University of Wisconsin–Madison Medical College of Wisconsin

Severe Maternal Morbidity and Neonatal Mortality After COVID-19 Infection: Case Report

Zachary J. Schoppen, MD; Kristen Stearns, MD; Kate Dielentheis, MD

WMJ. 2022;121(3):e37-e41

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Background: Maternal coagulopathy and adverse fetal effects are both possible results of COVID-19 infection during pregnancy. This case demonstrates the potentially fatal outcomes when both occur simultaneously.

Case Presentation: A 39-year-old multiparous woman at 31 weeks gestation presented with mild COVID-19 symptoms and decreased fetal movement. Evaluation included a biophysical profile with 2/8 scoring and fetal heart rate tracing that developed a terminal bradycardia. She underwent an emergent cesarean delivery that was complicated by disseminated intravascular coagulation (fibrinogen < 60mg/dL, platelets 34, international normalized ratio [INR] 2.1) and maternal hemorrhage requiring massive transfusion. The neonate ultimately required prolonged resuscitation with Apgar scores of 0/0/0 at 1, 5, and 10 minutes and passed away on day 6 of life.

Conclusions: Even in the absence of severe symptoms, maternal COVID-19 infection during pregnancy can cause a maternal systemic and placental reaction that can lead to serious maternal morbidity, as well as fetal or neonatal morbidity and mortality.

Author Affiliations: Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin (Schoppen, Stearns, Dielentheis).
Corresponding Author: Zachary Schoppen, MD, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522; phone 815.546.1604; email; ORCID ID 0000-0003-1778-8634
Acknowledgements: Thank you to James Linn, MD, Elissa Hellman, MD, and Margaret Carr, MD, for your contributions to patient care. The patient granted consent to be included in a published case report.
Funding/Support: None declared.
Financial Disclosures: None declared.
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