key: cord-273968-ym79axlo
authors: Di Renzo, Gian Carlo; Giardina, Irene
title: COVID-19 in Pregnancy: Consider Thromboembolic Disorders and Thromboprophylaxis
date: 2020-04-22
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.04.017
sha: 
doc_id: 273968
cord_uid: ym79axlo

nan

The disease caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is now termed coronavirus disease 2019 or COVID-19. This syndrome generally begins with respiratory symptoms, which may progress to single organ dysfunction (i.e. respiratory failure) and then to multiple organ failure, and death. In non-pregnant patients admitted to the intensive care unit with COVID-19 pneumonia, the frequency of venous thromboembolic disorders is 25% (20/81) ascertained by ultrasound examination of the lower extremities (1). In another series of 184 patients with proven COVID-19 pneumonia, 31% had venous or arterial thromboembolism (defined as acute pulmonary embolism, ischemic stroke, deep vein thrombosis, or myocardial infarction) (2) . The mechanism whereby viral infection causes multiorgan dysfunction is thought to involve the release of inflammatory cytokines (3) The optimal management of pregnant women with COVID-19 poses multiple challenges, ranging from screening for the virus on admission to labor and delivery, management of the acutely ill parturient, anesthesia, and protection of healthcare personnel (6) . Although originally thought that pregnant women with COVID-19 were no more likely to develop severe morbidity or die, recent reports suggest that a subset may develop multiple organ failure and even die.

Given that normal pregnant women have evidence of increased generation of thrombin and a prothrombotic state, as well as increased intravascular inflammation which is exaggerated in the context of infection, such patients may be at an increased risk for thrombosis when affected by COVID-19. The International Society of Thrombosis and Hemostasis has generated a simple algorithm for the management of COVID-19 coagulopathy (7). The recommendation has been made that low molecular weight heparin be considered in all such patients. This body of evidence should be considered by obstetricians caring for pregnant women affected by COVID-19. A coagulation profile to detect the presence of subclinical disseminated intravascular

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Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy