Coagulation changes and thromboembolic risk in COVID-19 obstetric patients

Ducloy-Bouthors, A.-S.; Benhamou, Dan; Bonnet, Marie; Bonnin, M.; Bouthors, Anne Sophie; Bouvet, Lionel; Castel, Adeline; Chassard, D.; Dewandre, P.-Y.; Fisher, Catherine; Julliac, B.; Keïta, H.; Mercier, Frédéric; Morau, Estelle; Rackelboom, T.; Vial, F.; Wernet, Anne

doi:10.1016/j.accpm.2020.05.003

Cited by 62 publications

(81 citation statements)

References 22 publications

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“…SARS-CoV-2 has an impact on coagulation, yet coagulation is already altered by pregnancy itself [ 25 ]. Whether SARS-CoV-2 can be attributable to the vascular and circulatory pathologies still needs further studies.…”

Section: Discussionmentioning

confidence: 99%

Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion

Mertz²,

et al. 2020

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Since the outbreak of coronavirus disease 2019 (COVID-19), there has been a debate whether pregnant women are at a specific risk for COVID-19 and whether it might be vertically transmittable through the placenta. We present a series of five placentas of SARS coronavirus 2 (SARS-CoV-2)-positive women who had been diagnosed with mild symptoms of COVID-19 or had been asymptomatic before birth. We provide a detailed histopathologic description of morphological changes accompanied by an analysis of presence of SARS-CoV-2 in the placental tissue. All placentas were term deliveries (40th and 41st gestational weeks). One SARS-CoV-2-positive patient presented with cough and dyspnoea. This placenta showed prominent lymphohistiocytic villitis and intervillositis and signs of maternal and foetal malperfusion. Viral RNA was present in both placenta tissue and the umbilical cord and could be visualized by in situ hybridization in the decidua. SARS-CoV-2 tests were negative at the time of delivery of 3/5 women, and their placentas did not show increased inflammatory infiltrates. Signs of maternal and/or foetal malperfusion were present in 100% and 40% of cases, respectively. There was no transplacental transmission to the infants. In our cohort, we can document different time points regarding SARS-CoV-2 infection. In acute COVID-19, prominent lymphohistiocytic villitis may occur and might potentially be attributable to SARS-CoV-2 infection of the placenta. Furthermore, there are histopathological signs of maternal and foetal malperfusion, which might have a relationship to an altered coagulative or microangiopathic state induced by SARS-CoV-2, yet this cannot be proven considering a plethora of confounding factors.

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Section: Discussionmentioning

confidence: 99%

Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion

Mertz²,

et al. 2020

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“…4 Furthermore, while reviews and case reports in nonpregnant populations have reported some severe morbidity and even mortality in COVID-19 associated with bleeding or hemorrhage, [1][2][3][4] there have been very limited data regarding specific laboratory derangements that may be predictive for or associated with bleeding risk related to COVID-19. [16][17][18] Further research should continue to investigate the impact of a COVID-19 diagnosis on hematologic physiology, and also its impact specifically in the setting of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States

et al. 2020

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Objective The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis. Study Design This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables. Results Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17–1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50–1.93) when compared with those without a diagnosis of COVID-19. Conclusion Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes. Key Points

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“…Interestingly Oxley et al noted an increased occurrence of younger SARS CoV2 virus-infected patients with no significant traditional risk factors for AIS, presenting with large vessel occlusion (6). Putative mechanisms suggested as inducing AIS in association with SARS CoV2 have included systemic inflammation, inflammatory cytokine storm, hyper-coagulability, and imbalances in the classical and alternative Renin Angiotensin System (RAS) in relation to SARS-CoV-2 spike glycoprotein-ACE2 binding related molecular mechanisms (3,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)). The RAS system comprises both a plasmabased RAS regulating cardiovascular system and tissue-based RAS regulating long term changes via a complex hormonal system, endocrine, paracrine, and autocrine in action.…”

Section: Introductionmentioning

confidence: 99%

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

2020

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Corona virus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is recognized as a global pandemic by WHO 2020 with 5,934 936 infections, 367,166 deaths and affecting over 200 countries as of 30th May 2020. Acute Ischemic Stroke (AIS) in brain is also emerging as an important neurovascular/neurological complication of COVID-19, associated with extreme immune responses leading to dysregulated coagulation system and generalized thrombo-embolic status and increased risk of AIS especially among usually less vulnerable younger adults in this cohort. Thus, in early June 2020, we aimed to review the clinical data on all published cases of COVID-19 and concomitant AIS, with a view to understanding the pertinent clinical, laboratory and imaging features. The neutrophil-lymphocyte ratio (NLR) at time of hospital admission for COVID infection correlates positively with the duration of time before onset of clinical features of AIS. Higher NLR, C-Reactive protein, serum ferritin, D-dimer and fibrinogen levels are associated with poor prognosis of AIS in COVID-19 with 75% of patients dying or being severely disabled at present. Currently it is too early to comment on the long-term outcomes for survivors.

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Coagulation changes and thromboembolic risk in COVID-19 obstetric patients

Abstract: Elsevier Masson SAS on behalf of Socié té française d'anesthé sie et de ré animation (Sfar).

Cited by 62 publications

References 22 publications

Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion

Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion

Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

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