Immediate delivery versus expectant management in women with chronic hypertension: a meta-analysis of randomized controlled trials.

INTRODUCTION: The current guidelines regarding chronic hypertension during pregnancy recommend induction of labor at term. The only previous meta-analysis on this topic found two randomized controlled trials but failed to pool together their results. We aimed to find the best literature-based evidence regarding delivery timing in chronic hypertension during pregnancy. EVIDENCE ACQUISITION: We searched the following electronic databases: MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, and the Cochrane Central Register of Controlled Trials, Google Scholar. We selected randomized controlled trials comparing expectant management versus immediate delivery. The search was performed by two authors and the conflicts resolved in meetings. Data collection and analysis: we collected maternal and neonatal outcomes in a metanalysis following the random-effects model. EVIDENCE SYNTHESIS: Two studies were found. The summary effect measure was 1.1 (C.I. 0.51-2.1) regarding the maternal outcomes, 2.6 (C.I. 0.91-7.44) regarding the neonatal outcomes, and 1.5 (C.I. 0.8-2.79) combined. There was no statistically significant difference between maternal and neonatal outcomes (P=0.2). CONCLUSIONS: The results of our meta-analysis pointed towards a non-difference between immediate delivery and expectant management, in women with chronic hypertension.

Fetal hyperechogenic pancreas and gestational diabetes mellitus: a meta-analysis.

INTRODUCTION: Gestational diabetes mellitus is the most common metabolic disorder in pregnancy, and it is associated with detrimental short- and long-term consequences to both the fetus and the mother. Some studies in the literature have found an association between the identification of fetal hyperechogenic pancreas via prenatal ultrasound and the presence of gestational diabetes mellitus. The aim of our study was to assess the association of fetal hyperechogenic pancreas with gestational diabetes mellitus using the meta-analytic method. EVIDENCE ACQUISITION: We searched electronic databases for articles describing association (or lack of) between fetal hyperechogenic pancreas and gestational diabetes mellitus. For each study, we identified patients with or without fetal hyperechogenic pancreas and with or without gestational diabetes mellitus. We then calculated risk ratios for gestational diabetes mellitus using the meta-analytic Mantel-Haenszel method with a random effect to estimate the risk ratio. EVIDENCE SYNTHESIS: We identified 286 patients in 2 studies. The risk ratio of gestational diabetes mellitus in women with fetal hyperechogenic pancreas was 3.34, P<0.0001 (95% CI, 1.56-7.17; I2=82% [95% CI 22.7-95.7%]). CONCLUSIONS: The presence of a fetal hyperechogenic pancreas was associated with gestational diabetes mellitus. We concluded that the detection of fetal pancreas echogenicity may be a promising indicator of gestational diabetes mellitus that, pending further research studies, can potentially help the clinician in making this diagnosis.

Maternal Outcomes Following Active vs. Expectant Management of Previable Preterm Pre-Labor Rupture of Membranes: A Meta-Analysis.

The diagnosis of previable preterm pre-labor rupture of membranes (PROM) is known to be associated with poor outcomes for both the mother and the fetus. Following previable preterm PROM, patients are generally offered either active management through the termination of the pregnancy or expectant management to increase the chances of fetal survival. It is difficult to counsel patients because there is a lack of data directly comparing maternal outcomes following active vs. expectant management. Using the data in the current literature, the goal of the present meta-analysis was to determine if there were any differences in terms of maternal risks when active versus elective management was chosen. PubMed, Google Scholar, EMBASE, and Scopus were searched. We found four studies accounting for a total of 506 patients. The risk ratio (RR) of chorioamnionitis in active vs. expectant management was 0.30 (with a 95% confidence interval, CI, of 0.09-1.02). The heterogeneity of the study results was 81% (I2). A sub-analysis of two included studies revealed an RR of postpartum hemorrhage in active vs. expectant management of 0.75 (95% CI 0.27-2.07) and an RR of maternal sepsis of 0.23 (95% CI 0.04-1.28). The heterogeneity of the study results for this sub-analysis was 68% (I2) for postpartum hemorrhage and 0% (I2) for maternal sepsis. Overall, there was no statistically significant difference in the risk of chorioamnionitis, postpartum hemorrhage, or maternal sepsis when active management was chosen over expectant management in previable preterm PROM at <24 weeks. The scarcity and the high heterogeneity of the available data likely contributed to the lack of statistical significance and calls for further work directly comparing maternal outcomes following active vs. expectant management.

