ABSTRACT
Background: Coronavirus Disease 2019 (COVID-19) has been associated with adverse pregnancy outcomes including preeclampsia. COVID-19 and pre-eclampsia have overlapping clinical features therefore challenging to differentiate. Since COVID-19 is not routinely tested among pregnant women, it’s prudent to test it among patients presenting with Pre-eclampsia-Eclampsia. Case Presentation: A 23 year old female Gravida 1 Para 0 at 36 weeks and 5 days of amenorrhea presented at Mal Super Specialty Hospital as a referral in a semi-conscious 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 a tachycardia (150 bpm), elevated blood pressure (187/111 mmHg), a tachypnea (36 breaths/minute) and SPO 2 of 94% at room air. Routine COVID-19 Rapid test turned positive, and the urine dipstick was +3. Additional tests revealed a 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 COVID-19 was made. She was managed with intravenous labetalol, she had already received a loading dose of IV Magnesium sulphate 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. A COVID-19 RT-PCR came back negative for the neonate and positive for the mother. She was shifted to the COVID-19 treatment unit and contact limited with the child. She was kept on a course of tablets Ivermectin, zinc, vitamin C, a montelukast, azithromycin, metronidazole and injectable pantoprazole. They were discharged on day 15 after recovery with a negative COVID nasopharyngeal swab. Conclusion: A diagnosis of pre-eclampsia-Eclampsia should prompt testing for COVID-19.