Determınıng the Covıd-19 Exıstence in Perıtoneal Fluıd

Purpose: To determine the SARS-CoV-2 existence in the peritoneal fluid for preventing healthcare workers from surgical smoke and aerosolization of Covid-19 during laparoscopyMethods: All the data of the 6 Covid-19 positive patients included in this study were collected prospectively between the 31st August 2020 and 31st November 2020. Clinicopathologic data of the patients including age, symptoms, radiological and laboratory findings, antiviral treatment before the operation, operation, and peritoneal fluid Covid-19 existence were recorded. Covid-19 status of the patients was diagnosed with a nasal swab test. Covid-19 existence in the peritoneal fluid was determined by the RT-PCR test.Results: All the 6 Covid-19 positive patients were pregnant. Therefore, all the operations were ceserean section operation. Only one patient had high fever. The Covid-19 specific radiological finding was detected only in one patient. In laboratory findings: 4 of 6 cases had lymphopenia and all cases had D-dimer positivity. Antiviral drugs were not used in any of the cases in this study. There was no detected Covid-19 virus in the peritoneal fluid examples of any cases. Conclusion: Aerosolization of Covid-19 from the peritoneal cavity by laparoscopy or electrocautery is not a big concern under the condition of applying cautions according to the guidelines.

Pregnancy emerged thrombocytopenia: maternal and fetal outcome

Background: A low platelet count is often an incidental finding in pregnancy. It can be an indicator of a severe systemic disorder requiring emergent maternal and fetal care or can just be unique to pregnancy with no harm to mother or fetus. Physiological decrease in platelet count is seen in pregnancy due to hemodilution and hypercoagulating state, though the exact pathophysiology is still unclear.Methods: It is a prospective observational study done in a tertiary care centre.Results: In about 11,258 cases screened 46 patients had thrombocytopenia (0.4%). The commonest etiology is found to be gestational thrombocytopenia (n=21, 45.6%) followed by preeclampsia/ eclampsia/ HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome (n=19, 41.3%). Only one patient had immune thrombocytopenic purpura (ITP) and 7 (15.3%) were associated with amplified fragment length polymorphism (AFLP). Maximum of them (n=19, 41.3%) underwent spontaneous vaginal delivery. 4 patients (8.6%) had postpartum haemorrhage, 6 (13.04%) had ceserean section wound infection, 4 (8.6%) had disseminated intravascular coagulation (DIC) and 4 (8.6%) had multiorgan failure. 13 patients (28.3%) had platelet count between 40 to 60 thousand per cumm, 11 (23.9%) had between 60 to 80 thousand per cumm, 10 (21.7%) had between 80,000 to 1 lakh and none had their platelet count less than 20,000 per cumm.Conclusions: Gestational thrombocytopenia is not a preventable condition. It is an incidental finding in pregnancy. With strict vigilance during intrapartum and postpartum period, even without any treatment proper for the same, the maternal and fetal outcome is found to be good.