Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body’s response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.

Maternal and neonatal outcomes of pregnant patients with COVID‐19: A prospective cohort study

“…2,21 However, it is known that during pregnancy, ACE2 plays an important role in regulating arterial blood pressure, and infection caused by COVID-19 can change the expression of ACE2, cause vascular contractions, and induce pre-eclampsia. 27,28 The risk of preterm labor in the exposed group was 2.70 times higher than in the control group. The rate of preterm labor in the general population is in the range of 5%-8%.…”

Is COVID-19 a risk factor for severe preeclampsia? Hospital experience in a developing country

“…The angiotensinconverting enzyme 2 (ACE2) receptor mediates the SARS-CoV-2 action that causes vasoconstriction resulting from renin-angiotensin system dysfunction [3]. During pregnancy, ACE2 plays an important role in the regulation of arterial pressure and expresses itself in excessive amounts in placental tissue, including syncytiotrophoblast, cytotrophoblast, endothelium, and vascular smooth muscle of the villi [4]. Intrauterine infection caused by COVID-19 can alter ACE2 expression, promoting a preeclamptic state.…”

SARS-CoV-2 Infection in Pregnant Women: Neuroimmune-Endocrine Changes at the Maternal-Fetal Interface

“…Other evidence shows that SARS-CoV-2 promotes lesions in the placenta that increase decidual arteriopathy and maternal vascular malperfusion, findings that are compatible with hypertensive disorders and preeclampsia [ 230 ]. It is worth mentioning that preeclampsia is mostly observed in the severe forms of COVID-19 [ 226 ] and pregnant women who have a history of hypertensive disorders of pregnancy [ 126 , 231 , 232 ].…”