Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery

Abstract

Background: It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. Case presentation: A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. Conclusions: This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.

Intrauterine vertical SARS‐CoV‐2 infection: a case confirming transplacental transmission followed by divergence of the viral genome

“…The mother presented with classic COVID‐19 symptoms including fever and a dry cough, 26 but abdominal pain and reduced fetal movements were also reported. Similar to previous reports, we observed that the clinical condition of the mother improved rapidly after delivery 27,28 . The mother also presented with elevated concentrations of several acute phase proteins including ferritin, procalcitonin and c‐reactive protein, indicating systemic inflammation 29 .…”

“…Similar to previous reports, we observed that the clinical condition of the mother improved rapidly after delivery. 27,28 The mother also presented with elevated concentrations of several acute phase proteins including ferritin, procalcitonin and c-reactive protein, indicating systemic inflammation. 29 In addition, at the time of delivery, SARS-CoV-2 RNA was found in the maternal blood and RT qPCR indicated the highest viral load within the placenta.…”

Intrauterine SARS-CoV-2 infection – a case confirming transplacental transmission followed by divergence of the viral genome

“…Similar to previous reports, we observed that the clinical condition of the mother improved rapidly after delivery 24,25 . Blood tests taken from the mother on the day of delivery revealed discreet liver injury.…”

Appendicitis with concurrent COVID-19 infection in a patient during the third trimester of pregnancy

“…8 Inducing early delivery to improve maternal health has precedent in SARS-CoV-2 infection as there has been a case report of a patient with deranged liver function whose biochemical abnormalities improved once she had delivered. 17 Currently the data are showing that the risks of SARS-CoV-2 infection in those who are pregnant are increased in comparison with those in the general population, as pregnant individuals with infection have increased rates of admission to intensive care units and are more prone to preterm birth. These preterm deliveries in these cases are cited to be due to iatrogenic intervention.…”