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Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report.
BMC Pregnancy Childbirth. 2020 Aug 24; 20(1):481.BP

Abstract

BACKGROUND

The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values.

CASE

The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets.

CONCLUSION

There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.

Links

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Authors+Show Affiliations

Kinsey KE
Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, NY, New York, USA. kellyelizabeth.kinsey@mountsinai.org.
Ganz E
Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, NY, New York, USA.
Khalil S
Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Icahn School of Medicine, New York, USA.
Brustman L
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, New York, USA.

MeSH

AdultAntifibrinolytic AgentsBetacoronavirusBlood Coagulation DisordersBlood Loss, SurgicalBreech PresentationC-Reactive ProteinCOVID-19CauteryCesarean SectionCoronavirus InfectionsFemaleFibrin Fibrinogen Degradation ProductsFibrinogenHemostasis, SurgicalHumansInternational Normalized RatioMethylergonovineOligohydramniosOxytocicsOxytocinPandemicsPlatelet CountPneumonia, ViralPregnancyPregnancy Complications, HematologicPregnancy Complications, InfectiousProthrombin TimeSARS-CoV-2Tranexamic AcidUterine Inertia

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32838744

Citation

Kinsey, Kelly Elizabeth, et al. "Intraoperative Coagulopathy During Cesarean Section as an Unsuspected Initial Presentation of COVID-19: a Case Report." BMC Pregnancy and Childbirth, vol. 20, no. 1, 2020, p. 481.
Kinsey KE, Ganz E, Khalil S, et al. Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report. BMC Pregnancy Childbirth. 2020;20(1):481.
Kinsey, K. E., Ganz, E., Khalil, S., & Brustman, L. (2020). Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report. BMC Pregnancy and Childbirth, 20(1), 481. https://doi.org/10.1186/s12884-020-03140-2
Kinsey KE, et al. Intraoperative Coagulopathy During Cesarean Section as an Unsuspected Initial Presentation of COVID-19: a Case Report. BMC Pregnancy Childbirth. 2020 Aug 24;20(1):481. PubMed PMID: 32838744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report. AU - Kinsey,Kelly Elizabeth, AU - Ganz,Eric, AU - Khalil,Susan, AU - Brustman,Lois, Y1 - 2020/08/24/ PY - 2020/06/11/received PY - 2020/07/28/accepted PY - 2020/8/26/entrez PY - 2020/8/26/pubmed PY - 2020/8/28/medline KW - COVID-19 KW - D-Dimer KW - Sars-CoV-2 KW - cesarean section KW - coagulopathy SP - 481 EP - 481 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 20 IS - 1 N2 - BACKGROUND: The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values. CASE: The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets. CONCLUSION: There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/32838744/Intraoperative_coagulopathy_during_cesarean_section_as_an_unsuspected_initial_presentation_of_COVID_19:_a_case_report_ DB - PRIME DP - Unbound Medicine ER -