Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases / 中华围产医学杂志

Objective:To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19.Methods:This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Specimens of maternal vaginal swab were collected in six pregnant women, and the specimens of amniotic fluid, cord blood, neonatal throat swab and breast milk samples were collected in four pregnant women who had a delivery during our study. All samples were tested for the existence of COVID-19. Descriptive analysis was applied in this study.Results:(1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37 +5 weeks, which was seven days after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and eight were treated with glucocorticoid. Six cases received immunotherapy. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit two days after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm baby was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above. Conclusions:There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. So far, there is no evidence for vertical transmission or worsening perinatal outcomes in mothers and babies.

Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases / 中华围产医学杂志

Objective To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19. Methods This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Specimens of maternal vaginal swab were collected in six pregnant women, and the specimens of amniotic fluid, cord blood, neonatal throat swab and breast milk samples were collected in four pregnant women who had a delivery during our study. All samples were tested for the existence of COVID-19. Descriptive analysis was applied in this study. Results (1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37 +5 weeks, which was 7 d after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and eight were treated with glucocorticoid. Six cases received immunotherapy. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit 2 d after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm baby was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above. Conclusions There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. So far, there is no evidence for vertical transmission or worsening perinatal outcome in mothers and babies.

Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases / 中华围产医学杂志

Objective@#To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19.@*Methods@#This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Descriptive analysis was applied in this study.@*Results@#(1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37+5 weeks, which was 7 d after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and seven were treated with glucocorticoid. One case received immunotherapy due to worsening conditions. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit 2 d after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm babies was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above.@*Conclusions@#There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. Currently, the evidence for vertical transmission of COVID-19 needs further studies with larger size of examples, but pregnancy may deteriorate COVID-19. Given that COVID-19 may have adverse effects on perinatal outcomes, it's recommended to take positive and effective measures for COVID-19 women in the third trimester.

Impact of atmospheric particulate matter at different period of gestation on low birth weight: a meta-analysis / 中华预防医学杂志

Objective@#To analyze the influence of atmospheric particulate matters (PM2.5 and PM10) on low-birth-weight (LBW) infants at different periods of gestation.@*Methods@#We conducted a systematic literature search for 2 471 articles related to particulate matter and LBW published from January 1st 2000 to January 1st 2016 using the PubMed, Cochrane Library, Web of Science, Science Direct, Chinese Web of Knowledge, Wanfang and Weipu, and the keywords were" air pollution" , "adverse birth outcomes" , "adverse pregnancy outcomes" , "low birth weight/LBW" . According to criteria, 27 literatures were selected and included. Metafor package of the R 3.1.1 Software was used to check the heterogeneity and merge the effect value of the selected literatures, and sensitivity analysis and publication bias were detected and adjusted.@*Results@#A total of 2 471 studies selected form the databases, 27 enrolled in this analysis according to the inclusion and exclusion criteria. Each 10 μg/m3 increase in PM2.5 was associated with combined OR values of 1st trimester, 2nd trimester, 3rd trimester and entire gestation at 1.02(95% CI: 0.87-1.19), 1.03 (95% CI: 0.91-1.16) , 1.07 (95%CI: 1.04-1.11) and 1.09 (95%CI: 1.04-1.15), respectively. And 10 μg/m3 increase in PM10 was associated with combined OR values of 1st trimester, 2nd trimester, 3rd trimester and entire gestation at 1.66 (95%CI: 1.06-2.61), 1.58 (95%CI:1.28-1.95) , 1.38 (95%CI: 1.23-1.56) and 1.04 (95%CI: 0.99-1.09), respectively. After adjusting the bias of publication, each 10 μg/m3 increase in PM2.5 was associated with the risk of low birth weight at 1.11 (95%CI: 1.02-1.21).@*Conclusion@#This meta analysis supports an adverse impact of maternal exposure to particulate air pollution on low birth weight, varying in effects by exposure period.

Application of the double balloon device in labor induction for women with preeclampsia and eclampsia / 中国医师杂志

Objective To evaluate the efficacy and safety of labor induction by the double balloon device in women with preeclampsia and eclampsia.Methods Labor induction was carried out in 37 women with preeclampsia and eclampsia from July 2011 to November 2012.All the labor inductions were performed using the double balloon device.Results The cervical Bishop scores of 37 cases of patients with preeclampsia and eclampsia were significantly lower before using double balloon device [(3.38 ± 0.50) scores] compared with after using double balloon device [(6.44 ± 0.63) scores] with a statistically significant difference (t =23.54,P ＜0.01).Blood pressure had no obvious change before and after using double balloon device [SBP(158.38 ± 13.89)mmHg vs (162.48 ± 12.56)mmHg,P ＞ 0.05,and SDP(112.71± 15.53) mmHg vs (108.19 ± 8.37) mmHg,P ＞ 0.05].The rate of vaginal delivery was 89.2％ (33/37),and the total hours of labor were (5.8 ± 0.63) h.Compared with selective cesarean section,vaginal delivery after double balloon to promote cervical mature had less blood loss (t =9.19,P ＜0.01),quicker postpartum recovery,shorter hospitalization time (t =11.18,P ＜ 0.01),lower birth body mass (t =2.96,P ＜0.01) and higher scores of 1 minutes Apgar score (t =2.34,P ＜0.05).Conclusions The double balloon device appeared to be a safe and effective method to induce labor in women with preeclampsia and eclampsia.Wide scale studies and further use of the device for labor induction in women with preeclampsia and eclampsia were warranted.

Clinical Observations on Acupuncture Treatment of Post-Stroke Dysphagia / 针灸推拿医学（英文版）

Objective: To seek a treatment that can improve the effect on dysphagia following post-stroke pseudobulbar palsy. Methods: Sixty patients were randomly allocated into observation and control groups, 30 cases each. The observation group was treated with Western drugs plus acupuncture at Tiantu (CV 22) and other three acupoints around Lianquan (CV 23) and the control group with simple Western drugs. Results: The effective rate was 86.7% in the observation group and 30.0% in the control group. Conclusion: Acupuncture can improve the curative effect of Western drugs on dysphagia following post-stroke pseudobulbar palsy.