Pre‐eclampsia‐like syndrome induced by severe COVID‐19: a prospective observational study

Abstract

Objectives To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre‐eclampsia (PE) in pregnancies with COVID‐19, and to assess their accuracy to differentiate between PE and the PE‐like features associated with COVID‐19. Design A prospective, observational study. Setting Tertiary referral hospital. Participants Singleton pregnancies with COVID‐19 at >20+0 weeks. Methods Forty‐two consecutive pregnancies were recruited and classified into two groups: severe and non‐severe COVID‐19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms‐like tyrosine kinase‐1/placental growth factor [sFlt‐1/PlGF]) were assessed in women with suspected PE. Main outcome measures Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt‐1/PlGF. Results Thirty‐four cases were classified as non‐severe and 8 as severe COVID‐19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID‐19 cases (62.5%). However, abnormal sFlt‐1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE‐like syndrome. Conclusions Pregnant women with severe COVID‐19 can develop a PE‐like syndrome that might be distinguished from actual PE by sFlt‐1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre‐eclampsia with caution. Tweetable abstract This study shows that a pre‐eclampsia‐like syndrome could be present in some pregnancies with severe COVID‐19.

Authors' reply re: Laparoscopic ablation or excision with helium thermal coagulator versus electrodiathermy for the treatment of mild‐to‐moderate endometriosis: randomised controlled trial

“…We thank Martin Hirsch and colleagues 1 for their interest in our study 2 and for pointing out a degree of mismatch between our reported findings and the information on the ISRCTN database. The primary outcome of pelvic pain was operationalised more specifically as cyclical pain in the trial, and unfortunately, the secondary outcome of dyspareunia was inadvertently omitted from those listed in the ISRCTN entry.…”

“…Future trials in endometriosis will now be able to profit from the clear guidance provided by this set of core outcomes, and our understanding of the effective management of this condition will be enhanced accordingly.& Sir, Thank you kindly for the opportunity to respond to the letter from Dr Amorim and her colleagues. 1 We would like to thank Dr Amorim and her team for their interest in our study 2 and their invaluable observations. We acknowledge that our series is small and heterogeneous.…”

Impact of COVID-19 on Cardio-obstetric Risk Indicators: Future Directions

“…One such interesting observation has been made by Mendoza and colleagues who reported PE-like syndrome in six out of eight pregnant patients with severe SARS-CoV-2 pneumonia. 12 However, only one out of six had evidence of placental dysfunction on Doppler examination and biochemical analysis. One more study has reported histopathological changes in placenta from COVID-19 patients postdelivery.…”

“…Doppler assessment (uterine artery pulsatility index) and estimation of angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor, lactate dehydrogenase) are few of the diagnostic measures to distinguish severe COVID-19 infection from true PE. 12…”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…The Doppler assessment (uterine artery pulsatility index) and estimation of angiogenic factors (soluble FMS-like tyrosine kinase-1/placental growth factor and lactate dehydrogenase) are few of the diagnostic measures to distinguish severe COVID-19 infection from true PE. Therefore, diagnosis of preeclampsia 46 in COVID-19 needs a careful approach and should interpreted in all aspects.…”