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Berger DS, Galyean A, Nguyen K, Alshak N, Blumenthal E. A Case of Significant Transaminitis with Liver Biopsy in a Pregnant Patient with COVID-19. AJP Rep 2023; 13:e78-e81. [PMID: 38033600 PMCID: PMC10684339 DOI: 10.1055/s-0043-1777099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/30/2023] [Indexed: 12/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global health crisis. The virus can cause varying severity of liver injury, but the mechanism has not yet been elucidated, especially in pregnancy. We present a morbidly obese 30-year-old woman with COVID-19 at 28 weeks' gestation complicated by significant transaminitis with peak liver enzymes levels of 501/1,313 (aspartate aminotransferase/alanine aminotransferase). Liver biopsy showed reactive changes consistent with medication effect and mild steatosis. Significant transaminitis has been found in both pregnant and nonpregnant patients with COVID-19. Our case demonstrates the multifactorial nature of liver injury in COVID-19 patients including mild underlying liver steatosis combined with possible viral potentiation of medication effect.
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Affiliation(s)
- Dana Senderoff Berger
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Anna Galyean
- Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
| | - Kelvin Nguyen
- Department of Gastroenterology, Southern California Permanente Medical Group, Pasadena, California
| | - Najeeb Alshak
- Department of Pathology, Southern California Permanente Medical Group, Pasadena, California
| | - Elizabeth Blumenthal
- Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
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Galyean A, Garite TJ, Maurel K, Abril D, Adair CD, Browne P, Combs CA, How H, Iriye BK, Kominiarek M, Lu G, Luthy D, Miller H, Nageotte M, Ozcan T, Porto M, Ramirez M, Sawai S, Sorokin Y. Removal versus retention of cerclage in preterm premature rupture of membranes: a randomized controlled trial. Am J Obstet Gynecol 2014; 211:399.e1-7. [PMID: 24726507 DOI: 10.1016/j.ajog.2014.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/18/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The decision of whether to retain or remove a previously placed cervical cerclage in women who subsequently rupture fetal membranes in a premature gestation is controversial and all studies to date are retrospective. We performed a multicenter randomized controlled trial of removal vs retention of cerclage in these patients to determine whether leaving the cerclage in place prolonged gestation and/or increased the risk of maternal or fetal infection. STUDY DESIGN A prospective randomized multicenter trial of 27 hospitals was performed. Patients included were those with cerclage placement at ≤23 weeks 6 days in singleton or twin pregnancies, with subsequent spontaneous rupture of membranes between 22 weeks 0 days and 32 weeks 6 days. Patients were randomized to retention or removal of cerclage. Patients were then expectantly managed and delivered only for evidence of labor, chorioamnionitis, fetal distress, or other medical or obstetrical indications. Management after 34 weeks was at the clinician's discretion. RESULTS The initial sample size calculation determined that a total of 142 patients should be included but after a second interim analysis, futility calculations determined that the conditional power for showing statistical significance after randomizing 142 patients for the primary outcome of prolonging pregnancy was 22.8%. Thus the study was terminated after a total of 56 subjects were randomized with complete data available for analysis, 32 to removal and 24 to retention of cerclage. There was no statistical significance in primary outcome of prolonging pregnancy by 1 week comparing the 2 groups (removal 18/32, 56.3%; retention 11/24, 45.8%) P = .59; or chorioamnionitis (removal 8/32, 25.0%; retention 10/24, 41.7%) P = .25, respectively. There was no statistical difference in composite neonatal outcomes (removal 16/33, 50%; retention 17/30, 56%), fetal/neonatal death (removal 4/33, 12%; retention 5/30, 16%); or gestational age at delivery (removal mean 200 days; retention mean 198 days). CONCLUSION Statistically significant differences were not seen in prolongation of latency, infection, or composite neonatal outcomes. However, there was a numerical trend in the direction of less infectious morbidity, with immediate removal of cerclage. These findings may not have met statistical significance if the original sample size of 142 was obtained, however they provide valuable data suggesting that there may be no advantage to retaining a cerclage after preterm premature rupture of membranes and a possibility of increased infection with cerclage retention.
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Affiliation(s)
- Anna Galyean
- Long Beach Memorial Medical Center, Long Beach, and Kaiser Permanente, Anaheim, CA
| | - Thomas J Garite
- University of California Irvine, Orange, CA; Obstetrix/Pediatrix Medical Group, Sunrise, FL
| | | | - Diana Abril
- Obstetrix/Pediatrix Medical Group, Sunrise, FL
| | - Charles D Adair
- Regional Obstetrical Consultants and University of Tennessee, Chattanooga, TN
| | - Paul Browne
- Obstetrix Medical Group of Georgia, Decatur, GA
| | | | - Helen How
- University of Cincinnati, Cincinnati, OH, and Norton Healthcare, Kosair Maternal-Fetal Medicine, Louisville, KY
| | | | | | - George Lu
- Obstetrix Medical Group, Kansas City, MO
| | | | | | - Michael Nageotte
- Long Beach Memorial Medical Center, Long Beach, and Kaiser Permanente, Anaheim, CA
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