A complicated pregnancy: Eclampsia or COVID-19?

Abstract

Pregnant women may be infected with SARS-CoV-2 virus and develop serious complications of the disease. Covid-19 causes primarilya respiratory system infection but can also affect cardiovascular, renal, gastrointestinal, and neurological systems. Cardiovascularinvolvement includes new onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism, and pre-eclampsia like syndrome.We report a confirmed Covid-19 pregnant case presented with eclampsia to the emergency department and undergone emergentcesarean section. Following surgery, she was admitted to the intensive care unit due to hypoxemia and hypertension. After observinglymphopenia and high CRP level with hypoxemia, radiological imaging revealed typical findings for viral pneumonia and nasopharyngealswab, which was not carried out at admission, was positive for Covid-19. On the 20th hour of follow-up, she became hypotensiverequiring noradrenalin infusion. Echocardiography diagnosed cardiomyopathy with left ventricular ejection fraction of 35-40 % withhigh levels of NT pro-BNP, hs-troponin, and CK-MB in the patient.Covid-19 should be considered in complicated pregnancies. In complicated cases, a chest CT scan upon admission may aid in quicklydetecting the presence of infection and preventing nosocomial spread of the virus. Cardiomyopathy could be found in pregnantpatients with Covid-19 infection. Since cardiomyopathy can be seen in late pregnancy and early postpartum period, it is difficult todistinguish between viral and postpartum cardiomyopathy in these patients. Recognizing the infection earlier will help to anticipate thecomplications that might contribute to deterioration of the patients, perioperatively.