Acute gynecologic pathology in patients with COVID-19

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OBJECTIVE

To determine the structure of emergency gynecological pathology among patients with COVID-19 and to optimize the algorithm of medical care.

MATERIAL AND METHODS

The examination and surgical treatment of 218 patients with COVID-19 in the surgical department of the Infectious Diseases Clinical Hospital of Moscow were carried out. The average age of the patients was 45.9±9.8 years. The most frequent cause of hospitalization was abnormal uterine bleeding — in 153 patients, i.e. more than 70% of all observations, which were divided into 2 groups. The 1st group included 88 (57.5%) patients, in whom uterine pathology (myoma, adenomyosis, endometrial hyperplasia, endometrial polyps) was detected during transvaginal ultrasound examination upon admission to the hospital. The 2nd group included 65 (42.5%) patients with uterine bleeding, in whom no structural changes of the uterus were detected by sonography; uterine bleeding occurred on standard therapy of COVID-19 and anticoagulant drugs prescribed on an outpatient basis. In all cases the diagnosis of coronavirus infection was confirmed by detection of SARS-CoV-2 coronavirus RNA in the smear by polymerase chain reaction.

RESULTS

The most significant laboratory changes were detected in patients with concomitant extragenital diseases — obesity, hypertension, diabetes mellitus. Patients with uterine bleeding and confirmed intrauterine pathology (group 1) underwent surgical hysteroscopy as a matter of urgency, and in 9 patients the scope of surgical intervention was expanded to laparoscopic hysterectomy. In the patients of the second group, transfusion of fresh frozen plasma (1—2 doses) was used, which led to the cessation of bleeding in all patients. Treatment of all patients, including the administration of low weight molecular heparins, was carried out with an infectious disease specialist before and after surgery, which allowed its optimization and avoidance of postoperative complications.

CONCLUSION

Administration of low weight molecular heparins in accordance with the current guidelines for the treatment of patients with COVID-19 is indicated for the prevention of thromboembolic complications in hospital. For female patients with COVID-19 and abnormal uterine bleeding diagnostic transvaginal ultrasound examination would be indicated and in the presence of endometrial pathology when the clinical picture of respiratory insufficiency would be eliminated, surgical intervention in the scope of surgical hysteroscopy would be accomplished. In the absence of indications for surgical intervention hemostatic effect is achieved by transfusion of fresh frozen plasma (1—2 doses). Low-traumatic (video-endoscopic) surgical interventions can and should be performed in patients with COVID-19 in the presence of emergencies.

Keywords:

patients with COVID-19

acute gynecological diseases

abnormal uterine bleeding

diagnostic transvaginal ultrasound examination

management of respiratory failure symptoms

surgical hysteroscopy

laparoscopic hysterectomy

transfusion of fresh frozen plasma

collaborative management of patients together with infectiologist

prescription of low-molecular-weight heparins

Authors:

Gafurov Yu.T.

Infectious Clinical Hospital No. 2

ORCID: 0000-0002-2750-4394

Faller A.P.

Infectious Clinical Hospital No. 2

ORCID: 0009-0008-2304-9743

Sundukov A.V.

A.I. Evdokimov Moscow State Medical and Dental

ORCID: 0000-0002-3798-7780

Received:

17.05.2023

Accepted:

22.06.2023

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