COVID19 and acute coagulopathy in pregnancy

Vlachodimitropoulou Koumoutsea, Evangelia; Vivanti, Alexandre J.; Shehata, Nadine; Benachi, Alexandra; Le Gouez, Agnes; Desconclois, Celine; Whittle, Wendy; Snelgrove, John; Malinowski, Kinga Ann

We present a putative link between maternal COVID19 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 syndrome, and thus knowledge of the COVID19 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 COVID19 as per ISTH guidance, monitoring of 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 COVID19 infection, and may warrant pre-emptive admission and consideration of delivery to achieve maternal stabilization