Braga Luiz Felipe Bagnatori, Sass Nelson
Hospital Municipal Maternidade Escola de Vila Nova Cachoeirinha, São Paulo, SP, Brazil.
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Rev Bras Ginecol Obstet. 2020 Oct;42(10):669-671. doi: 10.1055/s-0040-1718437. Epub 2020 Oct 31.
The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks. She presented with history of myalgia, jaundice, and abdominal discomfort. No flu-like symptoms as fever or cough. She was not aware of exposure to COVID-19. Normal blood pressure and O saturation. Laboratory tests showed platelet count of 218,000 mm, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl. Doppler ultrasound in one twin was compatible with brain sparing. Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed. On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress. Tomography revealed both lungs with ground-glass opacities. Swab for COVID-19 polymerase chain reaction (PCR) was positive. Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome. We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.
本报告描述了一名31岁初产妇的病例，其怀有双绒毛膜双胎，孕周31周。她有肌痛、黄疸和腹部不适的病史。无发热或咳嗽等流感样症状。她未意识到接触过新冠病毒。血压和血氧饱和度正常。实验室检查显示血小板计数为218,000/mm，丙氨酸转氨酶（ALT）558 IU，血清肌酐2.3 mg/dl。其中一个胎儿的多普勒超声检查结果符合脑保护表现。初步诊断为部分溶血、肝酶升高、血小板减少（HELLP）综合征，遂行剖宫产。术后第2天，白细胞计数升至33,730，患者意识减退，伴有轻度呼吸窘迫。断层扫描显示双肺有磨玻璃样混浊。新冠病毒聚合酶链反应（PCR）拭子检测呈阳性。新冠病毒感染患者的血小板减少似乎是多因素导致的，这与子痫前期和HELLP综合征的情况类似。我们认为这些病理生理机制的协同作用可能会加速母体状况的恶化，对产科实践具有警示意义。
