{
    "abstract": "Hypercoagulability frequently complicates\u00a0moderate or severe COVID-19 and can result in venous thromboembolism, arterial thrombosis, or microvascular thrombosis. Disseminated intravascular coagulation, however, is uncommon.\nWe sought to describe the\u00a0clinical presentation and outcome in\u00a0a series of pregnant patients with mild or asymptomatic COVID-19 who had disseminated intravascular coagulation.\nThis was a retrospective case series. Cases were solicited via e-mails targeted to obstetrical providers in the Mednax National Medical Group and a restricted\u00a0maternal-fetal medicine Facebook page. Inclusion criteria were: hospital admission during pregnancy, positive test for SARS-CoV-2 within 2 weeks of admission, and maternal disseminated intravascular coagulation defined as \u22652 of the following: platelet count \u2264100,000 per mm\nInclusion criteria were met in 19 cases from October\u00a02020 through December\u00a02021. Of these, 18 had not received any COVID-19 vaccine, and 1 had unknown vaccination status. Median gestational age on hospital admission was 30 weeks (interquartile range, 29-34 weeks). The main presenting symptom or sign was decreased fetal movement (56%) or nonreassuring fetal heart rate pattern (16%). COVID-19 was asymptomatic in 79% of cases. Two of the 3 defining coagulation abnormalities were found in 89% of cases and all 3 in the remaining 11%. Aspartate aminotransferase was elevated in all cases and \u22652 times the upper normal limit in 69%. Only 2 cases (11%) had signs of preeclampsia other than thrombocytopenia or transaminase elevation. Delivery was performed on the day of admission in 74% and on the next day in the remaining 26%, most often by cesarean delivery (68%) under general anesthesia (62%) because of nonreassuring fetal heart rate pattern (63%). Postpartum hemorrhage occurred in 47% of cases. Blood product transfusions were given in 95% of cases, including cryoprecipitate (89% of cases), fresh/frozen plasma (79%), platelets (68%), and red cells (63%). Placental histopathology was abnormal in 82%, with common findings being histiocytic intervillositis, perivillous fibrin deposition, and infarcts or necrosis. Among the 18 singleton pregnancies and 1 twin pregnancy, there were 13 live newborns (65%) and 7 stillbirths (35%). Among liveborn neonates, 5-minute Apgar score was \u22645 in 54%, and among cases with umbilical cord blood gases, pH \u22647.1 was found in 78% and base deficit \u226510 mEq/L in 75%. Positive COVID-19 tests were found in 62% of liveborn infants.\nClinicians should be alert to the possibility of disseminated intravascular coagulation when a COVID-19 patient complains of decreased fetal movement in the early third trimester. If time allows, we recommend evaluation of coagulation studies and ordering of blood products for massive transfusion protocols before cesarean delivery if fetal tracing is nonreassuring.",
    "authors": [
        {
            "affiliation": "Obstetrix Medical Group of the Mountain States, Salt Lake City, UT.",
            "firstname": "Jeanette",
            "initials": "J",
            "lastname": "Carpenter"
        },
        {
            "affiliation": "Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL.",
            "firstname": "C Andrew",
            "initials": "CA",
            "lastname": "Combs"
        },
        {
            "affiliation": "Obstetrix Medical Group of Colorado, Denver, CO.",
            "firstname": "Bronwen",
            "initials": "B",
            "lastname": "Kahn"
        },
        {
            "affiliation": "Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL.",
            "firstname": "Kimberly",
            "initials": "K",
            "lastname": "Maurel"
        },
        {
            "affiliation": "Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL.",
            "firstname": "Reese",
            "initials": "R",
            "lastname": "Clark"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": "Clinicians should be alert to the possibility of disseminated intravascular coagulation when a COVID-19 patient complains of decreased fetal movement in the early third trimester. If time allows, we recommend evaluation of coagulation studies and ordering of blood products for massive transfusion protocols before cesarean delivery if fetal tracing is nonreassuring.",
    "copyrights": "\u00a9 2022 The Authors.",
    "doi": "10.1016/j.xagr.2022.100110",
    "journal": "AJOG global reports",
    "keywords": [
        "SARS-CoV-2 placentitis",
        "decreased fetal movement",
        "intrauterine fetal demise",
        "massive transfusion",
        "placental fibrinoid deposition",
        "placental histiocytic intervillositis",
        "placental necrosis",
        "stillbirth"
    ],
    "methods": null,
    "publication_date": "2022-09-29",
    "pubmed_id": "36168543\n32311448\n32282949\n32492712\n32339221\n32467443\n32846051\n34399021\n34260818\n33368021\n33524866\n36943814\n32658609\n34119049\n32374815\n34534497\n33631519\n33546624\n35114422\n35042979\n35129581\n35034863\n32302459\n32665677\n32573498\n33465727\n32853442\n35024844\n34338723\n34329973\n33560778\n27372270\n24728139\n35213734\n25840271\n35142798\n11910510\n23905710\n33023403\n34818318\n33351086\n32298273\n32853537\n34302772\n35133427\n27223167",
    "results": "Inclusion criteria were met in 19 cases from October\u00a02020 through December\u00a02021. Of these, 18 had not received any COVID-19 vaccine, and 1 had unknown vaccination status. Median gestational age on hospital admission was 30 weeks (interquartile range, 29-34 weeks). The main presenting symptom or sign was decreased fetal movement (56%) or nonreassuring fetal heart rate pattern (16%). COVID-19 was asymptomatic in 79% of cases. Two of the 3 defining coagulation abnormalities were found in 89% of cases and all 3 in the remaining 11%. Aspartate aminotransferase was elevated in all cases and \u22652 times the upper normal limit in 69%. Only 2 cases (11%) had signs of preeclampsia other than thrombocytopenia or transaminase elevation. Delivery was performed on the day of admission in 74% and on the next day in the remaining 26%, most often by cesarean delivery (68%) under general anesthesia (62%) because of nonreassuring fetal heart rate pattern (63%). Postpartum hemorrhage occurred in 47% of cases. Blood product transfusions were given in 95% of cases, including cryoprecipitate (89% of cases), fresh/frozen plasma (79%), platelets (68%), and red cells (63%). Placental histopathology was abnormal in 82%, with common findings being histiocytic intervillositis, perivillous fibrin deposition, and infarcts or necrosis. Among the 18 singleton pregnancies and 1 twin pregnancy, there were 13 live newborns (65%) and 7 stillbirths (35%). Among liveborn neonates, 5-minute Apgar score was \u22645 in 54%, and among cases with umbilical cord blood gases, pH \u22647.1 was found in 78% and base deficit \u226510 mEq/L in 75%. Positive COVID-19 tests were found in 62% of liveborn infants.",
    "title": "Disseminated intravascular coagulation complicating mild or asymptomatic maternal COVID-19.",
    "xml": "<Element 'PubmedArticle' at 0x7885031c5a30>"
}