АПЛАСТИЧЕСКИЙ СИНДРОМ У БЕРЕМЕННОЙ НА ФОНЕ COVID-19: КЛИНИЧЕСКИЙ СЛУЧАЙ

Abstract

Women during the gestational process have high risks of contracting the new coronavirus infection COVID-19 due to significant immunological changes in the body of the expectant mother. Physiological changes are also known in other systems, for example, respiratory, digestive, urinary and cardiovascular, which suggest vulnerability to the influence of pathological agents and the formation of severe infection, which can lead to an increase in maternal morbidity and mortality.

Patient B. was diagnosed with COVID-19 infection with lung damage at 26 weeks of pregnancy, and was treated with glucocorticosteroids, antiviral drugs, and antibiotics. Later, the clinic of pseudomembranous colitis joined, an etiological factor was discovered – Clostridium difficile. Vancomycin therapy was continued. However, a tendency to cytopenia began to be noted, a skin-mucous hemorrhagic syndrome appeared in the form of hematomas, petechiae, nosebleeds, hemorrhoids. At 32 weeks, she was delivered naturally in the pelvic presentation of the fetus due to spontaneous delivery. Further, aplastic syndrome was diagnosed, which developed against the background of pregnancy and infectious complications. Antibacterial, immunosuppressive, and hemotransfusion therapy were performed. During the follow-up, a complete recovery of hemogram parameters was noted: hemoglobin 97 g/l, leukocytes 3.87 thousand/l, platelets 339 thousand/L.

Regression of infectious complications was observed, persistent normothermia (36-36.6°C), according to the control computed tomography, positive dynamics, a decrease in the amount of fluid in the right pleural cavity was noted.

Conclusion. The case is of interest for a rare pancytopenic reaction that developed against the background of gestation and infectious complications caused by COVID-19, which was successfully eliminated, while preserving the reproductive function of the woman and a positive perinatal outcome.