Does Lung Ultrasound Have a Role in the Clinical Management of Pregnant Women with SARS COV2 Infection?

Abstract

Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is a major health threat. Pregnancy can lead to an increased susceptibility to viral infections. Although chest computed tomography (CT) represents the gold standard for the diagnosis of SARS-CoV-2 pneumonia, lung ultrasound (LUS) could be a valid alternative in pregnancy. The objectives of this prospective study were to assess the role of LUS in the diagnosis of lung involvement and in helping the physicians in the management of affected patients. Thirty pregnant women with SARS-CoV-2 infection were admitted at the obstetrical ward of our Hospital. Mean age was 31.2 years, mean gestational age 33.8 weeks. Several LUS were performed during hospitalization. The management of the patients was decided according to the LUS score and the clinical conditions. Mean gestational age at delivery was at 37.7 weeks, preterm birth was induced in 20% of cases for a worsening of the clinical conditions. No neonatal complications occurred. In 9 cases with a high LUS score, a chest CT was performed after delivery. CT confirmed the results of LUS, showing a significant positive correlation between the two techniques. LUS seems a safe alternative to CT in pregnancy and may help in the management of these patients.

Keywords: SARS-CoV-2 infection; chest computed tomography; lung ultrasound (LUS) examination; pregnancy.

Figure 1

Lung US images obtained with linear transducers., frequency 7.5 MHz, focus on the pleural line. Trapezoidal view. The pleura line (indicated by red arrows) is continuous. Below, horizontal artifacts (A line), indicated by blue arrows, may be visible. This pattern is classified as score 0.

Figure 2

Lung US images obtained with linear transducers, frequency 7.5 MHz, focus on the pleural line. Trapezoidal view. The pleural line is not continuous. Below the point of discontinuity (indicated by green arrows), vertical areas of white (or B lines) are visible (indicated by yellow arrows). B-lines occupying <50% the screen. This pattern is classified as score 1p.

Figure 3

Lung US images obtained with linear transducers, frequency 7.5 MHz, focus on the pleural line. Trapezoidal view. The pleural line is not continuous. Below the point of discontinuity (indicated by green arrows), vertical areas of white (or B lines) are visible (indicated by yellow arrows). B-lines occupying >50% the screen. This pattern is classified as score 2.

Figure 4

LUS image of the patient with extensive pneumonia obtained with linear transducers, frequency 7.5 MHz, focus on the pleural line. Trapezoidal view. Presence of large consolidations (at least >1 cm) (indicated by green arrows). This pattern is classified as score 3.

Figure 5

CHEST CT shows extensive interstitial pneumonia on the axial plane (a) with crazy paving pattern and consolidation area. Multiplanar reconstruction (MPR) on coronal and sagittal planes (b,c) demonstrate scissure thickening and fibrosis.