ABSTRACT
Aim: to asses an opportunity for predicting an unfavorable perinatal and maternal pregnancy outcome in severe novel coronavirus infection (NCI) COVID-19. Materials and Methods. A retrospective comparative study of the course and outcomes of pregnancies was performed in 40 patients with a gestational age of 22-42 weeks who had severe and extremely severe COVID-19 in 2021. The main group included 21 cases with an extremely severe course of the disease resulting in maternal mortality;the comparison group consisted of 19 patients with severe COVID-19 who successfully completed pregnancy. The diagnosis of NCI COVID-19 was confirmed in all cases by identifying SARS-CoV-2 RNA by polymerase chain reaction in a nasopharyngeal swab. During the study, all patients (during hospitalization, at the peak of the disease and before death/discharge from the hospital) underwent a comprehensive anamnestic, clinical and laboratory-instrumental examination. There were analyzed clinical blood test, biochemical parameters - lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase, creatinine, glucose, total bilirubin, total protein;coagulation parameters - prothrombin level according to Quick and fibrinogen, activated partial thromboplastin time, international normalized ratio;the level of C-reactive protein, procalcitonin, D-dimer, interleukin-6 (IL-6);ultrasound examination was performed during pregnancy (fetometry, placentometry), dopplerometry of uteroplacental blood flow and ultrasound of the pelvic organs, as well as pathomorphological placenta examination. Results. In patients who died from extremely severe NCI COVID-19 (main group), the course of the infection was accompanied by developing of respiratory distress (RD) degree III (chi2 = 12.84;p <= 0.05), and a progressive deterioration in mother's condition and/or fetal distress was an indication for emergency delivery by caesarean section (CS). The course of severe NCI COVID-19 in patients with a favorable outcome (comparison group), as a rule, was accompanied by the development of RD grade I and/or II;most of them were also delivered by CS on an emergency/urgent basis. Predictors of rapid progression of severe NCI COVID-19 in the main group were identified: subfebrile body temperature at the initial stages skewing to high fever during treatment instead of rapid temperature normalization (chi2 = 5.41;p <= 0.05;odds ratio (OR) = 5.0;95 % confidence interval (CI) = 1.23-20.3);lack of leukocytosis at the initial stages (chi2 = 4.91;p <= 0.05;OR = 50;95 % CI = 5.43-460.54) with rapidly increased leukocyte count with persistent stagnation in dynamics until death (chi2 = 19.79, p <= 0.05, OR = 50;95 % CI = 5.43-460.54);severe lymphopenia (chi2 = 8.09;p <= 0.05;OR = 7.29;95 % CI = 1.74-30.56), neutrophilia (chi2 = 10.17;p <= 0.05;OR = 10.29;95 % CI = 2.21-47.84);high LDH values (chi2 = 17.99;p <= 0.05;OR = 31.88;95 % CI = 5.09-199.49);increased IL-6 level at the peak of the disease (chi2 = 9.66;p <= 0.05;OR = 18;95 % CI = 1.99-162.62) and in dynamics, as well as stably high D-dimer values (chi2 = 9.53, p <= 0.05;OR = 11.33;95 % CI = 2.07-62.11). Conclusion. Significant changes observed in clinical and laboratory examination were identified, which reliably reflect the degree of patients' state, to be interpreted as predictors of adverse pregnancy outcomes during NCI COVID-19 and as a potentially justified serious reason for making a decision in the light of timely delivery aimed at a favorable outcome for mother and child. Timely delivery, carried out within the time limits for enabling adequate compensatory capabilities of the pregnant woman's body, demonstrates a rapid normalization of the main laboratory parameters.Copyright © 2023 IRBIS LLC. Pravo. All rights reserved.
ABSTRACT
BACKGROUND: In the context of the COVID-19 pandemic caused by the SARS-CoV-2 virus, viral pneumonia is the leading clinical form of coronavirus infection and a significant cause of maternal mortality. AIM: The aim of this study was to assess the course of severe and extremely severe forms of COVID-19, its impact on pregnancy and fetus, as well as on maternal mortality. MATERIALS AND METHODS: In this retrospective study, we evaluated 39 case histories of patients with severe and extremely severe COVID-19, which were divided into two groups. Group 1 included 22 pregnant women with a severe course of coronavirus infection and a favorable outcome. Group 2 comprised 17 pregnant women in whom complications caused by SARS-CoV-2 were fatal. RESULTS: More than 80% of patients with severe disease course had anaemia in pregnancy. The most significant clinical and anamnestic factors of adverse outcome were gestational diabetes mellitus (p = 0.02), preeclampsia (p = 0.05), and oligoamnios (p = 0.01). Obesity in group 2 was twice more common. The clinical manifestations of the disease in the both study groups were dominated by fever, shortness of breath, weakness and dry cough. In patients with a fatal outcome at the height of the disease, the levels of leukocytosis, urea and lactate dehydrogenase were higher than in those who recovered (p = 0.05). Besides, the levels of alanine transferase and aspartate transaminase were twice as high as in pregnant women who recovered later. Patients in the both study groups required oxygen support as respiratory failure progressed. The vast majority of patients with severe and extremely severe forms of coronavirus infection were in the third trimester of pregnancy. CONCLUSIONS: Women in the third trimester of pregnancy are more susceptible to severe and extremely severe COVID-19 with an unfavorable outcome. Gestational diabetes mellitus, preeclampsia and oligoamnios are significant comorbidities that predispose to severe course and poor outcome in pregnant women and puerperas with COVID-19. The characteristic clinical manifestations of the severe course of coronavirus infection are shortness of breath and fever against a backdrop of significant damage to the lung tissue. A pronounced increase in hepatic enzymes and placental insufficiency is a harbinger of an unfavorable outcome as a manifestation of multiple organ failure. © 2022 by the authors.
ABSTRACT
The novel coronavirus infection is a global pandemic with a continuing upward trend for global cases. The virus can infect any person;however, pregnant women may be more susceptible due to physiological changes in the body. This paper describes a clinical case of the rapid course of COVID-19 pneumonia in a pregnant patient without substantial risk factors for a severe, complicated form of the disease. Patient Zh. was infected with COVID-19 at 37-38 weeks’ gestation. The first clinical manifestations of the disease were sore throat accompanied by a rise in temperature up to 38° C. Taking into consideration that the patient felt worse, cough and fever appeared, she was admitted to a specialized hospital on day 5 after the onset of the disease. On day 7 of hospitalization, worsening respiratory symptoms and intoxication syndrome led to the development of acute cardiopulmonary failure that was the cause of death in the pregnant woman and her fetus. Despite the relatively small number of maternal deaths due to COVID-19, obstetricians/gynecologists and other health care workers need additional data on the characteristics of the course of the disease and possible adverse maternal and perinatal outcomes. Conclusion. Physicians should be informed about mortality and its associated clinical characteristics in patients mainly because the median time from the onset of symptoms of the infectious process to the fatal outcome can be as little as two weeks. © A group of authors, 2021.