COVID-19 and acute coagulopathy in pregnancy.
COVID-19 and acute coagulopathy in pregnancy.
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DOI：
10.1111/jth.14856
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发表时间：
2020-07
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影响因子：
--
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中科院分区：
文献类型：
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我们提出了围产期孕产妇COVID-19感染与孕产妇病情迅速恶化并伴有早期器官功能障碍和凝血功能障碍之间的推定联系。目前的SARS-CoV-2大流行已经导致大量重症患者和非妊娠人群死亡，主要原因是呼吸衰竭。在病毒爆发期间，由于免疫功能的变化，以及生理适应性改变，如氧气消耗增加和呼吸道水肿，怀孕对妇女造成了独特的风险增加。实验室紊乱可能会让人联想到HELLP（溶血、肝酶升高、血小板计数低）综合征，因此了解COVID-19的关系对于适当的诊断和管理至关重要。除了根据国际血栓形成与止血学会（ISTH）指南对所有COVID-19患者进行D-二聚体、凝血酶原时间和血小板计数的常规测量外，还应考虑在妊娠期间监测活化部分凝血活酶时间（APTT）和纤维蛋白原水平，如本报告所强调。对SARS-CoV-2-阳性孕妇的这些研究至关重要，因为它们的紊乱可能预示着更严重的COVID-19感染，并且可能需要先发制人的入院和考虑分娩以实现产妇稳定。
We present a putative link between maternal COVID‐19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS‐CoV‐2 has already resulted in high numbers of critically ill patients and deaths in the non‐pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID‐19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D‐dimers, prothrombin time, and platelet count in all patients presenting with COVID‐19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS‐CoV‐2‐positive pregnant women are vital, as their derangement may signal a more severe COVID‐19 infection, and may warrant pre‐emptive admission and consideration of delivery to achieve maternal stabilization.
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