SARS-CoV-2 infection complicated by intrahepatic cholestasis of pregnancy

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.)

Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection.

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.