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British Journal of Midwifery ; 29(11):654-657, 2021.
Article in English | Academic Search Complete | ID: covidwho-1505519

ABSTRACT

This article reports a case of SARS-CoV-2 infection complicated by intrahepatic cholestasis of pregnancy in the second trimester in a South Asian woman. She presented with itchiness and grossly elevated bile acid following SARS-CoV-2 virus infection. Her cholestasis resolved in parallel with her infection while she was being treated with ursodeoxycholic acid. Bile acid is considered harmful to a developing fetus and is associated with adverse pregnancy outcomes, particularly stillbirth. Ursodeoxycholic acid is still commonly used in the treatment of these patients despite controversy about its value. It has anti-inflammatory properties and there have been suggestions that this could benefit patients with SARS-CoV-2. Elevated levels of primary bile acids (cholic and chenodeoxycholic acid) are considered harmful to a developing fetus, and are associated with adverse pregnancy outcomes, in particular, stillbirth. The secondary bile acid, ursodeoxycholic acid, is thought to be beneficial by reducing cholesterol production in the liver. This clinical case study highlights a diagnostic enigma in the management of this unique clinical case presentation. [ABSTRACT FROM AUTHOR] Copyright of British Journal of Midwifery is the property of Mark Allen Holdings Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

2.
Eur J Obstet Gynecol Reprod Biol ; 252: 559-562, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-935582

ABSTRACT

OBJECTIVE: To study the effect of COVID-19 on pregnancy and neonatal outcomes. STUDY DESIGN: Prospective cohort study in a large tertiary maternity unit within a university hospital with an average annual birth of over 10,000 births. We prospectively collected and analysed data for a cohort of 23 pregnant patients including singleton and multiple pregnancies tested positive for COVID-19 between February 2020 and April 2020 inclusive to assess the effect of COVID-19 on pregnancy, and neonatal outcomes. RESULTS: Twenty-three pregnant patients tested positive for COVID-19, delivering 20 babies including a set of twins, with four ongoing pregnancies at the time of manuscript submission. 16/23 (70 %) whom tested positive were patients from Asian (Indian sub-continent) background. The severity of the symptoms ranged from mild in 13/23 (65.2 %) of the patients, moderate in 2/23 (8.7 %), and severe in 8/23 (34.8 %). Four out of total 23 COVID-19 pregnant patients (17.4 %) developed severe adult respiratory distress syndrome complications requiring ICU support, one of whom led to maternal death 1/23 (4.3 %). 11/23 (48 %) of the patients had pre-existing co-morbidities, with morbid obesity 5/23 (21.7 %) and diabetes 4/23 (17.4 %) being the more commonly represented. Of the 23 pregnant patients 19 were in their third trimester of pregnancy and delivered; 7/19 (36.8 %) had preterm birth, 3/19 (15.8 %) developed adult respiratory distress syndrome before delivery, and 2/19 (10.5 %) had pre-eclampsia. 16/19 (84 %) of patients delivered by C-section. Out of the 20 new-borns, 18 were singletons with a set of twin. CONCLUSION: COVID-19 is associated with high prevalence of preterm birth, preeclampsia, and caesarean section compared to non-COVID pregnancies. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Pregnancy Complications, Infectious/virology , Pregnancy Outcome/epidemiology , Adult , COVID-19 , Cesarean Section/statistics & numerical data , Coronavirus Infections/virology , Female , Humans , Infant, Newborn , Pandemics , Pneumonia, Viral/virology , Pre-Eclampsia/epidemiology , Pre-Eclampsia/virology , Pregnancy , Premature Birth/epidemiology , Premature Birth/virology , Prospective Studies , SARS-CoV-2
4.
BMJ Case Rep ; 13(8)2020 Aug 11.
Article in English | MEDLINE | ID: covidwho-712861

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.


Subject(s)
Acute Kidney Injury/complications , Betacoronavirus , Coronavirus Infections/complications , Fatty Liver/complications , HELLP Syndrome/diagnosis , Pneumonia, Viral/complications , Pre-Eclampsia/diagnosis , Pregnancy Complications, Infectious/diagnosis , Acute Kidney Injury/blood , Acute Kidney Injury/diagnosis , Adult , COVID-19 , Coronavirus Infections/blood , Fatty Liver/blood , Fatty Liver/diagnosis , Female , HELLP Syndrome/blood , Humans , Kidney Function Tests , Pandemics , Pneumonia, Viral/blood , Pre-Eclampsia/blood , Pregnancy , Pregnancy Complications/blood , Pregnancy Complications/diagnosis , Pregnancy Complications, Infectious/blood , SARS-CoV-2
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