Dyspnea and COVID-19: A Review of Confounding Diagnoses during the Postpartum Period

Castro, Clara Nunes; Lopes, Pedro Paulo Machado; Mayrink, Jussara

doi:10.1055/s-0041-1736304

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Review Article • Rev. Bras. Ginecol. Obstet. 43 (11) • Nov 2021 • https://doi.org/10.1055/s-0041-1736304 copy

Dyspnea and COVID-19: A Review of Confounding Diagnoses during the Postpartum Period

Dispneia e COVID-19: uma revisão de diagnósticos confundidores no período pós-parto

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of blood volume occur. This period is conducive to the occurrence of thromboembolic events. In the context of the SARS-CoV-2 pandemic, the virus responsible for COVID-19, the attention of the scientific community and health professionals has been focused on obtaining insights on different aspects of this disease, including etiology, transmission, diagnosis, and treatment. Regarding the pregnancy-postpartum cycle, it is opportune to review the clinical conditions that can occur during this period and to investigate dyspnea as a postpartum symptom in order to avoid its immediate association with COVID-19 without further investigation, which can lead to overlooking the diagnosis of other important and occasionally fatal conditions.

Keywords:
dyspnea; postpartum period; puerperium; COVID-19 diagnosis

		COVID-19	Influenza	Pulmonary Embolism	Peripartum Cardiomyopathy
Clinical presentation		Dyspnea, fever, respiratory discomfort		Sudden dyspnea, hemoptysis, and pleuritic pain	Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, lower limb edema
Associated symptoms		Sore throat, dry cough, nasal congestion, fatigue, anorexia, myalgias		Cough, tachycardia, fever, anxiety, calf or thigh pain and/or swelling	Tachycardia, tachypnea, palpitations and chest pain, abdominal discomfort
Physical examinations		Tachycardia, respiratory effort, desaturation, rales	Tachycardia, fatigue; can show pharyngitis and focal wheezing	Tachypnea; calf of thigh pain and/or swelling, edema erythema, tenderness, decreased pulmonary sounds, rales	Pulmonary rales, edema, raised jugular venous pressure, S3 gallop
Imaging	Chest radiography	Consolidation and ground-glass opacities: bilateral, peripheral in lower lung zones.	Diffuse, bilateral patchy interstitial infiltrates	Non-specific findings or normal imaging	Pulmonary edema, enlarged cardiac silhouette, pleural effusions
Imaging	Other	Chest CT (management)	–	Ventilation perfusion scintigraphy; CTPa	Echocardiography: LVEF < 45% and hypokinesis; CMR LV dilated
Laboratory findings		RT-PCR; lymphopenia, elevated transaminase, LDH and inflammatory markers	RT-PCR; rapid antigen testing or immunofluorescent antibody staining tests	Leukocytosis; increased BNP; D-dimer levels increase during the course of a normal pregnancy and slowly decline postpartum, not being used as a diagnostic tool	Troponin slightly elevated, BNP elevated
Natural course and prognosis		Symptoms tend to improve in < 2 weeks	Postpartum women have an increased risk for severe complications	The course of the disease depends on its gravity and the patient's precondition	In most cases, left ventricular systolic function recovers to the normal range, usually withing 6 months
Management		Symptomatic relief, supportive therapy, and social isolation	Symptomatic relief, Oseltamivir, and supportive therapy	Respiratory and hemodynamic support; empiric anticoagulation (depending on risk of bleeding)	Standard treatment for heart failure with reduced ejection fraction, loop diuretic for edema control, and serial echocardiograms

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[1] Address for correspondence Jussara Mayrink, MD, PhD, Av. Pres. Antônio Carlos, 6627, 31270-901, Belo Horizonte, MG, Brazil (e-mail: jussaramayrink@gmail.com).