ABSTRACT
OBJECTIVES: To analyze soluble Fms-like tyrosine Kinase 1 (sFlt-1) and Placental Growth Factor (PlGF) ratio concentrations in COVID-19 pregnant patients with and without Hypertensive Disorders of Pregnancy (HDP), compared with non COVID-19 pregnant patients with HDP and a control group. STUDY DESIGN: We recruited and obtained a complete follow-up of 19 COVID-19 pregnant patients with HDP and of 24 COVID-19 normotensive pregnant patients. Demographic, clinical and sFlt-1/PlGF ratio findings were compared with a group of 185 non COVID-19 pregnant patients with HDP and 41 non COVID normotensive patients. Findings were based on univariate analysis and on a multivariate adjusted model, and a case by case analysis of COVID-19 pregnant patients with an abnormal sFlt-1/PlGF ratio > 38 at recruitment. MAIN OUTCOME MEASURES: sFlt-1/PlGF ratio. RESULTS: We confirmed a significant higher prevalence of HDP in women affected by COVID-19 compared to control population. sFlt-1/PlGF ratio was found high in HDP patients, with and without of Sars-Cov2 infection. COVID-19 patients with worse evolution of the disease showed greater rates of obesity and other comorbidities. sFlt/PlGF ratio proved not to be helpful in the differential diagnosis of the severity of this infection. CONCLUSIONS: COVID-19 pregnant patients showed a higher prevalence of HDP compared to non COVID-19 controls, as well as higher comorbidity rates. In spite of the possible common endothelial target and damage, between Sars-Cov-2 infection and HDP, the sFlt1/PlGF ratio did not correlate with the severity of this syndrome.
Subject(s)
COVID-19/complications , Hypertension, Pregnancy-Induced/virology , Placenta Growth Factor/blood , Vascular Endothelial Growth Factor Receptor-1/blood , Adolescent , Adult , Biomarkers/blood , COVID-19/blood , Case-Control Studies , Female , Follow-Up Studies , Humans , Hypertension, Pregnancy-Induced/blood , Hypertension, Pregnancy-Induced/diagnosis , Multivariate Analysis , Pregnancy , Severity of Illness Index , Young AdultABSTRACT
Continuous positive airway pressure (CPAP) has been successfully applied to patients with COVID-19 to prevent endotracheal intubation. However, experience of CPAP application in pregnant women with acute respiratory failure (ARF) due to SARS-CoV-2 pneumonia is scarce. This study aimed to describe the natural history and outcome of ARF in a cohort of pregnant women with SARS-CoV-2 pneumonia, focusing on the feasibility of helmet CPAP (h-CPAP) application and the variables related to ARF worsening. A retrospective, observational study enrolling 41 consecutive pregnant women hospitalised for SARS-CoV-2 pneumonia in a tertiary care center between March 2020 and March 2021. h-CPAP was applied if arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) was inferior to 200 and/or patients had respiratory distress despite adequate oxygen supplementation. Characteristics of patients requiring h-CPAP vs those in room air or oxygen only were compared. Twenty-seven (66%) patients showed hypoxemic ARF requiring oxygen supplementation and h-CPAP was needed in 10 cases (24%). PaO2/FiO2 was significantly improved during h-CPAP application. The device was well-tolerated in all cases with no adverse events. Higher serum C reactive protein and more extensive (≥3 lobes) involvement at chest X-ray upon admission were observed in the h-CPAP group. Assessment of temporal distribution of cases showed a substantially increased rate of CPAP requirement during the third pandemic wave (January-March 2021). In conclusion, h-CPAP was feasible, safe, well-tolerated and improved oxygenation in pregnant women with moderate-to-severe ARF due to SARS-CoV-2 pneumonia. Moderate-to-severe ARF was more frequently observed during the third pandemic wave.
Subject(s)
COVID-19 , Continuous Positive Airway Pressure , Oxygen/administration & dosage , Pregnancy Complications, Infectious , Respiratory Insufficiency , SARS-CoV-2/metabolism , Tertiary Care Centers , Acute Disease , Adult , COVID-19/blood , COVID-19/therapy , Female , Humans , Oxygen/blood , Pregnancy , Pregnancy Complications, Infectious/blood , Pregnancy Complications, Infectious/therapy , Protein C/metabolism , Respiratory Insufficiency/blood , Respiratory Insufficiency/therapy , Retrospective StudiesABSTRACT
OBJECTIVE: To determine the impact on perinatal health of changes in social policies and obstetric care implemented to curb SARS-CoV-2 transmission. However, robust data on the topic are lacking since most of the studies has examined only the first few months of the outbreak. METHODS: A retrospective analysis of prospectively collected data on uninfected and asymptomatically infected women giving birth between March and November 2020 and in the same time frame of 2019 at our tertiary care center in Lombardy, northern Italy. Perinatal outcomes were compared according to the year (2019 versus 2020) and to the trimester (March-May, June-August, September-November) of childbirth, corresponding to the three phases of the pandemic (first wave, deceleration, second wave) and covering a 9-month period. RESULTS: We identified increased rates of gestational diabetes mellitus, spontaneous preterm birth, and neuraxial analgesia in 2020 versus 2019, with different temporal distributions: gestational diabetes mellitus and spontaneous preterm birth were more prevalent during the deceleration and the second wave phase, whereas epidural analgesia was more prevalent during the first wave. CONCLUSION: By assessing a prolonged time frame of the pandemic, we show that pandemic-related control measures, as applied in Lombardy, impacted relevant perinatal outcomes of women giving birth at our center.