Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report
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(2020) 20:481
CASE REPORT
Open Access
Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report Kelly Elizabeth Kinsey1*, Eric Ganz1, Susan Khalil2 and Lois Brustman3
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 DDimer, may help identify the patients in which this presentation occurs. Keywords: Sars-CoV-2, COVID-19, cesarean section, coagulopathy, D-Dimer
Background With the spread of SARS-Cov-2, lessons learned both locally and globally are providing us with the knowledge to arrive at evidence-based practices in this unforeseen pandemic. This case study discusses the possibility of SARSCoV-2 instigating an abnormal hemodynamic response and coagulopathy in a patient undergoing a primary cesarean section in the setting of abnormal COVID laboratory values and normal coagulation factors.
* Correspondence: [email protected]; [email protected] 1 Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, NY, New York, USA Full list of author information is available at the end of the article
Case Presentation This case describes a 26 year-old G1P0 who presented to a large Manhattan hospital at 37 weeks 6 days for a scheduled external cephalic version. Her past medical history was notable for well-controlled chronic Hepatitis B with an undetectable viral load (< 10 IU/mL) and normal liver function tests. In triage, she was found to have oligohydramnios and a confirmed frank breech presentation. Accordingly, delivery by cesarean section was recommended. As per routine practice in this hospital, the patient was tested for SARS-CoV-2 in triage. She denied symptoms of the disease at the time, was clinically perceived to be asymptomatic, and had normal vitals and a benign physical exam. While in triage
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