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Published on: June 15, 2019
Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report
Kelly Elizabeth Kinsey1, Eric Ganz2, Susan Khalil3
1Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, NY, New York, USA. kellyelizabeth.kinsey@mountsinai.org.
Background:
The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values.
Case:
The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets.
Conclusion:
There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.
