Characteristics of COVID-19 positive pregnant patients admitted in a private tertiary hospital and their maternal and neonatal outcomes / Philippine Journal of Obstetrics and Gynecology

Introduction@#The severe acute respiratory syndrome coronavirus 2 pandemic has had profound effects globally. Historical experience with previous Coronaviruses has shown increased maternal and perinatal morbidity and mortality, theoretically secondary to the physiologic changes of pregnancy. As of August 2021, the Philippines is the 23rd top country worldwide in terms of total number of cases, yet there remains to be a sparse pool of information both internationally and locally@*Objectives@#This study aims to present the prevalence, clinical characteristics, as well as the neonatal, obstetric, and maternal outcomes of all pregnant women admitted in the institution who had active or previous COVID‑19 infection@*Methodology@#Retrospective review of data using the hospital’s health information system was utilized. Within the study period, all admitted obstetric patients who had at least one positive result in a RT‑PCR naso‑oropharyngeal swab for SARS‑CoV‑2 were included in this study and categorized into: (1) symptomatic, (2) recovered, and (3) asymptomatic@*Results@#A total of 48 patients were included in the study, where prevalence of COVID‑19 in pregnancy was 3.65%. Results showed that most patients were in the third trimester, and contrary to the non‑pregnant population, majority (60.41%) did not have comorbidities. Most remained asymptomatic (33.33%) or had mild symptoms (18.75%), and underwent abdominal delivery (50%) for obstetric indications. COVID‑19 status was not associated with adverse obstetric outcomes in this study population, but had significant association with preterm birth (p=0.019) and NICU admission (P=<0.001@*Conclusion@#Overall, most cases were asymptomatic and had good prognosis even with the adaptations a pregnant woman undergoes. In addition, neonatal outcomes were generally good regardless of the association with preterm birth and NICU admission. Lastly, there was no appreciated evidence for vertical transmission

Comparison of the diagnostic accuracy of early screening for Preeclampsia by NICE guidelines, ACOG guidelines and comprehensive first trimester screening using maternal characteristics, ultrasonographic findings and maternal serum biochemical markers in the prediction of the development of Preeclampsia in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Introduction@#Preeclampsia remains to be a major cause of both fetal and maternal morbidity and mortality, particularly in severe forms leading to preterm birth. There is a lack of consensus, however, on the preferred screening test for early diagnosis with the aim of reducing the prevalence and morbidity of the disease. @*Objective@#To compare the performance of the comprehensive first trimester screening using maternal characteristics, ultrasonographic findings and serum biochemical markers, with the NICE and ACOG guidelines in predicting the development of preeclampsia. The study also aims to determine the compliance rate of clinicians in giving aspirin prophylaxis using the different screening tests. Methodology: This is a retrospective, analytical, cross sectional study of all pregnant patients between 11 to 13 6/7 weeks referred for comprehensive first trimester screening for preeclampsia from January 2014 to January 2018. Maternal factors were assessed to determine the risk of preeclampsia using NICE guidelines, ACOG guidelines and comprehensive first trimester screening. The compliance on aspirin administration for high-risk patients was also determined. The outcome measure was diagnosis of preeclampsia and the detection rate (DR) of the three screening tests were compared. @*Results@#A total of 202 women were included in the analysis where 24 (11.9%), 11 (5.4%) and 13 (6.4%) developed preeclampsia, early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE) respectively. The NICE and ACOG guidelines were able to detect preeclampsia with an accuracy of 76.73% (Sn 75%, Sp 77% PPV 30.5%) and 43.07% (Sn 83.3%, Sp 37.6% PPV 15.3%) respectively. The comprehensive first trimester screening was able to detect preeclampsia with an accuracy of 89.60% (Sn 83.3%, Sp 90.5% PPV 54.1%). EO-PE and LO-PE were detected with an accuracy of up to 97.2% using the comprehensive screening (Sn 90.9%, Sp 97.9% PPV 71.4%), compared with the NICE guideline (up to 74.26%, Sn 81.8%, Sp 73.8% PPV 15.3%) and the ACOG guideline (up to 39.6%, Sn 90.9%, Sp 36.6, PPV 7.63%). Compliance with the NICE and ACOG recommendation on aspirin administration was only 42.37% and 33.33%, respectively, and this increased to up to 62% when comprehensive first trimester screening was used. @*Conclusion@#This study confirmed that the performance of screening for PE, and therefore appropriate selection of the patients that would benefit from prophylactic use of aspirin and closer surveillance, is by far superior if the comprehensive first trimester screening is used than the method advocated by ACOG and NICE.