medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Number 03

<< Back Next >>

Ginecol Obstet Mex 2021; 89 (03)

COVID-19 and HELLP Syndrome, uncertain diagnosis: Case report

Martínez-Martínez C, Montes-García AE, Barrera-García AG, Marchan-Tovar TL, Adaya-Leythe EA, Mendoza-Hernández F, Cepeda-Nieto AC

Language: Spanish
References: 26
Page: 247-254
PDF size: 319.55 Kb.


ABSTRACT

Background: It is possible that the hyperinflammatory state in pregnant patients with COVID-19 is associated with hypoxic lesions in the placenta, which induce a clinical and biochemical picture similar to that of preeclampsia and HELLP syndrome.
Clinical case: 40-year-old patient, with a history of primary infertility, with 33.1 weeks of pregnancy achieved by in vitro fertilization and embryo transfer. She was admitted to the emergency department due to hypertensive crisis accompanied by respiratory distress, hemolysis, hyperbilirubinemia and increased lactate dehydrogenase, elevated liver enzymes, thrombocytopenia and proteinuria. It was decided to terminate the pregnancy due to a suspected diagnosis of HELLP syndrome and probable acute pulmonary edema secondary to preeclampsia, with severity criteria. During the immediate postpartum period, chest CT scan showed pulmonary changes due to SARS-CoV-2 pneumonia, CORADS classification 5. During her stay in intensive care, she experienced clinical and biochemical improvement and was discharged on the sixth day after hospitalization.
Conclusion: In this case we found similarity of the clinical picture and biochemical alterations of SARS-CoV-2 with preeclampsia and HELLP syndrome. To avoid in treatment and complications associated with late diagnosis it is important to establish the differential diagnosis.


REFERENCES

  1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382 (8): 727-33. doi.10.1056/NEJMoa2001017.

  2. WHO. Coronavirus disease 2019 (COVID-19). Situation Report- 66. https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200326-sitrep-66-covid-19. pdf?sfvrsn=81b94e61_2.

  3. Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020; 222 (6): 521-31. https://doi.org/10.1016/j. ajog.2020.03.021.

  4. Informe epidemiológico semanal de embarazadas y puerperas estudiadas, ante sospecha de COVID-19. Semana epi demiológica 28 de 2020, emitido el 6 de julio. https://www. gob.mx/cms/uploads/attachment/file/562206/sem28.pdf.

  5. Informe semanal de vigilancia epidemiológica. Información relevante de muertes maternas. Semana epidemiológica 27. https://omm.org.mx/wp-content/uploads/2020/07/ BOLETIN_27_2020.pdf.

  6. Kreutz R, Algharably EAE, Azizi M, et al. Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19. Cardiovasc Res. 2020; 116 (10):1 688-99. https:// doi.org/10.1093/cvr/cvaa097.

  7. Lippi G, Wong J, Henry BM. Hypertension in patients with coronavirus disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med. 2020; 130 (4): 304-9. doi.10.20452/pamw.15272.

  8. Audibert F, Friedman SA, Frangieh AY, Sibai BM. Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol. 1996; 175 (2): 460-64. https://doi. org/10.1016/S0002-9378(96)70162-X.

  9. Magann EF, Martin JN Jr. Twelve steps to optimal management of HELLP syndrome. Clin Obstet Gynecol. 1999; 42 (3): 532-550. doi.10.1097/00003081-199909000-00009.

  10. Dusse LM, Alpoim PN, Silva JT, Rios DR, Brandão AH, Cabral AC. Revisiting HELLP syndrome. Clin Chim Acta. 2015;451(Pt B):117-120. doi.10.1016/j.cca.2015.10.024.

  11. Weinstein L. It has been a great ride: The history of HELLP syndrome. Am J Obstet Gynecol. 2005; 193 (3 Pt 1): 860-63. doi.10.1016/j.ajog.2005.06.058.

  12. Rivas E, Mendivil C. Síndrome de Hellp: Revisión. Salud Uninorte. 2011 Jul-dic. 27(2). http://rcientificas.uninorte. edu.co/index.php/salud/article/viewArticle/224/5843.

  13. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol. 1993; 169 (4): 1000-6. https://doi.org/10.1016/0002-9378(93)90043-I.

  14. Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol. 2013; 166 (2): 117-123. doi.10.1016/j.ejogrb.2012.09.026.

  15. Lillicrap D. Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia. J Thromb Haemost. 2020;18(4):786-787. doi.10.1111/jth.14781.

  16. Khan MM, Khan MN, Mustagir MG. COVID-19 infection during pregnancy: A systematic review to summarize possible symptoms, treatments, and pregnancy out-comes. Med Rxiv. 2020. https://www.medrxiv.org/content/medrxiv/ea rly/2020/04/03/2020.03.31.20049304.full.pdf.

  17. Gheblawi M, Wang K, Viveiros A, et al. Angiotensin- Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2. Circ Res. 2020; 126 (10): 1456-74. doi.10.1161/CIRCRESAHA.120.317015.

  18. Turpin CA, Sakyi SA, Owiredu WK, Ephraim RK, Anto EO. Association between adverse pregnancy outcome and imbalance in angiogenic regulators and oxidative stress biomarkers in gestational hypertension and preeclampsia. BMC Pregnancy Childbirth. 2015; 15: 189. doi.10.1186/ s12884-015-0624-y.

  19. Liu R, Ma Q, Han H, et al. The value of urine biochemical parameters in the prediction of the severity of coronavirus disease 2019. Clin Chem Lab Med. 2020; 58 (7): 1121-24. doi.10.1515/cclm-2020-0220.

  20. Di Mascio D, Khalil A, Saccone G, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. 2020; 2 (2): 100107. doi. 10.1016/j.ajogmf.2020.100107.

  21. Pittet JF, Mackersie RC, Martin TR, Matthay MA. Biological markers of acute lung injury: prognostic and pathogenetic significance. Am J Respir Crit Care Med. 1997; 155 (4): 1187- 1205. https://doi.org/10.1164/ajrccm.155.4.9105054.

  22. Futterman I, Toaff M, Navi L, Clare CA. COVID-19 and HELLP: Overlapping Clinical Pictures in Two Gravid Patients. AJP Rep. 2020;10(2):e179-e182. doi.10.1055/s-0040-1712978.

  23. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020; 395 (10226): 809-15. https://doi.org/10.1016/ S0140-6736(20)30360-3.

  24. Yoon SH, Lee KH, Kim JY, et al. Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID- 19): Analysis of Nine Patients Treated in Korea. Korean J Radiol. 2020;21(4):494-500. https://doi.org/10.3348/ kjr.2020.0132,

  25. Schnettler WT, Al Ahwel Y, Suhag A. Severe acute respiratory distress syndrome in coronavirus disease 2019 -infected pregnancy: Obstetric and intensive care considerations. Am J Obstet Gynecol MFM. 2020; 2 (3): 100120. doi: 10.1016/j.ajogmf.2020.100120.

  26. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 2009; 9:8. https://doi.org/10.1186/1471- 2393-9-8.




2020     |     www.medigraphic.com