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COVID-19-Associated Coagulopathy in the Peripartum Setting: A Case Report
Ashley Allen1, Christine Hoang1, Roopina Sangha1
1Department of Obstetrics and Gynecology, John Peter Smith Hospital, Fort Worth, Texas.
AJP Reports
|February 10, 2022
Summary
COVID-19-induced coagulopathy in postpartum patients is difficult to manage. Further studies are needed to validate D-dimer and Sepsis-induced coagulopathy (SIC) scoring in this unique patient population.
Area of Science:
- Critical Care Medicine
- Obstetrics
- Infectious Diseases
Background:
- COVID-19-induced coagulopathy (CIC) management is challenging, particularly in the peripartum period.
- Current diagnostic tools like Sepsis-induced coagulopathy (SIC) scoring and D-dimer levels have unclear utility in postpartum CIC.
- Anticoagulation guidance for peripartum CIC remains ambiguous.
Observation:
- A critically ill postpartum patient with COVID-19 developed acute respiratory failure.
- The patient required mechanical ventilation and cesarean delivery, initially improving postoperatively.
- Deterioration occurred on postoperative day 5, with a significantly elevated D-dimer (58 μg/mL), prompting escalated anticoagulation.
Findings:
- The case highlights diagnostic and therapeutic challenges in managing CIC during the peripartum phase.
- Elevated D-dimer levels were observed, necessitating increased anticoagulation therapy.
- The patient ultimately succumbed to gram-positive bacteremia after prolonged ventilation.
Implications:
- This case underscores the complexity of recognizing and managing CIC in postpartum women.
- There is a critical need for research to validate D-dimer and SIC scoring in the peripartum population.
- Establishing clear anticoagulation protocols for peripartum CIC is essential for improved patient outcomes.
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