A new coronavirus infection (COVID-19) raises reasonable concerns about the impact of the Sars-CoV-2 virus on pregnant women and women in the postpartum period, given the high risk of COVID-19-associated acute respiratory distress syndrome with refractory hypoxemia, even against the background of artificial lung ventilation. When this situation arises, the use of Extracorporeal membrane oxygenation (ECMO) is justified to improve respiratory function and support blood circulation. In the given clinical case, the experience of successful treatment of a patient with COVID-19 infection in the early postpartum period with ECMO for 22 days, who was hospitalized at the Grodno Regional Clinical Cardiology Center, is presented. In the current clinical situation, all methods of respiratory support have been consistently used: from oxygen therapy through high-flow ventilation and non-invasive mechanical ventilation, to invasive mechanical ventilation. During her stay on ECMO, the patient experienced two hemorrhagic events that required surgical interventions. During therapy, it was possible to avoid thrombosis of the circuit and prevent the development of rebleeding against the background of anticoagulant therapy by carefully monitoring the hemostasis system using clotting hemostasiological tests and ROTEM indicators and correcting their violations.
Background. The unexpected emergence and rapid spread around the world of a new coronavirus infection COVID-19, with a large number of deaths, has shown the importance of developing the methods for predicting a severe course of viral infections, creating diagnostic tests, preventive vaccines and drugs that act on key factors in the course and progression of the disease. Clinical studies examining metabolomic changes in pregnant women with COVID-19 infection are virtually non-existent. Purpose of the study. To study the features of the metabolic profile of free amino acids during pregnancy complicated by COVID-19. Material and methods. The concentrations of free amino acids and their derivatives in the blood plasma of 86 women were studied. The main group included 51 pregnant women with a confirmed diagnosis of COVID-19; the control group was composed of 35 somatically healthy women with uncomplicated pregnancies. The analysis of amino acids and their derivatives was carried out using high performance liquid chromatography. Results. During the development of COVID-19 infection, protein catabolism predominates, as evidenced by an increase in the concentration of 28 amino acids and their derivatives in venous blood plasma. We revealed a statistically significant increase in the concentration of cysteine, homocysteine, γ-glutamylcysteine, phosphoserine, cysteine sulfinate, aspartate, homocysteate, glutamate, asparagine, serine, threonine, 1-methylhistidine, glycine, citrulline, arginine, alanine, symmetric dimethylarginine, asymmetric dimethylarginine, β-aminobutyric acid, γ-aminobutyric acid, tyrosine, valine, methionine, phenylalanine, leucine, isoleucine, lysine, ornithine in pregnant women with a new coronavirus infection as compared to the patients in the control group. Conclusion. The study of the features of the metabolic profile of free amino acids in pregnant women with a new coronavirus infection will enable us to identify additional biomarkers of the severity of the disease and predict the course of the disease in patients during the gestation period.
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