Hepatic manifestations of COVID-19 in the obstetric population
Anaesthesia
; 78(Supplement 1):52.0, 2023.
Article
in English
| EMBASE | ID: covidwho-2235448
ABSTRACT
COVID-19 has and continues to affect healthcare across the world. Pregnant women have been identified as a moderate-risk group with regards to clinical susceptibility to COVID-19. Acute liver injury in pregnancy secondary to COVID-19 has been documented sparsely across the world. In this report, we describe the case of a pregnant women who presented with COVID-19 liver injury. A second women with a similar presentation and outcome also presented during the same COVID-19 wave but contact details were lost and consent not gained. Description The cases occurred in December 2020 during which time the predominant reported variant was the alpha strain of COVID-19. Patient A was a multiparous woman, who presented to the labour ward at 37 weeks, a few days after a positive COVID-19 test with vomiting. Investigations revealed significant derangement of liver function tests (LFTs) but with normal bilirubin and clotting. On a working diagnosis of acute fatty liver of pregnancy and with breech presentation, she underwent a caesarean section. Liver enzymes continued to deteriorate with a mild coagulopathy. A non-invasive liver screen and ultrasound did not reveal any significant abnormalities. She was discussed with the tertiary liver centre and started on a Nacetylcysteine infusion with some additional vitamin K. A few days later LFTs began to improve and she was discharged home with follow-up in the community. Her baby was treated with antibiotics for 5 days empirically due to the unknown nature of the transaminitis but remained well. Following further discussion with the tertiary centre, a diagnosis of acute liver injury secondary to COVID-19 was made. Discussion Extra-pulmonary features of COVID-19 have been reported in the literature. A number of theories have been postulated to describe the hepatic effects. This has mainly manifested itself as a transaminitis with varying outcomes. The prevalence in the obstetric population has been more sparsely reported but most isolated cases have been relatively self-limiting with positive outcomes [1]. This case also highlighted the diagnostic difficulties with other severe hepatic diseases of pregnancy. A handful of case reports have already described some of the crossover and difficulty in decisionmaking when these patients present acutely unwell to hospital [2]. The severity and rapid progression of some hepatic disorders in pregnancy not only warrants decisive decision-making but also involvement of the multidisciplinary team.
acute fatty liver of pregnancy; adult; blood clotting; blood clotting disorder; breech presentation; case report; cesarean section; clinical article; conference abstract; coronavirus disease 2019; COVID-19 testing; decision making; female; follow up; human; hypertransaminasemia; infant; liver disease; liver function test; liver injury; multidisciplinary team; multipara; pregnancy; pregnant woman; prevalence; ultrasound; vomiting; antibiotic agent; bilirubin; liver enzyme; vitamin K group
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
Topics:
Variants
Language:
English
Journal:
Anaesthesia
Year:
2023
Document Type:
Article
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