Neutrophil gelatinase-associated lipocalin as a predictor of pre-eclampsia: A systematic review and meta-analysis.

BACKGROUND: Protein neutrophil gelatinase-associated lipocalin (NGAL) has been associated with kidney injury and inflammatory conditions. In particular, several studies have found an association between maternal blood and urine levels and the development of pre-eclampsia. OBJECTIVES: To examine whether maternal blood and urine levels of NGAL are good predictors of pre-eclampsia. SEARCH STRATEGY: The authors searched MEDLINE databases via PubMed, Embase, Scopus, Scielo, Google Scholar, PROSPERO International Prospective Register of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. SELECTION CRITERIA: The authors included case-control observational clinical studies comparing protein levels of NGAL in serum and urine in women with pre-eclampsia with uncomplicated pregnancies. Only studies where the collection of blood or urine was peformed before the occurrence of pre-eclampsia were selected. DATA COLLECTION AND ANALYSIS: The primary outcome was the difference in NGAL levels in blood or urine between women with and without pre-eclampsia. RESULTS: Seven studies in total were included: five studies measuring NGAL in blood and two in urine. Regarding the serum studies, 315 patients were included as cases and 540 as controls. Higher NGAL in maternal blood during all three trimesters together was associated with pre-eclampsia; the standardized mean difference was 1.15 ng/mL (95% confidence interval, 0.92-1.39; P < 0.01). Regarding the urine studies, 39 patients were included as cases and 220 as controls. There was no statistically significant difference between patients with pre-eclampsia and controls regarding urine NGAL. CONCLUSIONS: NGAL in maternal blood is higher in patients who later develop pre-eclampsia compared with controls and could be used as a potential predicting test in the routine clinical setting.

Is blood pressure 120-139/80-89 mmHg before 20 weeks a risk factor for hypertensive disorders of pregnancy? A meta-analysis.

AIM: Hypertensive disorders of pregnancy affect approximately 10% of pregnant women worldwide with serious fetal and maternal implications. Chronic hypertension is diagnosed prior to 20 weeks of gestation and affects 1.5% of pregnant women. The American College of Obstetricians and Gynecologists defines hypertension in pregnancy as a systolic blood pressure higher than 140 mmHg or a diastolic blood pressure higher than 90 mmHg. In real-world clinical practice, practitioners consider the cut-off of 140/90 mmHg as a marker of true hypertension in pregnancy and consider blood pressures lower than that as normal. METHODS: To assess the association between a lower range of blood pressures and the development of hypertensive disorders of pregnancy, we performed a meta-analysis of current published studies comparing the occurrence of hypertensive disorders of pregnancy in patients with blood pressures of 120-139/80-89 mmHg before 20 weeks to those with blood pressures<120/80 mmHg. RESULTS: We included 24 studies: 12362/106870 (11.6 %) patients with blood pressures of 120-139/80-89 mmHg, and 26044/463280 (5.6 %) with blood pressures lower than 120/80 mmHg, developed hypertensive disorders of pregnancy [risk ratio 2.85 (C.I. 2.47-3.3)] - test for overall effect: Z = 14.1 (p < 0.00001). CONCLUSIONS: We showed evidence of poor pregnancy outcome in patients with blood pressure lower than the routinely accepted cut-off of 140/90 mmHg. Therefore, interventions to mitigate the risk of hypertensive disorders in pregnancy in women with blood pressures 120-139/80-89 mmHg should be planned in new clinical trials.

Association between first trimester platelet to lymphocyte ratio and stillbirth.

