Introduction

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), responsible for causing the novel coronavirus disease has led to a global health crisis. Pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant women^[1]. Additionally, pregnant women with COVID-19 are at increased risk of adverse maternal and foetal outcomes.

Case Report

A 23-year-old female having no comorbidities, gravida 2, para 1 with previous LSCS 2.5 year back presented at SMGS hospital, Jammu, India on 19 jan 2022. She was at 37 weeks and 5 days period of gestation and experienced labour pains. She had no symptoms suggestive of COVID-19 infection. She had not received COVID-19 vaccination. As per hospital protocol she underwent COVID-19 RAT on admission which was negative. Basic investigations were performed, her hb was 10.8 gm%, RFT and LFT were within normal limits. After 5 hours of admission she had an emergency LSCS in view of impending rupture of pervious uterine scar.

7 hours after the uneventful surgery she developed diarrhoea and had 4 episodes of loose stools. Her pulse was feeble and reached 110bpm. BP dropped to 100/60 mm  of hg and extremities were cold. This led to metabolic acidosis with hypokalemia and hypocalcemia. Patient was shifted to ICU. Supportive treatment was provided in form of IV fluids, IV antibiotics metronidazole and tazobactam, oral probiotics, IV electrolyte and acid base correction was performed. Her Systolic BP continued to fall below 80mm of hg, despite resuscitation with IV crystalloids, therefore inotropic support was started with noradrenaline and dopamine.

The levels of serum urea and creatinine began to rise on 1^st post-op day (POD) as mentioned in table 1. CBC, LFTs, PT, PTI were initially normal. Urine output was normal. ECG showed sinus tachycardia. Her Sp02 levels fell to 86% on room air.

The sudden deterioration in her general health led to high suspicion of underlying COVID-19 infection. RT-PCR sample was sent on first POD and she was confirmed as a case of SARS-CoV-2 infection on her second POD.

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Dr Ankita Sharma