia coli Infections* / complications
  • Escherichia coli Infections* / diagnosis
  • Female
  • Fetofetal Transfusion* / diagnosis
  • Fetofetal Transfusion* / etiology
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control
  • Placenta* / diagnostic imaging
  • Placenta* / physiopathology
  • Pregnancy
  • Pregnancy Complications, Infectious* / physiopathology
  • Pregnancy Complications, Infectious* / virology
  • Pregnancy Outcome
  • Pregnancy Trimester, Second*
  • Pregnancy, Twin
  • Premature Birth / etiology
  • Premature Birth / virology
  • SARS-CoV-2
  • Shock, Septic* / diagnosis
  • Shock, Septic* / etiology
  • Twins, Monozygotic
  • Ultrasonography, Prenatal / methods