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been investigated as inflammatory markers of malignancies, cardiovascular and autoimmune diseases. We explored the association between NLR, PRL, measured during pregnancy, and stillbirth (SB). METHODS: We conducted a retrospective case control study at a tertiary hospital center in New York City from May 2015 to July 2018. Cases were defined as SB pregnancies and controls as uncomplicated pregnancies. We calculated NLR and PLR using the complete blood count components routinely collected during prenatal care in the first trimester. The groups were matched by age, parity, body mass index (BMI) and race. We used receiver operating characteristic (ROC) curve analysis to evaluate the association of NLR and PLR to SB. RESULTS: We identified 28 patients with SB pregnancies and matched them with 28 controls. Age, parity, BMI, and race were equally distributed between the groups. The median gestational age of SB was 30 weeks (22-34). In the first trimester PLR was significantly lower in SB cases compared to controls (124.8 vs. 153.4, P=0.044) with an area under the curve (AUC) of 0.65. A PLR value higher than 156.4 accurately excluded SB with a sensitivity of 0.50, specificity of 0.89, positive predictive value of 0.013 and a negative predictive value of 0.998. NLR did not show a significant difference in the first trimester. CONCLUSIONS: A PLR higher than 156.4 in the first trimester appears to reliably exclude the occurrence of SB later during pregnancy. Lower platelet and higher lymphocyte levels may be related to an early inflammatory process. We speculate that pregnancies in which the initial myometrial invasion by the placental cells is dysfunctional and reflected by a high level of inflammation in the peripheral maternal blood, may contribute to fetal demise. Larger studies are needed to confirm our results.

Predictive value of preoperative complete blood count components on the occurrence of surgical site infection after elective cesarean section.

BACKGROUND: To analyze the predictive value of the preoperative complete blood count components on the occurrence of surgical site infection (SSI) after elective cesarean section. METHODS: We conducted a retrospective case control study in a tertiary care hospital located in New York City during the period of November 1, 2018, to October 30, 2020. We included patients who developed SSI after elective cesarean section as cases and patients who did not develop SSI as controls. We tested the ability of neutrophil, lymphocyte, platelet, hemoglobin, hematocrit, total white blood cells, neutrophil to lymphocyte ratio, hemoglobin to platelet ratio, platelet to lymphocyte ratio, platelet to neutrophil ratio, platelet to hemoglobin ratio and neutrophil to hemoglobin ratio to identify the occurrence of SSI after cesarean section. RESULTS: We compared ten cases and 20 controls. The median lymphocyte and lymphocyte to hemoglobin ratio were statistically significantly higher in cases compared to controls (P=0.049 and P=0.04, respectively). A lymphocyte value higher than 1.5 x103/µL was the best cut-off to exclude the occurrence of SSI, with a sensitivity of 95%, a specificity of 50%, a positive predictive value of 5.5% and a negative predictive value of >99%. A lymphocyte to hemoglobin ratio higher than 1.13 was the best cut off to exclude the occurrence of SSI, with a sensitivity of 95%, a specificity of 60%, a positive predictive value of 6.8% and a negative predictive value >99%. CONCLUSIONS: The preoperative lymphocyte and lymphocyte to hemoglobin ratio should be incorporated into patient counseling and preoperative algorithms to identify patients who will develop SSI. The biological mechanisms involved remain to be investigated and our data should be confirmed by further and larger studies.

Preeclampsia: state of art and future perspectives. A special focus on possible preventions.

Preeclampsia (PE) is characterised by the new onset of hypertension after the 20th week of pregnancy, with or without proteinuria or hypertension that leads to end-organ dysfunction. Since the only definitive treatment is delivery, PE still represents one of the leading causes of preterm birth and perinatal mobility and mortality. Therefore, any strategies that aim to reduce adverse outcomes are based on early primary prevention, prenatal surveillance and prophylactic interventions. In the last decade, intense research has been focussed on the study of predictive models in order to identify women at higher risk accurately. To date, the most effective screening model is based on the combination of anamnestic, demographic, biophysical and maternal biochemical factors. In this review, we provide a detailed discussion about the current and future perspectives in the field of PE. We will examine pathogenesis, risk factors and clinical features. Moreover, recent developments in screening and prevention strategies, novel therapies and healthcare management strategies will be discussed.

Hispanic race is a risk factor for COVID-19 during pregnancy: data from an urban New York City hospital.

