Annotated Bibliography: COVID-19, Thromboembolisms, and Pregnancy
Zhodamoradi, Z., Boogar, S.S., Shirazi, F.K., & Kouhi, P. (2020). COVID-19 and acute pulmonary embolism in postpartum patient. Emerging Infectious Diseases, 26(8), 1937-1939. doi: https://doi.org/10.3201/eid2608.201383 (Links to an external site.)
The authors discuss the association of COVID-19 with venous embolisms, more specifically pulmonary embolisms, in the non-pregnant population. Many patients who are diagnosed with COVID-19 are also being diagnosis with venous embolisms. The authors then review the increased risk of developing venous embolisms during pregnancy and within several weeks of delivery due to the hypercoagulable state. The article examines a case study of a 36-year-old Iranian women who underwent an uncomplicated elective scheduled caesarean section. She presented to the ED on postpartum day 5 with COVID-19 and an acute pulmonary embolism. The authors state the importance of evaluating pregnant and postpartum patient who are positive for COVID-19 for signs or symptoms of venous embolisms due to their already heightened risk.
Thrombosis and Pulmonary Embolism
Clots can develop for several reasons, such as the endothelial surface of a blood vessel has been roughened or damaged by arteriosclerosis, infection, or trauma and clotting occurs when there is stasis or pooling of blood in the vessel (J. Hall & M. Hall, 2021). If a clot becomes dislodged and travels through the right side of the heart and into the pulmonary artery it can cause a blockage of the pulmonary arteries (J. Hall & M. Hall, 2021). If both pulmonary arteries become blocked, death occurs immediately. If only one side becomes blocked the patient may live if appropriate action is taken quickly. Tissue plasminogen activator (t-PA) can be used to help dissolve some intravascular clots if used within 1 to 2 hours after onset (J. Hall & M. Hall, 2021).
Women who are pregnant are recommended to avoid exposure to COVID-19 as much as possible as well as use social distancing, hand washing, wearing a mask, and disinfecting surfaces (Berghella, 2020). For healthcare workers taking care of these patients it is imperative that the staff and OB providers come up with an individual plan for the management of care of pregnant patients with COVID. Because pregnant women are already at an increased risk for clotting, it is recommended by the article written by Berghella (2020) that they be started on pharmacologic venous thromboembolism prophylaxis, such as heparin, for women who are hospitalized. NSAIDs, such as Aspirin, should be considered on a case to case basis but should be continued if medically indicated (e.g., prevention of preeclampsia). Some antiviral drugs, such as Remdesivir, are being offered to pregnant patient with severe COVID-19 symptoms on a compassionate-use basis because there is little research with pregnancy and this antiviral medication (Berghella, 2020). Mode of delivery should not be changed necessarily based on COVID-19 status and patients postpartum should be monitored closely for signs and symptoms of thromboembolisms and continue prophylaxis up to 7 to 14 days postpartum (Berghella, 2020). Doctors and nurses should individualize patient care for those women hospitalized with COVID-19 based on symptoms, severity of symptoms, underlying health problems, and gestational age.