Pneumonia in pregnant women with COVID-19: is it a new thrombotic microangiopathy in obstetric practice?

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Abstract

Thrombotic microangiopathies during pregnancy and puerperium are rare and, if undiagnosed, can be life-threating conditions for both the mother and the baby. The aim of this review article is to briefly describe clinical profile and highlight the clues for a correct diagnosis of pregnancy-related thrombotic microangiopathies. Of particular interest and important practical significance are the presented data on changes in the hemostatic system in patients with a new coronavirus infection COVID-19 through the prism of thrombotic microangiopathies.

About the authors

Irina E. Zazerskaya

V.A. Almazov National Medical Research Center

Email: zazera@mail.ru
ORCID iD: 0000-0002-8175-7886
SPIN-code: 5873-2280

MD, PhD, DSci (Medicine), Head of the Department of Obstetrics and Gynecology. The Faculty of Medicine, the Institute of Medical Education

Russian Federation, St. Petersburg

Vitaly F. Bezhenar

Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929

MD, PhD, DSci (Medicine), Professor, Chief Expert in Obstetrics and Gynecology of Saint Petersburg Healthcare Committee and the Russian Ministry of Healthcare in the North-Western Federal Region of the Russian Federation, Head of the Department of Obstetrics, Gynecology, and Reproductive Sciences

Russian Federation, Saint Petersburg

Alina O. Godzoyeva

V.A. Almazov National Medical Research Center

Author for correspondence.
Email: godzoevaalina@mail.ru
ORCID iD: 0000-0002-1730-2019

MD, Post-Graduate Student. The Department of Obstetrics and Gynecology, the Faculty of Medicine, the Institute of Medical Education

Russian Federation, Saint Petersburg

Valentina V. Ishkarayeva

V.A. Almazov National Medical Research Center

Email: yahont84@list.ru

MD, PhD, Assistant. The Department of Obstetrics and Gynecology, the Faculty of Medicine, the Institute of Medical Education

Russian Federation, Saint Petersburg

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2. Fig. 1. Schematic representation of the complement system activation cascade

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3. Fig. 2. Peripheral blood smear in patients with thrombotic microangiopathy (blue arrows indicate schistocytes)

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4. Fig. 3. Flow chart for the differential diagnosis of thrombotic microangiopathy in pregnancy (adapted from Sarno L., Stefanovic V., Maruotti G., et al., 2019): ТМА, thrombotic microangiopathy; aHUS, atypical hemolytic uremic syndrome; LDH, lactate dehydrogenase; TTP, thrombotic thrombocytopenic purpura

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5. Fig. 4. Lung histological findings in COVID-19 patients: а — emphysematous changes and diffuse thrombosis of intra-septal microvessels (indicated by the arrows); b — small sized arterioles (open arrow) with complete luminal thrombosis and occlusive thromboses of intraseptal capillaries (closed arrow) (adapted from Marini J.J., Gattinoni L., 2020)

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Copyright (c) 2020 Zazerskaya I.E., Bezhenar V.F., Godzoyeva A.O., Ishkarayeva V.V.

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