Emergency cesarean section in an epidemic of the middle east respiratory syndrome: a case report

Park, Mi Hye; Kim, Hee Ryun; Choi, Duck Hwan; Sung, Ji Hee; Kim, Jong Hwa

Our case complained of severe myalgia without fever on June 8 and was admitted to the isolation ward 5 days after discharge. Her sputum sample was positive for MERS-CoV by RT-PCR. Creactive protein (CRP) was elevated to 1.95 mg/dl and a chest X-ray revealed patchy opacity in both lower lobes, suggesting bronchopneumonia ( Fig. 1) . A chest X-ray taken 4 days later was improved and CRP had decreased to a value within the normal range (0.15 mg/dl). However, she complained persistently of episodes of dyspnea, sputum, and myalgia without fever. She was provided supportive treatment, but no antiviral agent or steroid because the disease was not progressing. Fetal growth was within normal gestational limits, and she recovered gradually from the myalgia and other symptoms. The results of RT-PCR follow-up tests performed on June 19 and 21 were all negative in sputum samples. The Division of Infectious Diseases confirmed a full recovery, and she moved to the obstetrics ward on June 22 where she was expected to have a normal delivery. However, she began sudden bleeding with abdominal pain on the day after recovery was declared. A pelvic examination with a speculum confirmed the vaginal bleeding. However, the transabdominal ultrasonography did not detect any placental problems or hid-den hemorrhaging. Baseline fetal heart rate (FHR) was 120-130 bpm with moderate variability. An obstetrician diagnosed placental abruption based on the symptoms and physical examinations. We considered spread of MERS-CoV because her symptom onset was very recent, and delivery would involve a large volume of contagious body fluids. An emergency C-sec under combined spinal-epidural anesthesia (CSE) was scheduled with precautions. The surgery was performed in a designated negative pressure-ventilated isolation operating room. All designated specialized infection control personnel prepared for the surgery and wore enhanced personal protective equipment (PPE) (Fig. 2) .