There are limited studies on predisposing factors for COVID-19 positivity in asymptomatic pregnant women. The literature published to date on asymptomatic COVID-19 pregnant carriers does not focus on pregnancy or pre-pregnancy comorbidities. We wanted to identify risk factors for COVID-19 in asymptomatic pregnant women. We performed a retrospective chart review of 263 asymptomatic pregnant women admitted to labour and delivery at New York City Health + Hospitals/Lincoln.We analysed the association between race, body mass index (BMI), smoking, indication for admission, gravidity, parity, pre-pregnancy comorbidity, pregnancy comorbidity via uni- and multivariate statistical tests. Only Hispanic race was significant in the univariate analysis (p = .049). At the post-hoc analysis, Hispanics had a higher proportion of COVID-19 cases compared to non-Hispanic Blacks (p = .019). No variables were significantly associated with COVID-19 positivity in the multivariate analysis.Hispanic race appears to be a risk factor for asymptomatic COVID-19 infection during pregnancy. We speculate that the cultural and socioeconomic reality of Hispanic women living in our community leads to more exposure opportunities and therefore, a higher infection rate.Impact statementWhat is already known on this subject? Little is known on the role of comorbidities and risk factors that can favour COVID-19 infection during pregnancy.What do the results of this study add? We found that Hispanic pregnant asymptomatic women had a higher rate of COVID-19 in comparison to non-Hispanic Black women. Pre-pregnancy comorbidities such as pregestational diabetes, hypertension and asthma were not associated with COVID-19 positivity.What are the implications of these findings for clinical practice and/or further research? The reasons why the Hispanic race is more affected by COVID-19 during pregnancy is unclear. The social environment of Hispanic women living in our community, such as their tendency to live in multigenerational and multi-family households, might contribute to a higher infection rate. More resources might be dedicated in the future to Hispanic-dense neighbourhoods.

Efficacy of phloroglucinol in shortening the first stage of labor: systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Protracted labor is associated with an elevated risk of maternal and fetal complications. Results of randomized controlled trials on the efficacy in labor of phloroglucinol (PHL), a pure antispasmodic drug, are uncertain. OBJECTIVES: To evaluate whether PHL is effective in shortening the first stage of labor. SEARCH STRATEGY: MEDLINE, EMBASE, LILACS, Scopus, ClinicalTrials.gov, and the Cochrane Library were searched from inception to July 2020. SELECTION CRITERIA: Randomized controlled trials (RCTs) concerning women with a singleton vertex pregnancy at term who were treated with PHL. DATA COLLECTION AND ANALYSIS: Relevant data were extracted and tabulated. Review Manager 5.3 was used for data analysis. Primary outcome evaluated was the mean reduction of the first stage of labor. MAIN RESULTS: Five RCTs, including 487 pregnant women, were analyzed. The first stage of labor duration was significantly shorter in the treatment arm compared to the control group [MD-113.21 min (95% CI-119.63,-106.79)]. A significant shortening of the second stage was achieved in the PHL group [MD-11.12 min (95% CI-12.64,-9.75)] while no differences were reported for the third stage. CONCLUSIONS: PHL might represent an effective treatment to shorten the duration of the first and second stage of labor. SYNOPSIS: A meta-analysis of 5 trials found that Phloroglucinol favorably impacts on the total duration of the labor in primiparae and multiparae women with a singleton pregnancy.

Timing of delivery and blood pressure cut-off in chronic hypertension during pregnancy: State of art and new proposals.

OBJECTIVE: Pregnant women with chronic hypertension are recommended to deliver at 36-396/7  weeks. The American College of Cardiology and American Heart Association in 2017 lowered the blood pressure cut-off for stage I hypertension to 130/80 mm Hg. METHODS: We performed a literature review on studies comparing elective induction of labor versus expectant management in pregnant women with chronic hypertension. In addition, we reviewed fetal and maternal outcomes in pregnant women with blood pressure of 120-139/80-89 or 130-139/80-89 mm Hg. RESULTS: We found two randomized clinical trials and one retrospective observational study comparing elective delivery of pregnant women with chronic hypertension versus expectant management. The randomized trials favored expectant management and the observational study favored induction of labor. We found 15 retrospective cohort studies analyzing maternal and fetal outcomes in pregnant women with blood pressure cut-off lower than 140/90 mm Hg. There was a consistent finding of increased risk of any hypertensive disorder of pregnancy, gestational diabetes mellitus, and small-for-gestational-age neonate. CONCLUSION: Randomized clinical trials are needed to assess the appropriate timing of delivery for women with stage I hypertension with a blood pressure cut-off of 130/80 mm Hg.

