COVID-19 Disease During Pregnancy and Peripartum Period: A Cardiovascular Review

Abstract

Pregnancy with various physiological effects on cardiovascular system, makes mothers with borderline cardiovascular reserve at significant risk for adverse events during labor and early postpartum period. Cardiac imaging modalities, have shown that COVID-19 disease is associated with subclinical myocardial injury in significant numbers of infected people, even in mild or asymptomatic disease and previous healthy ones . Herein, we have discussed the cardiovascular aspects of prepartum pregnant women with COVID-19 disease, especially patients with moderate to severe illness. Also, we have proposed how to handle the hemodynamic load during labor and the first 48 hours postpartum in the hypoxemic overloaded parturients with possible subclinical myocardial injury.

The association between pregnancy and COVID-19: A systematic review and meta-analysis

“…COVID-19 infection in pregnant women can lead to further alterations in the cardiovascular system, and elevated cardiac enzymes, such as pro-brain natriuretic peptide and cardiac troponin, are elevated, indicating evolving myocardial inflammation and injury. Studies have linked myocardial inflammation and injury to more severe disease and higher mortality in infected patients [ [55] , [56] , [57] ].…”

Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review

“…Other cardiovascular events among pregnant COVID-19 cases were MI and thrombotic events. A German cohort study among non-pregnant patients reported that 71% of 100 patients had elevated cardiac biomarkers, including cardiac troponin (CTn) and pro-BNP, which indicate myocardial inflammation [ 118 , 119 ]. However, in a series of 31 positive SARS-CoV-2 pregnant women, 22% had elevated troponin levels, and 30% in BNP levels.…”

COVID-19’s immuno-pathology and cardiovascular diseases

“…Important risk factors of the venous thrombosis involve endothelial injury, stasis, and a hypercoagulable state, together known as Virchow's triad. [66][67][68][69][70][71] Inflammation has a main role in thrombosis through perpetuating a hypercoagulable state and endothelial injury that can be done via fibrinolysis reduction, stimulation of the TF pathway, and NETosis. Also, complement activation is involved in thrombosis.…”

“…Important risk factors of the venous thrombosis involve endothelial injury, stasis, and a hypercoagulable state, together known as Virchow’s triad. 66 – 71 …”