Coronavirus disease 2019 on routine testing in eclampsia: a case report.

BACKGROUND: Coronavirus disease 2019 has been associated with adverse pregnancy outcomes, including preeclampsia. Coronavirus disease 2019 and preeclampsia have overlapping clinical features and are therefore challenging to differentiate. Since pregnant women are not routinely tested for coronavirus disease 2019, it is prudent to test for it among patients presenting with preeclampsia or eclampsia. CASE PRESENTATION: A 23-year-old female, a Munda, gravida 1 para 0, at 36 weeks and 5 days of amenorrhea presented to Mal Super Specialty Hospital as a referral in a semiconscious state after a severe attack of tonic-clonic seizures. Detailed history from the husband was insignificant except for a persistent cough for the last 7 days. She had denied any visual changes, headaches, or vaginal discharge. Physical examination revealed tachycardia (150 beats per minute), elevated blood pressure (187/111 mmHg), tachypnea (36 breaths per minute), and oxygen saturation of 94% on room air. Routine coronavirus disease 2019 rapid test was positive, and urine dipstick was +3. Additional tests revealed leukocytosis and elevated liver enzymes. Chest radiograph revealed prominent interstitial markings, and a bedside transabdominal ultrasonography showed a live single intrauterine fetus in cephalic presentation with normal cardiac activity and movements. A diagnosis of a prime gravida with eclampsia and coronavirus disease 2019 was made. She was managed with intravenous labetalol; she had already received a loading dose of intravenous magnesium sulfate, and we administered two maintenance doses during monitoring. Within an hour of admission, she had a spontaneous rupture of the amniotic membranes, with meconium-stained liquor (grade 2), and the fetal heart rate (148 beats per minute) was reassuring. She had an uncomplicated vaginal delivery of a live male newborn. Shortly after delivery, she developed slight respiratory distress and significant fluid overload that was managed with furosemide. Coronavirus disease 2019 reverse-transcription polymerase chain reaction test came back negative for the neonate and positive for the mother. She was shifted to the coronavirus disease 2019 treatment unit, and her contact with the child was limited. She was kept on a course of tablets ivermectin, zinc, vitamin C, montelukast, azithromycin, metronidazole, and injectable pantoprazole. The mother and child were discharged on day 15 after recovery with negative COVID nasopharyngeal swab. CONCLUSION: A diagnosis of preeclampsia or eclampsia should prompt testing for coronavirus disease 2019.

Severe Postpartum Hemorrhage in an Asymptomatic COVID-19 Patient: A Call to Be on Guard.

Postpartum hemorrhage (PPH), the loss of more than 500 mL of blood following childbirth, is a leading cause of maternal mortality worldwide. The current coronavirus disease 2019 (COVID-19) pandemic has strained health-care systems globally. Pregnant women are a vulnerable group at a high risk of severe infection with COVID-19 due to the physiological changes in their immune state. Although the infection can be asymptomatic, severe COVID-19 infection is associated with respiratory distress, fever and coagulopathies that can complicate an already hypercoagulable pregnancy state. There is a dearth of existing literature regarding the complications of COVID-19 infection during pregnancy, and much is yet to be known about this rapidly evolving pandemic. In our case report, we received a 23-year-old gravida 2 para 1 woman who was COVID-19 positive but asymptomatic; she presented to the obstetric department with labor pains which progressed to severe postpartum hemorrhage and development of mild respiratory distress.