Spontaneous liver rupture following SARS-CoV-2 infection in late pregnancy: A case report

Clinical characteristics of pregnant women with COVID-19 and infection outcomes in one of the largest cities in the Brazilian Amazon

BACKGROUND

Pregnancy can be a risk factor for the development of more severe COVID-19 with a possible increase in the risk of complications during pregnancy/birth and adverse neonatal outcomes. This study aimed to describe and analyze the clinical and epidemiological aspects of SARS-CoV-2 infection in women in the perinatal period attended in the city of Belém, northern region of Brazil.

METHODS

This is a clinical, observational, analytical, and cross-sectional study with a quantitative approach, conducted at the Santa Casa de Misericórdia do Pará Foundation (FSCMPA). It included 230 pregnant women hospitalized at FSCMPA with a positive SARS-CoV-2 RT-PCR molecular test between April 2020 and June 2022. Clinical and epidemiological information (origin, gestational age, prenatal care, comorbidities, birth complications, and chest tomography) were obtained from medical records, and correlation was made between the types of cases (mild, moderate, and severe) and maternal outcome. The chi-square test and G test were used to assess the possibility of association between variables.

RESULTS

Evidence of association was observed between the severity of COVID-19 and the following parameters: gestational age, specific pregnancy comorbidities, baby and maternal death, birth complications, and prematurity. Dyspnea, headache, anosmia, odynophagia, diarrhea, and chest pain were the symptoms most related to disease aggravation. The maternal mortality rate in the study was 8.7%.

CONCLUSION

Specific pregnancy-related and pre-existing comorbidities associated with SARS-CoV-2 infection directly contribute to the worsening clinical condition, leading to complications such as prematurity, fetal, and maternal death.

Intraabdominal hypertension and Abdominal Compartment Syndrome in patients with COVID-19: an integrative review

The first cases of COVID-19 were diagnosed in China, rapidly evolving with worldwide spread, turning into a pandemic. A percentage of these patients develop the severe form of the disease and progress to respiratory distress syndrome, requiring support in Intensive Care Units. Intra-abdominal Hypertension and Abdominal Compartment Syndrome are characterized by increased intra-abdominal pressure, and are subject to several predisposing factors, such as mechanical ventilation assistance, extracorporeal membrane oxygenation, elevated PEEP, intestinal obstructions, excessive fluid replacement, major burns and coagulopathies. Hence, for the management of patients with severe COVID-19, there are numerous risk factors for the development of intra-abdominal hypertension and abdominal compartment syndrome. Therefore, this study proposes to analyze the variables that directly interfere with the increase in intra-abdominal pressure in patients with COVID-19, as well as the changes in the organic systems caused, through an integrative literature review.

COVID-19 related liver injuries in pregnancy

While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) quickly spread across the globe, our understanding of its pathogenic mechanisms evolved. Importantly, coronavirus disease 2019 (COVID-19) is now considered a syndromic multisystem inflammatory disease involving not only the respiratory system but also the cardiovascular, excretory, nervous, musculoskeletal, and gastrointestinal systems. Moreover, a membrane-bound form of angiotensin-converting enzyme 2, the entry receptor for SARS-CoV-2, is expressed on the surface of cholangiocytes and hepatocytes, suggesting the potential of COVID-19 to involve the liver. With the widespread distribution of SARS-CoV-2 throughout the population, infection during pregnancy is no longer a rare occurrence; however, little is known about the course of hepatic injuries and related outcomes in pregnant SARS-CoV-2-positive women. Thus, the understudied topic of COVID-related liver disease during pregnancy poses a great challenge for the consulting gynecologist and hepatologist. In this review, we aim to describe and summarize potential liver injuries in pregnant women with COVID-19.

COVID-19 and hepatic injury: cellular and molecular mechanisms in diverse liver cells

The coronavirus disease 2019 (COVID-19) represents a global health and economic challenge. Hepatic injuries have been approved to be associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. The viral tropism pattern of SARS-CoV-2 can induce hepatic injuries either by itself or by worsening the conditions of patients with hepatic diseases. Besides, other factors have been reported to play a crucial role in the pathological forms of hepatic injuries induced by SARS-CoV-2, including cytokine storm, hypoxia, endothelial cells, and even some treatments for COVID-19. On the other hand, several groups of people could be at risk of hepatic COVID-19 complications, such as pregnant women and neonates. The present review outlines and discusses the interplay between SARS-CoV-2 infection and hepatic injury, hepatic illness comorbidity, and risk factors. Besides, it is focused on the vaccination process and the role of developed vaccines in preventing hepatic injuries due to SARS-CoV-2 infection.