COVID-19 causing HELLP-like syndrome in pregnancy and role of angiogenic factors for differential diagnosis

ImportanceThe clinical presentation of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is one of the more severe forms of preeclampsia. COVID-19 infection exhibits signs that are shared with preeclampsia and HELLP syndrome, which may lead to needless interventions and iatrogenic preterm delivery. ObjectiveWe evaluated the prevalence of HELLP-like signs in pregnant women admitted for COVID-19 and the value of angiogenic factors to rule out preeclampsia. Methodsa consecutive series of 27 pregnant women beyond 20 weeks of gestation, with symptomatic COVID-19. Clinical and analytical features were recorded and those cases with signs of HELLP syndrome were tested for sFlt-1/PlGF ratio. ResultsSeven patients (25.9%) presented at least one sign of suspected HELLP syndrome, of which 2 (7.4%) were diagnosed clinically with PE because of hypertension and high transaminases and 5 (18.5%) had only elevated transaminases. sFlt-1/PlGF ratio was normal in 6 of 7. ConclusionSymptomatic COVID-19 may simulate severe preeclampsia in pregnancy. Angiogenic factors may be essential to avoid false diagnosis and needless interventions. KEY-POINTSO_ST_ABSQuestionC_ST_ABSDo pregnant women with symptomatic COVID-19 infection exhibit signs shared with preeclampsia and HELLP syndrome? Are these conditions ruled out by the measurement of angiogenic factors? FindingsIn series of 27 pregnancies with symptomatic COVID-19 infection, 7 presented at least one sign of suspected HELLP syndrome. In 6 of them, the level of angiogenic factors ruled out preeclampsia. MeaningSymptomatic COVID-19 may simulate severe pregnancy in pregnancy. Angiogenic factors may be essential to avoid false diagnosis and needless interventions. These data were presented in a Virtual Symposium on Covid-19 and Pregnancy on 17 April: 2020:(http://medicinafetalbarcelona.org/simposiocovid19/ [Spanish] and https://medicinafetalbarcelona.org/symposiumcovid19/ [English]