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 primarily
a respiratory system infection but can also affect cardiovascular, renal, gastrointestinal, and neurological systems. Cardiovascular
involvement 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 emergent
cesarean section. Following surgery, she was admitted to the intensive care unit due to hypoxemia and hypertension. After observing
lymphopenia and high CRP level with hypoxemia, radiological imaging revealed typical findings for viral pneumonia and nasopharyngeal
swab, which was not carried out at admission, was positive for Covid-19. On the 20th hour of follow-up, she became hypotensive
requiring noradrenalin infusion. Echocardiography diagnosed cardiomyopathy with left ventricular ejection fraction of 35-40 % with
high 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 quickly
detecting the presence of infection and preventing nosocomial spread of the virus. Cardiomyopathy could be found in pregnant
patients with Covid-19 infection. Since cardiomyopathy can be seen in late pregnancy and early postpartum period, it is difficult to
distinguish between viral and postpartum cardiomyopathy in these patients. Recognizing the infection earlier will help to anticipate the
complications that might contribute to deterioration of the patients, perioperatively.