Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report

Abstract

Background: The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values. Case: The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets. Conclusion: There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.

Qual a relação existente entre coagulopatias e gestantes com Covid-19? Uma revisão de literatura

“…A necessidade de monitorar pacientes gestantes com COVID-19, mesmo que assintomático, também foi evidenciado por autores que relataram evoluções de gestantes e/ou fetos a estados graves e/ou óbito (BAHIA et al, 2021;LLAU et al, 2020;SERVANTE et al, 2021). O relato produzido por Kinsey et al (2020) é especialmente interessante pois mostra diversas alterações bioquímicas em uma gestante assintomática, mas positivada, para COVID-19. A gravidade dos eventos tromboembólicos podem ser tão severas que os microtrombos afetam diversos tipos de tecido (PEIRIS et al, 2020).…”

“…Durante o procedimento, a mesma sofreu hemorragia e ocorreram alterações importantes em seus exames (baixa contagem de plaquetas, aumento de protrombina e D-dímero), o que levou a equipe médica a testá-la para COVID-19. O teste positivou e, mesmo após a cirurgia, a paciente não apresentou sintomas de COVID-19, mas permaneceu com as alterações nos exames laboratoriais(KINSEY et al, 2020).Diante do exposto acima e sem indícios de pesquisa de um marcador sensível para relacionar os processos de coagulopatia, COVID-19 e gestação, os exames avaliados tradicionalmente em distúrbios da coagulação (mesmo que em pacientes não gestantes) parecem ser os mais adequados para monitoração nesse contexto. Essa constatação é fortalecida Brazilian Journal of Health Review, Curitiba, v. 6, n. 2, p. 5939-5958, mar./apr., 2023 por vários dos autores analisados no presente estudo, como Benhamou et al (2020), Ronnje et al (2020), Peiris et al (2021), Rostami et al (2020), Takayama et al (2020), Vlachodimitropoulou et al (2020), dentre outros.…”

The Deleterious Effects of COVID-19 in the Peripartum Period: A Case Report

“…The patient should be carefully assessed in collaboration with the anesthesia department throughout the peripartum period. As highlighted in the American Journal of Obstetrics and Gynecology, patients of Hispanic race, advanced maternal age, and with medical co-morbidities are risk factors for COVID-19 sequelae, all of which our patient matched [ 18 ]. Therefore, pregnant patients with risk factors and co-morbidities who are diagnosed with COVID-19 should be counseled extensively regarding risks of extended hospital stay, anesthetic complications, intensive care unit admission, need for mechanical ventilation and ventilatory support, or even death.…”

Empfehlungen zu SARS-CoV-2/COVID-19 in Schwangerschaft, Geburt und Wochenbett – Update November 2021 (Langfassung)

“…In einem nicht nach COVID-19-Schweregrad unterteilten Kollektiv von Schwangeren, die zur Geburt hospitalisiert waren, lag die Prävalenz einer VTE bei 0,2% (15/6380) vs. 0,1% (268/400 066) [aOR 3,43; 95% KI 2,01–5,82] 168 . Ein thromboembolisches Ereignis kann auch die Erstmanifestation einer COVID-19 Erkrankung in der Schwangerschaft darstellen 265 266 267 . Fallberichte von Sinusvenenthrombose und Hypophysenapoplex wurden dokumentiert 268 269 .…”