ABSTRACT
Objective: The start of quarantine for the COVID-19 pandemic in March 2020 began a prolonged period of isolation from family and crucial social support for many pregnant and postpartum patients throughout the country. The objective of this study was to compare the score of the Edinburgh Postnatal Depression Scale (EPDS), breastfeeding, and compliance with postpartum gestational diabetes follow-up in cohorts before and after the beginning of the COVID-19 pandemic. Study Design: This was a historical cohort study of women presenting for postpartum care in March through May of 2019 and 2020 at a tertiary academic medical center. Demographic information, parity, delivery routes, EPDS scores, maternal mental health history, partner status, and postpartum diabetes screening completion were ed from the electronic medical record. Results were compared between the 2019 and 2020 cohorts. Results: There were 579 women with postpartum visits in the study timeframe, with 260 in 2019 and 319 in 2020. Age, gestational age at delivery, pre-gravid BMI, and partner status were similar between cohorts. (Table 1) There was no difference in history of a mental health diagnosis, history of mental health medication use, or mental health treatment during pregnancy between cohorts. There were more nulliparous patients, cesarean deliveries, African American patients, and Asian patients in 2020. The mean EPDS score was similar between cohorts;there was no difference in breastfeeding or 2-hour glucose tolerance test compliance in women who had gestational diabetes. (Table 2) There was a non-significant trend toward more new postpartum depression treatment in 2020. Conclusion: In our population, the start of the COVID-19 pandemic and resulting social disruption was not associated with a difference between EPDS scores, breastfeeding, completion of gestational diabetes follow up or incidence of initiation of mental health treatment in the postpartum period in our population. [Formula presented] [Formula presented]
ABSTRACT
Background : The prothrombotic state of COVID-19 infection is well documented, but recommendations for management of clot in transit in the post-partum state are lacking. Aims : We describe a unique case of a 39-year-old female, 34-week gravida with pregnancy complicated by COVID-19 and clot in transit. Methods : Our patient presented to our hospital for a week of worsening dyspnea, cough, and fevers. Given her respiratory decline, she underwent urgent cesarean delivery of a healthy male infant. Initial chest x-ray was consistent with severe COVID-19 pneumonia. Noninvasive methods of oxygenation were exhausted, and she was eventually intubated. Troponin was <0.02 ng/mL, BNP was 71 pg/mL, and D-Dimer increased from 601 to 13.000 ng/mL. Transthoracic echocardiogram showed preserved cardiac function, but imaging was sub-optimal for the right ventricle (RV). On post-cesarean day 6, CT Pulmonary Angiogram (CTPA) showed bilateral segmental and subsegmental Pulmonary Embolism (PE) with filling defect in the RV consistent with clot in transit (CIT). No RV strain was noted on Echo or CTPA. Lower extremity venous duplex showed only acute calf thrombus. She was anticoagulated with enoxaparin at 1 mg/ kg, but her oxygen requirements worsened requiring 100% FiO2 on the ventilator. Emergent multidisciplinary discussion was held by PE Response Team (PERT) regarding use of catheter directed lysis, systemic lysis, ECMO or surgical embolectomy. Results : PERT team ultimately recommended 50 mg alteplase be given systemically with family's consent. After alteplase was given, her oxygen requirements quickly improved to 45% FiO2 and her vitals remained normal. CT Head reported no hemorrhage, and repeat CTPA showed near-complete resolution of RV thrombus. Conclusions : This case exemplifies the role of both emergent multidisciplinary decision-making in complex case scenarios, and systemic thrombolysis for the management of COVID-19 related CIT in patients who recently underwent cesarean delivery.