Puerperal Infections Complicated by COVID-19 Co-Infection: Two Independent Case Reports with Need for Intensive Care

Abstract

Introduction: The current SARS-CoV-2 pandemic affects all medical fields. In obstetrics, the focus is on the effects on pregnancy and fetuses. Here we present two cases of parturient women that demonstrate the high risk of postpartum SARS-CoV-2 co-infections. Materials and Methods: Patients` data were obtained from their medical records after confirmation of written informed consent. Literature review was conducted across PubMed. Case Report: i) A 33-year-old Caucasian Gravida II, Para I was transferred to our tertiary hospital at 23+1 weeks of pregnancy with previous preterm premature rupture of membranes (PPROM) at 17+5 weeks of gestation. During antenatal corticosteroid therapy for fetal lung maturation with 24+0 weeks, intrauterine fetal death was diagnosed in the course of amniotic infection. Due to progressive hemodynamic instability and confirmed SARS-CoV-2 co-infection, our patient had to be treated with catecholamines for 24 hours and stayed at the intensive care unit (ICU) for 72 hours. An acute myocardial injury occurred during septic shock. Immediate intensive care prevented permanent damage. ii) A 27-year-old Caucasian Gravida III, Para III was admitted to our tertiary hospital, 11 days after her third caesarean section. After circulatory collapse at home, the patient arrived with signs of hemorrhagic shock. Emergency curettage was performed, and because of cardiopulmonary worsening pulmonary embolism was suspected. Computed tomography revealed typical signs of COVID-19 pneumonia. Our patient was treated by nasal oxygen in the ICU for 24 hours. Similar to the first patient, acute myocardial injury occurred without any lasting harm. Conclusion: Our two cases show rapid and worse clinical courses in parturient women with SARS-CoV-2 co-infection. Rapid diagnosis and availability of intensive care were crucial for the prevention of long-term harm. In peri- and postpartum situations of acute clinical worsening, exclusion of SARS-CoV-2 co-infection is an important diagnostic step.