November 21, 2022
2 min learn
Carpenter experiences no related monetary disclosures.
Even in instances of delicate or asymptomatic COVID-19, extreme disseminated intravascular coagulation was a chance for pregnant individuals, findings from a retrospective case sequence present.
“There isn’t any standardized protocol for maternal-fetal surveillance after maternal COVID-19 prognosis,” Jeanette Carpenter, MD, a maternal-fetal drugs specialist at Pediatrix Medical Group, and colleagues wrote within the American Journal of Obstetrics & Gynecology International Studies. “Clinicians usually discover it reassuring if sufferers are mildly symptomatic or asymptomatic. After pregnant sufferers check constructive for SARS-CoV-2, routine visits for prenatal care, ultrasound examinations and fetal surveillance are sometimes postponed to reduce potential publicity of noninfected individuals.”
Nonetheless, sufferers with delicate or asymptomatic cases of COVID-19 who had disseminated intravascular coagulation typically reported decreased fetal motion (56%) or nonreassuring fetal coronary heart price sample (16%).
Healio spoke with Carpenter to be taught extra in regards to the scientific and analysis implications for pregnant individuals with delicate or asymptomatic illness.
Healio: What prompted this research?
Carpenter: Via discussions on a personal maternal-fetal drugs scientific discussion board and a maternal-fetal drugs Fb web page, we found that many clinicians have been seeing related instances throughout america of pregnant sufferers with both asymptomatic or delicate COVID, disseminated intravascular coagulation, and proof of fetal compromise within the type of decreased fetal motion, nonreassuring fetal coronary heart price tracings and stillbirth. We sought to explain the scientific options and outcomes in 19 recognized instances between October 2020 and December 2021 (pre-omicron surge).
Healio: What’s the major message for clinicians?
Carpenter: Extreme disseminated intravascular coagulation can happen even when maternal COVID seems delicate. The entire sufferers included on this case sequence have been within the third trimester. Most (95%) required blood product transfusion and most (82%) had irregular placental histopathology with proof of what has been termed SARS-CoV-2 placentitis — histiocytic intervillositis, intervillous fibrin deposition and necrosis. Our findings recommend a hyperlink between an infection of the placenta with SARS-CoV-2 and the event of maternal disseminated intravascular coagulation.
Healio: Have been any of the findings shocking?
Carpenter: Sure. Earlier research had discovered that opposed being pregnant outcomes with COVID have been primarily seen in these sufferers with extreme or essential illness. In distinction, the sufferers on this retrospective case sequence had delicate or asymptomatic COVID however extreme scientific outcomes.
Healio: What work must be completed to deal with disseminated intravascular coagulation in pregnant sufferers with COVID-19?
Carpenter: Of the 19 ladies included on this instances sequence, 18 have been unvaccinated and one had an unknown vaccination historical past. COVID vaccination for pregnant patients ought to proceed to be inspired. When a pregnant affected person presents within the third trimester with a current constructive check for COVID and decreased fetal motion, they need to have immediate fetal monitoring. If fetal standing isn’t reassuring and cesarean supply is required, we advocate — if time permits — laboratory analysis for proof of disseminated intravascular coagulation (platelet rely, fibrinogen and prothrombin time/partial thromboplastin time) and ordering of blood merchandise for potential large transfusion protocol previous to supply.
Healio: What analysis on this matter would you prefer to conduct subsequent?
Carpenter: Future analysis ought to give attention to whether or not these sufferers have opposed outcomes in future pregnancies. The present research didn’t embody sufferers in the course of the omicron surge. It is going to be vital to find out if SARS-CoV-2 placentitis and maternal disseminated intravascular coagulation are kind of widespread with specific variants.