Abnormal uterine bleeding types according to the PALM-COEIN FIGO classification in a medically underserved American community

Objective: To describe the distribution of abnormal uterine bleeding (AUB) type according to the polyp (AUB-P); adenomyosis (AUB-A); leiomyoma (AUB-L); malignancy and hyperplasia (AUB-M); coagulopathy (AUB-C); ovulatory dysfunction (AUB-O); endometrial (AUB-E); iatrogenic (AUB-I); and not yet classified International Federation of Gynecology and Obstetrics classification system in a medically underserved American inner-city population. Our secondary objective was to find an association between risk factors and type of AUB. Material and Methods: We conducted a descriptive cross-sectional analysis at our outpatient women's health clinic located in the Bronx, New York City, from November 2016 to December 2019. Results: Among 390 patients, the most common AUB type was AUB-L (n=185, 47.4%), followed AUB-P (n=100, 25.6%), AUB-A (n=55, 14.1%), AUB-O (n=19, 4.9%), AUB-M (n=15, 3.8%), AUB-E (n=14, 3.6%) and AUB-I (n=2, 0.5%). Race was distributed as follows: Hispanic (68.2%), Black (25.9%), Caucasian (3.3%), and Asian (2.1%). Comorbidities included hypertension (36.4%), diabetes (15.6%), and thyroid disease (6.9%). The median age at diagnosis was significantly higher in AUB-M (59 years old, p<0.001), AUB-P (52.5 years old, p<0.001), AUB-E (51.5 years old, p=0.001) compared to AUB-L (46 years old). The median body mass index (BMI) was significantly higher in AUB-E (34.2 kg/m2, p=0.048) and AUB-O (32.6 kg/m2, p=0.038) compared to AUB-L (30 kg/m2). Race was equally distributed among the AUB types. AUB-M (66.6%, p=0.002), AUB-E (57.1%, p=0.022), AUB-P (47%, p<0.001), and AUB-A (30.8%, p<0.001), had statistically significantly more cases of hypertension compared to AUB-L (28.1%). AUB-P (27%, p<0.001), AUB-M (26.6%, p=0.025), AUB-E (35.7%, p=0.001) and AUB-A (9%, p<0.001) had more patients with diabetes mellitus (DM) than AUB-L (3.3%). Conclusion: In an American population of medically underserved patients, the most common cause of AUB was leiomyoma and the most common race was Hispanic. Women with AUB-L were younger, with lower BMI, and with fewer cases of hypertension and DM when compared to other types of AUB.

Utilization of platelet count in prediction of post-embolization syndrome after uterine artery embolization.

OBJECTIVE: To analyze the predictive value of neutrophils, lymphocytes, platelets, neutrophils to lymphocytes ratio (NLR), platelets to lymphocytes ratio (PLR) in identifying the occurrence of post-embolization syndrome (PES) after uterine artery embolization (UAE). METHODS: We conducted a retrospective observational study in a single tertiary care center located in New York City during period of November 2014 - December 2018, for patients who underwent UAE. PES was defined as the occurrence of pelvic pain, nausea or fever within one week after the procedure. RESULTS: We enrolled 62 patients: 12 of them had PES and 50 served as controls. Platelets were statistically significantly higher in patients with PES (p=0.036). Specifically, a platelet count greater than 336×103/uL was identified as cut-off with a specificity of 91.8 %, a sensitivity of 33.3 %, a positive predictive value of 46 % and a negative predictive value of 85 %. The area under the curve (AUC) was 0.721 (CI 0.536-0.907). CONCLUSION: Patients with a preprocedural platelet count less than 336×103/uL were less likely to have PES. If confirmed by larger studies, the platelet count could be incorporated into patient counseling and preoperative algorithms to identify the ideal UAE candidates.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Twins Compared with Singletons.

