Case report: Complex evaluation of coagulation, fibrinolysis and inflammatory cytokines in a SARS-CoV-2 infected pregnant woman with fetal loss

• DOI: 10.3389/fimmu.2024.1329236
• Publication Date: 2024-02-21T04:47:20Z
• Authors: Eszter Lilla Tóth; Rita Orbán-Kálmándi; Zsuzsa Bagoly; Linda Lóczi; Tamás Deli; Olga Török; Sarolta Molnár; Sándor Baráth; Parvind Singh; Zsuzsanna Hevessy; Éva Katona; Miklós Fagyas; Attila Ádám Szabó; Szabolcs Molnár; Zoárd Tibor Krasznai
• Keywords: 0301 basic medicine; placenta; Immunology; szülészet; 610; COVID-19; RC581-607; 03 medical and health sciences; RG Gynecology and obstetrics / nőgyógyászat; 616; hemostasis; R850-854 Experimental medicine / kisérleti orvostudomány; case report; stillbirth; fetal death; Immunologic diseases. Allergy

Background SARS-CoV-2 infection during pregnancy increases the risk of severe obstetrical complications. Detailed evaluation COVID-19-associated coagulopathy in a with stillbirth hasn’t been described so far. Besides knowledge gaps pathomechanism leading to COVID-19 pregnancies, currently, no prognostic biomarker is available identify pregnant patients who are at imminent maternal and fetal complications, requiring immediate medical attention. Case Here we report case 28-year-old infected patient, admitted our hospital 28 weeks gestation intrauterine loss. The presence placentitis was confirmed by immunohistological placenta. She had only mild upper respiratory symptoms her vital signs were within reference throughout labor postpartum. stillborn infant delivered per vias naturales. Fibrinogen concentrate administered before after due markedly decreased fibrinogen levels (1.49 g/l) admission excessive bleeding delivery. Although coagulation screening tests not alarming admission, balance hemostasis strikingly distorted patient. As compared healthy age- gestational age-matched controls, increased D-dimer, low FVIII activity, FXIII level, marked hypocoagulability as demonstrated thrombin generation assay, together shortened clot lysis fibrinolytic proteins observed. These alterations most likely have contributed observed early postpartum period. Interestingly, same time, moderately altered inflammatory cytokine found admission. Serum ACE2 activity did differ patient from that suggesting despite previous speculations literature, may be used potential for prediction threatening loss SARS-CoV-2-infected pregnancies. Conclusions based on this could identified use associated placentitis, above-described warrant awareness hemorrhagic complications helpful intensified