Almaty Branch of the National Center for Biotechnology, Central Reference Laboratory, 14 Zhahanger St., Almaty, 050054, Kazakhstan.
Semey Medical University, 103 Abay Kunanbayev St., Semey, 071400, Kazakhstan.
J Med Case Rep. 2023 Nov 2;17(1):455. doi: 10.1186/s13256-023-04180-w.
A limited number of studies have described thrombotic complications in pregnant women with COVID-19. Here we report on fatal pulmonary embolism in a pregnant woman with laboratory confirmed SARS-CoV-2 infection.
A 28-year-old Kazakh woman was hospitalized with muscle pain, dry cough and a temperature of 37.5 °C at the 29th week of gestation. Upon admission, a blood test demonstrated elevated neutrophil-to-lymphocyte ratio, decreased levels of erythrocytes and hemoglobin, as well as prolonged prothrombin and activated partial thromboplastin time. Within 14 days of admission, she experienced respiratory distress and underwent transfer to the intensive care unit, intubation and a cesarean section. The patient received intravenous antibiotics, antiviral medications, systemic corticosteroids and dual anticoagulation with aspirin and enoxaparin. Death outcome was reported on day 18 of illness despite aggressive supportive care. Histological analysis demonstrated that obstruction of the main pulmonary arthery and disseminated intravascular coagulation were the causes of death.
This case demonstrates that in the management of pregnancy and childbirth in patients with suspected or confirmed COVID-19 infection, special attention should be paid to coagulation system parameters and timely appropriate prophylaxis of thromboembolic complications, which has yet to be determined.
已有少量研究描述了 COVID-19 孕妇的血栓并发症。在此，我们报告了一例实验室确诊 SARS-CoV-2 感染的孕妇发生致命性肺栓塞。
一名 28 岁哈萨克族女性在妊娠 29 周时因肌肉疼痛、干咳和体温 37.5°C 住院。入院时，血液检查显示中性粒细胞与淋巴细胞比值升高、红细胞和血红蛋白水平降低，以及凝血酶原时间和活化部分凝血活酶时间延长。入院后 14 天内，她出现呼吸窘迫，转入重症监护病房，进行气管插管和剖宫产。患者接受了静脉内抗生素、抗病毒药物、全身皮质类固醇和阿司匹林联合依诺肝素的双联抗凝治疗。尽管进行了积极的支持性治疗，但在发病第 18 天仍报告了死亡结局。组织学分析表明，主肺动脉阻塞和弥散性血管内凝血是导致死亡的原因。
本病例表明，在疑似或确诊 COVID-19 感染患者的妊娠和分娩管理中，应特别注意凝血系统参数，并及时进行适当的血栓栓塞并发症预防，这一点尚待确定。
