COVID-19 Infection Complicated by Disseminated Intravascular Coagulation during Pregnancy—Two Cases Report

Abstract

Coagulopathies are one of the obstetric complications affecting the period of pregnancy, childbirth, and puerperium. One of the more severe and complex disorders of the haemostatic system is the disseminated intravascular coagulation syndrome (DIC), in which generalised activation of the coagulation system and activation of inflammatory cells occurs. DIC syndrome was observed in patients whose pregnancy was complicated by SARS-CoV-2 infection. Both the course of these cases and literature review indicate that particular notice should be paid to laboratory parameters of the coagulation system, closely monitoring the well-being of the foetus and, in the situation of acute DIC development, it is advised to deliver a baby and initiate intensive therapy.

A Review of the Prevalence of Thromboembolic Complications among Pregnant Women Infected with COVID-19

“…The search identified 150 articles, which after the screening of titles, abstracts, and assessing for eligibility, only 19 studies were included ( Figure 1 ). From the 19 studies, most [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] of them were ( n = 5) case series [ 16 , 17 , 18 , 19 , 20 ] and case reports ( n = 6) [ 21 , 22 , 23 , 24 , 25 , 26 ]. Seven studies [ 8 , 10 , 11 , 12 , 13 , 14 , 15 ] were performed retrospectively and one [ 9 ] was a systematic review.…”

“…According to Table 1 and Table 2 , from the 19 studies included, 7 studies were conducted in North America [ 10 , 12 , 13 , 14 , 15 , 18 , 20 ], 6 in Europe [ 11 , 17 , 19 , 23 , 24 , 26 ], 1 in the Middle East [ 21 ], and others were each conducted in South Asia [ 22 ], East Asia [ 8 ], and South America [ 25 ], and one was a multicentre study [ 16 ]. Most studies were performed in adults (mean/median age ranging from 17 to 47 years).…”

“…Based on the 19 studies included, pregnant mothers have many comorbidities, e.g., diabetes mellitus type 1 and type 2 [ 13 , 15 , 23 , 24 ], gestational diabetes [ 15 ], hypothyroidism [ 13 , 17 ], hypertension [ 13 , 15 ], preeclampsia [ 13 , 23 ], and asthma [ 13 , 15 , 24 ] ( Table 1 and Table 2 ). One case report [ 21 ] recorded in Iran presented a patient with clinical manifestations of loss of consciousness, double mydriasis, and tonic-clonic seizures ( Table 1 ).…”

“…Laboratory findings ( Table 3 , Table 4 and Table 5 ) that were associated with TE events include D-dimer, fibrinogen and C-reactive protein (CRP) levels, as well as radiological imaging. Eight studies [ 9 , 11 , 16 , 17 , 22 , 23 , 25 , 26 ] showed elevated D-dimer level (1.8 to 34.47 mg/L) (Normal range (NR): 0.1–1.7 mg/L), five studies [ 8 , 11 , 16 , 23 , 26 ] for elevated CRP level ranging from 14 to 60 mg/L (NR: 1–10 mg/L), and four studies [ 16 , 21 , 25 , 26 ] for elevated fibrinogen ranging from 5.43 to 3530 g/L (NR: 1.5–4.2 g/L). In addition, seven studies [ 12 , 18 , 21 , 22 , 24 , 25 , 26 ] included radiological imaging and histopathology examination to confirm the diagnosis of TE complications.…”

“…TE complications that occur during pregnancy were DIC ( n = 37, 33.3%), TE ( n = 13, 11.7%), CAC ( n = 3, 2.7%), and PE ( n = 2, 1.8%), whereas cases that occur during the postpartum period were IVT ( n = 36, 32.4%), SCT ( n = 9, 8.1%), placenta thrombosis ( n = 5, 4.5%), DVT ( n = 2, 1.8%), PE ( n = 2, 1.8%), and CAC ( n = 2, 1.8%) ( Table 1 and Table 2 ). From the 19 studies included, seven mothers [ 9 , 15 , 21 , 24 ] and two neonates died [ 21 , 25 ], whereas the others were discharged well [ 8 , 15 , 16 , 17 , 18 , 22 , 23 , 26 ] ( Table 3 , Table 4 and Table 5 ).…”