COVID-19 in pregnant women: description of a possible case of COVID-19-linked HELLP-like syndrome

Submitted: 18 December 2023
Accepted: 1 March 2024
Published: 25 March 2024
Abstract Views: 57
PDF: 21
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New evidence suggests that Sars-CoV2 infection during pregnancy may result in complications such as hypertension, nephropathy, thrombocytopenia, and liver damage. A pre-eclampsia-like syndrome has also been proposed in pregnant women with severe SARS-CoV-2 infection, which meets the pre-eclampsia criteria but resolves without delivery, with improvement in respiratory symptoms. 31-year-old, second pregnancy, in Emergency Room for PROM (premature rupture of membranes), has Sars-CoV2 infection and has not been vaccinated. Normal examinations and mild hypertension were present upon admission, but no treatment was administered. Vaginal Leukocytic Delivery 12 hours after admission, newborn Apgar score 9/10, weight 3.250 kg. At 20 hours after delivery, epigastric pain VAS 8-9 for 20 minutes, systolic/diastolic hypertension peak, increase in transaminases, LDH, ALP, Bilirubin, Dimer, platelet and fibrinogen drop. Neurological and respiratory objectivity were negative, and renal indices were within normal limits, so nifedipine 30mgx2/day + methyldopa 500 mgx2/day was started. Abdominal ultrasound revealed a thin perihepatic fluid stratum. A prophilaxis of dexamethasone 12mg twice a day and magnesium sulfate was introduced. At 32 hours after delivery, the laboratory detected an increase in transaminases, LDH, and worsening of thrombocytopenia. The patient is always eupnoic, and the diuresis is adequate. Blood tests improved gradually after 56 hours postpartum. Methyldopa and steroids are escalating. On day 7, discharge with normalized platelet and bilirubin counts and a decreasing trend in transaminases, LDH, and PAL. At the one-week follow-up, liver enzymes and coagulation were completely normal, and blood pressure was well controlled with methyldopa. We conclude that the simultaneous presence of the two diseases could have had a synergistic or opportunistic effect, resulting in severe clinical manifestations via interaction with the Renin-Angiotensin-Aldosterone system.

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Citations

Sánchez-Aranguren LC, Prada CE, Riaño-Medina CE, Lopez M. Endothelial dysfunction and preeclampsia: role of oxidative stress. Front Physiol 2014;10:372. DOI: https://doi.org/10.3389/fphys.2014.00372
Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) – Initiative on Preeclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynecol Obstet 2019;145:1-33. DOI: https://doi.org/10.1002/ijgo.12892
Mullins E, Evans D, Viner RM, et al. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020;55:586-92. DOI: https://doi.org/10.1002/uog.22014
Dashraath P, Wong JLL, Lim MXK, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020;222;521-31. DOI: https://doi.org/10.1016/j.ajog.2020.03.021
Di Mascio D, Khalil A, Saccone G, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020;2:100107. DOI: https://doi.org/10.1016/j.ajogmf.2020.100107
Smith ER, Oakley E, Grandner GW, et al. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. BMJ Glob Health 2023;8:e009495.
Lai J, Romero R, Tarca AL, et al. SARS-CoV-2 and the subsequent development of preeclampsia and preterm birth: evidence of a dose-response relationship supporting causality. Am J Obstet Gynecol 2021;225:689–93. DOI: https://doi.org/10.1016/j.ajog.2021.08.020
da Cunha Sobieray NLE, Zanela M, Padilha SL,et al. HELLP syndrome and COVID-19: A minor revision of a possible new "COVID-19-linked HELLP-like syndrome”. Review Eur J Obstet Gynecol Reprod Biol 2023;283:90-4. DOI: https://doi.org/10.1016/j.ejogrb.2023.02.005
Yan R, Zhang Y, Li Y, et al. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science 2020;367:1444-8. DOI: https://doi.org/10.1126/science.abb2762
Gusev E, Sarapultsev A, Solomatina L, Chereshnev V. SARS-CoV-2-Specific Immune Response and the Pathogenesis of COVID-19. Int J Mol Sci 2022;23:1716. DOI: https://doi.org/10.3390/ijms23031716
Shanes ED, Mithal LB, Otero S, et al. Placental Pathology in COVID-19. Am J Clin Pathol 2020;154:23-32. DOI: https://doi.org/10.1093/ajcp/aqaa089
Mendoza M, Garcia-Ruiz I, Maiz N, et al. Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG 2020;127:1374-80. DOI: https://doi.org/10.1111/1471-0528.16339
Coronado-Arroyo JC, Concepción-Zavaleta MJ, Zavaleta-Gutiérrez FE, Concepción-Urteaga LA. Is COVID-19 a risk factor for severe preeclampsia? Hospital experience in a developing country. Eur J Obstet Gynecol Reprod Biol 2021;256:502-3. DOI: https://doi.org/10.1016/j.ejogrb.2020.09.020
Ronnje L, Länsberg JK, Vikhareva O, et al. Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery. BMC Pregnancy Childbirth 2020;20:511. DOI: https://doi.org/10.1186/s12884-020-03172-8
Figueras F, Martinez‐Portilla RJ, Llurba E, et al. VP45.03: COVID‐19 causing HELLP‐like syndrome in pregnancy and the role of angiogenic factors for differential diagnosis. Ultrasound Obstet Gynecol 2020;56:257–8. DOI: https://doi.org/10.1002/uog.23034
Arslan E. COVID-19: A Cause of HELLP Syndrome? A Case Report. Int J Womens Health 2022;14:617-623. DOI: https://doi.org/10.2147/IJWH.S362877
Ahmed I, Eltaweel N, Antoun L, Rehal A. Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection. BMJ Case Rep 2020;13:e237521. DOI: https://doi.org/10.1136/bcr-2020-237521
Madaan S, Talwar D, Kumar S, et al. HELLP Syndrome and COVID-19; association or accident: A case series. J Family Med Prim Care 2022;11:802-6. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1136_21
Čivrná J, Skanderová D, Ehrmann J, Pilka R. HELLP syndrome and HELLP-like syndrome in pregnancies with covid-19 - case reports. Ceska Gynekol 2021;86:236-41. DOI: https://doi.org/10.48095/cccg2021236

How to Cite

Russo, F., Vitiello, A., Russo, M. C., Riccio, A., & Candurro, C. (2024). COVID-19 in pregnant women: description of a possible case of COVID-19-linked HELLP-like syndrome. Acute Care Medicine Surgery and Anesthesia, 2(1). https://doi.org/10.4081/amsa.2024.39