Management and Perspective of Coronavirus Disease 2019 (COVID-19), Pregnancy, and Hypercoagulability

A retrospective observational study on maternal and neonatal outcomes of COVID-19: Does the mild SARS-CoV-2 infection affect the outcome?

Background

Currently, several SARS-CoV-2 variants, including Omicron, are still circulating globally. This underscores the necessity for a comprehensive understanding of their impact on obstetric and neonatal outcomes in pregnant women, even in cases of mild infection.

Methods

We conducted a retrospective, single-center observational study to investigate the association between gestational SARS-CoV-2 infection and maternal-fetal outcomes in the Chinese population. The study enrolled 311 pregnant patients with SARS-CoV-2 infection (exposure group) and 205 uninfected pregnant patients (control group). We scrutinized the hospital records to collect data on demographics, clinical characteristics, and maternal and neonatal outcomes for subsequently comparison.

Results

Similar characteristics were observed in both groups, including maternal age, height, BMI, gravidity, parity, and comorbidities (p > 0.05). A majority (97.4%) of pregnant women in the exposure group with COVID-19 experienced mild clinical symptoms, with fever (86.5%) and cough (74.3%) as the primary symptoms. The exposure group exhibited significantly higher incidences of cesarean section and fetal distress compared to the control group (p < 0.05). Furthermore, pregnant women in the exposure group showed reduced levels of hemoglobin and high-sensitivity C-reactive protein, while experiencing significantly increased levels of lymphocytes, prothrombin time, alanine aminotransferase, and aspartate aminotransferase (p < 0.05). Notably, recent SARS-CoV-2 infection prior to delivery appeared to have an adverse impact on liver function, blood and coagulation levels in pregnant women. When comparing the two groups, there were no significant differences in the postpartum hemorrhage rate, premature birth rate, birth weight, neonatal asphyxia rate, neonatal department transfer rate, and neonatal pneumonia incidence.

Conclusions

Our study suggests that mild COVID-19 infection during pregnancy does not have detrimental effects on maternal and neonatal outcomes. However, the increased risks of events such as fetal distress and cesarean section, coupled with potential alterations in physical function, reveal the consequences of SARS-CoV-2 infection during pregnancy, even in mild cases. These findings emphasize the importance of proactive management and monitoring of pregnant individuals with COVID-19.

Regional Anesthesia Conversion to General Anesthesia during Cesarean Section of a Woman with Antepartum Hemorrhage due to Placenta Previa and Ovarian Cyst with Moderate Confirmed COVID-19: A

Physiological changes during pregnancy and COVID-19 may affect one another. This report presents a 37-year-old female G4P10021 with gestational age 37+2 weeks infected with COVID-19 in Dr. Moewardi Hospital Surakarta, Central Java, Indonesia. The patient was diagnosed with antepartum hemorrhage due to total placenta previa with low-risk Morbidly Adherent Placenta score, a history of cesarean section, and ovarian cyst. The patient underwent conversion from spinal anesthesia to general anesthesia. Within 40 min after spinal anesthesia, the patient complained shortness of breath, which then worsened into decreased consciousness and inadequate spontaneous breathing. This may be complicated by the COVID-19 infection which has several effects on pregnancy.

Hypercoagulability in COVID-19: from an unknown beginning to future therapies

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health concern and is characterized by an exaggerated inflammatory response that can lead to a large variety of clinical manifestations such as respiratory distress, sepsis, coagulopathy, and death. While it was initially considered primarily a respiratory illness, different data suggests that COVID-19 can lead to a pro-inflammatory milieu and a hypercoagulable state. Several mechanisms attempt to explain the pro-coagulant state seen in COVID-19 patients, including increased fibrinogen concentration, different receptor binding, exhausted fibrinolysis, cytokine storm, and endothelial dysfunction. Some hematological parameters, such as elevated D-dimers and other fibrinolytic products, indicate that the essence of coagulopathy is massive fibrin formation. Moreover, elevated D-dimer levels have emerged as an independent risk factor for a worse outcome, including death, indicating a potential risk for deep vein thrombosis and pulmonary thromboembolism. Prophylactic anticoagulation is recommended in all in-patients with COVID-19 to reduce the incidence of thrombosis. Those with elevated D-dimer values or with a higher risk of developing thromboembolic events should be treated with higher doses of anticoagulant. Anticoagulation may not be enough in some circumstances, highlighting the need for alternative therapies. An understanding of the complex cross-talk between inflammation and coagulopathy is necessary for developing direct appropriate interventional strategies.

Coagulopathy of Coronavirus Disease 2019: A Case Series

BACKGROUND: In Coronavirus disease 2019 (COVID-19), the main manifestations were fever, cough, and anosmia. AIM: We aimed to investigate coagulopathy and disseminated intravascular coagulation in severe COVID-19 patients. METHODS: Five cases of COVID-19 with coagulopathy have been reported. RESULTS: All patients presented with various main complaints such as fever, cough, shortness of breath, and diarrhea. An increase in D-dimer value was found in all cases, with an increase of 4–5 times from the upper limit of normal. All patients were evaluated with the IMPROVE-VTE and PADUA thrombotic risk assessment models. Thromboprophylaxis with low molecular weight heparin LMWH intensive dosage was given to four patients. However, one patient was not given thromboprophylaxis because of the high risk of bleeding. All cases were not given long-term thromboprophylaxis after the patients were discharged from the hospital. All hospitalized COVID-19 patients can be considered to give thromboprophylaxis unless contraindicated. Thromboprophylaxis is preferable to use LMWH with a dose adjusted to the severity of COVID-19. Administration of thromboprophylaxis after hospitalization may be considered in patients who have thromboembolic risk factors. CONCLUSION: More research is being encouraged to increase understanding of the prevention and treatment of thrombotic complications of COVID-19.