COVID‐19 and acute coagulopathy in pregnancy

• Published in: Journal of thrombosis and haemostasis Vol. 18; no. 7; pp. 1648 - 1652
• Main Authors: Vlachodimitropoulou Koumoutsea, Evangelia, Vivanti, Alexandre J., Shehata, Nadine, Benachi, Alexandra, Le Gouez, Agnes, Desconclois, Celine, Whittle, Wendy, Snelgrove, John, Malinowski, Ann Kinga
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01.07.2020; International Society on Thrombosis and Haemostasis. Published by Elsevier Inc
• Subjects: Adult; Betacoronavirus - pathogenicity; Blood Coagulation; Blood Coagulation Tests; Case Report; Clinical Laboratory Techniques; coagulopathy; Coronavirus Infections - blood; Coronavirus Infections - diagnosis; Coronavirus Infections - virology; COVID-19; COVID-19 Testing; Disseminated Intravascular Coagulation - blood; Disseminated Intravascular Coagulation - diagnosis; Disseminated Intravascular Coagulation - therapy; Disseminated Intravascular Coagulation - virology; disseminated intravascular coagulopathy; Edema; Female; Fibrinogen; Host-Pathogen Interactions; Humans; Immune response; Oxygen consumption; Pandemics; Platelets; Pneumonia, Viral - blood; Pneumonia, Viral - diagnosis; Pneumonia, Viral - virology; Pregnancy; Pregnancy Complications, Hematologic - blood; Pregnancy Complications, Hematologic - diagnosis; Pregnancy Complications, Hematologic - therapy; Pregnancy Complications, Hematologic - virology; Pregnancy Complications, Infectious - blood; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - therapy; Pregnancy Complications, Infectious - virology; Pregnancy Trimester, Third - blood; Prothrombin; Respiratory failure; Respiratory tract; SARS-CoV-2; Thromboplastin; Thrombosis; Treatment Outcome; Young Adult; COVID-19; disseminated intravascular coagulopathy; coagulopathy; fibrinogen; pregnancy
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.14856

We present a putative link between maternal COVID‐19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS‐CoV‐2 has already resulted in high numbers of critically ill patients and deaths in the non‐pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID‐19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D‐dimers, prothrombin time, and platelet count in all patients presenting with COVID‐19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS‐CoV‐2‐positive pregnant women are vital, as their derangement may signal a more severe COVID‐19 infection, and may warrant pre‐emptive admission and consideration of delivery to achieve maternal stabilization.