OBJECTIVES: It is well known that twin pregnancies confer a high degree of adverse perinatal outcomes. Fetal growth restriction, preterm labor/delivery, and hypertensive disorders of pregnancy are among the causal etiologies associated. Hematologic parameters, specifically, the neutrophil:lymphocyte ratio (NLR), the platelet:lymphocyte ratio (PLR), and some of the routine complete blood cell count components denote a peculiar inflammatory and immunologic profile and have been used as clinical markers for specific obstetric syndromes. To our knowledge, no study has ever evaluated NLR/PLR in twins as a distinct population from singletons. Our primary objective was to analyze NLR/PLR in twins compared with singletons. Our secondary objective was to compare white blood cells, neutrophils, lymphocytes, and platelets between twins and singletons. METHODS: We conducted a retrospective case-control study comparing NLR/PLR markers in twin gestations (dichorionic/diamniotic and monochorionic/dichorionic) versus singleton pregnancies, from January 2019 to April 2020. We excluded pregnancies with potential confounding factors such as human immunodeficiency virus, chronic hypertension, smoking, pregestational diabetes mellitus, or cases with miscarriage/intrauterine fetal demise. We included twin pregnancies (two fetuses) as cases and singletons as controls. RESULTS: We recruited 29 twins and 29 singletons, matched for age, body mass index, and parity. NLR was statistically significantly higher in the first trimester in twins compared with singletons (3.3 vs 2.7, P < 0.01) and the platelet value was lower in the second trimester in twins compared with singletons (199 vs 251, P = 0.01). CONCLUSIONS: We speculate that a decrease in NLR from the first to the second trimester and a decrease in platelet in the second trimester reflect both the physiologic inflammatory/immune reaction of early pregnancy and denote a vital response for the development of normal placentation in twin gestations.

Transversus abdominis plane block versus wound infiltration for post-cesarean section analgesia: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Transversus abdominis plane (TAP) block and wound infiltration (WI) with local anesthetics are used for postoperative analgesia after cesarean section (CS), reducing the need for administration of opioids. OBJECTIVE: To compare the analgesic effect of TAP block related to WI. SEARCH STRATEGY: MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Library, and CINAHL were searched from inception until April 2020. SELECTION CRITERIA: Randomized controlled trials (RCTs) about women who underwent TAP block or WI after CS. DATA COLLECTION AND ANALYSIS: Relevant data were extracted and tabulated. Review Manager 5.3 was used for data analysis. Primary outcome was cumulative opioid consumption (COC) 24 and 48 h after CS. MAIN RESULTS: Five RCTs, enrolling 268 women, were included. There were no significant differences between the interventions regarding COC at 24 (mean difference [MD] -1.68, 95% confidence interval [CI] -6.29 to 2.93) and 48 hours (MD 1.28, 95% CI -10.44 to 13.00). Adverse effects (relative risk [RR] 0.93, 95% CI 0.75-1.16), gastrointestinal reactions (RR 1.30, 95% CI 0.46-3.68), or mild-moderate sedation (RR 1.12, 95% CI 0.72-1.74), pain scores, satisfaction of women, and withdrawals were similar between groups. CONCLUSIONS: There might be no significant advantages selecting TAP block over WI for post-CS analgesia.

Intrauterine transmission of COVID-19 in Pregnancy: case report and review of literature.

We report the first case of SARS-CoV-2 pregnancy in the U.S. Our literature review highlights the rarity of COVID-19 intrauterine transmission and the need for clinicians to promptly test neonates born to SARS-CoV-2 positive mothers at delivery for COVID-19. It is imperative to establish the real risk of intrauterine transmission and to develop appropriate preventive and treatment strategies.

Elevated transaminases in a COVID-19 positive patient at term of gestation: a case report.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome 2 virus (SARS-CoV-2) and it is spreading worldwide with an alarming high transmission rate. SARS-CoV-2 usually attacks the lungs causing a wide range of symptoms ranging from mild dyspnea to severe shortness of breath requiring intubation. Elevation of liver transaminases in the patients' sera has been described in up to 53% of the COVID-19 positive patients. The underlying pathogenic mechanisms of the virus on the liver cells are unclear and only few hypotheses are currently available. Data on COVID-19 in pregnant women are lacking and the management of COVID-19 pregnant women is challenging. An elevation of the transaminases during pregnancies infected by SARS-CoV-2 has never been described before. METHODS: Here we presented the case of a 29 years-old patient at 38 weeks of gestation COVID-19 positive with elevated transaminases. RESULTS: The patient showed a progressive decrease of transaminases after the delivery of the fetus. We provided details about the daily transaminases trend, the therapy used and the maternal/neonatal outcomes. CONCLUSIONS: We speculate that in our case the delivery of the fetus contributed to the normalization of the liver enzymes. In patients affected by COVID-19, at term of gestation, with elevated transaminases, delivery of the fetus is an appealing option. If confirmed by larger studies, our proposed management might be incorporated in the obstetrical management guidelines for COVID-19 positive patients.