Objectives: To highlight the significance of environmental stressors, such as the COVID-19 pandemic, on perinatal care and obstetric complications.
Methods: The patient presented to the emergency department with elevated blood pressure from the office after her first prenatal visit. Her medical history was complicated by obesity, PCOS, denial of pregnancy, and multiple life challenges and psychosocial issues in the setting of the COVID-19 pandemic.
Results: The patient is a 34-year-old African American woman, G1P0000 at 31 weeks and 1-day gestation by third-trimester ultrasound. The patient had recently left an abusive relationship and moved to Florida, where she had a lack of financial and social support. She attributed her physical and emotional changes to the social isolation and dietary changes during the pandemic and attributed her amenorrhea to PCOS. Upon admission to the antepartum unit, she was diagnosed with preeclampsia, which eventually progressed as she developed severe features. The decision was made for emergent delivery of the pre-term infant and admission to the NICU. Although the pregnancy was initially determined to be 31 weeks, after delivery, the infant was determined to be closer to 34 weeks based on neonatal maturity scales.
Conclusions: Denial of pregnancy has a reported incidence of 1:500 pregnancies. This condition is often very challenging, as the late diagnosis of the pregnancy is associated with obstetric complications, psychological struggles, and of course risks to the fetus. This case demonstrates how environmental factors such as the COVID-19 pandemic can have a significant effect on obstetric care and complications.