Managing COVID-19 in pregnant women

Pregnant women are no more likely to contract coronavirus disease 2019 (COVID-19) than the background population and two-thirds of those testing positive are asymptomatic [1, 2]. Risk factors for severe infection reflect those outside pregnancy and include being unvaccinated, aged >35 years, having a body mass index >25 kg·m−2, having a medical comorbidity, being in the Black, Asian and Minority Ethnicity (BAME) population, and socioeconomic deprivation [1]. Pregnant women who develop moderate/severe disease are more likely to require hospitalisation and critical care admission, particularly in the third trimester [1]. Principles of management of COVID-19 in the general population apply in pregnancy with few exceptions. Clinical inertia can lead to preventable morbidity and mortality. COVID-19 vaccines are safe and should be recommended at any stage of pregnancy.https://bit.ly/3Rj8nWr

Managing COVID-19 in pregnant women.

Principles of management of COVID-19 in the general population apply in pregnancy with few exceptions. Clinical inertia can lead to preventable morbidity and mortality. COVID-19 vaccines are safe and should be recommended at any stage of pregnancy. https://bit.ly/3Rj8nWr.

Starvation ketosis in a pregnant woman with COVID-19: a case report.

Summary: COVID-19 is associated with severe disease in pregnancy. Complications of the disease, or simultaneous diagnoses, may be missed if clinicians do not retain a large differential diagnosis when assessing such women. Starvation ketoacidosis is one such diagnosis which may complicate the disease and should not be missed. A 37-year-old woman, 33 weeks' gestation presented with breathlessness. Clinical history, examination and investigations supported a diagnosis of starvation ketosis of pregnancy complicating COVID-19 pneumonitis. Prompt correction of the metabolic disturbance resulted in resolution, and preterm delivery was avoided at this time. Early recognition and prompt management of starvation ketosis of pregnancy in women with COVID-19 are important in reducing maternal and neonatal morbidity and mortality. Preterm delivery may be avoided with prompt resolution of the metabolic disturbance. Clinicians should keep a wide differential diagnosis when assessing women with breathlessness. A multidisciplinary team (MDT) approach is required to facilitate optimal care. Learning points: Clinicians should maintain a wide differential when assessing women who are unwell with COVID-19 in pregnancy. Complications such as starvation ketoacidosis are rare but life-threatening. An awareness of such complications facilitates early identification of the condition, and involvement of appropriate specialists who can initiate optimal and timely management. In the context of pregnancy, where ketoacidosis poses a threat to the mother or baby, prompt management and resolution may avoid preterm delivery. Conditions that may increase the risk of developing starvation ketoacidosis include pregnancy, medication use such as corticosteroids or tocolytic therapies, previous gastric surgery, intercurrent illness and pregnancy-related conditions that might contribute towards a degree of chronic starvation. Multidisciplinary input supports the delivery of best practice and care for the patients.

Diagnosis and management of covid-19 in pregnancy.

Pregnant women with covid-19 are at greater risk of severe disease than their non-pregnant peers, and yet they are frequently denied investigations or treatments because of unfounded concerns about risk to the fetus. The basic principles of diagnosing and managing covid-19 are the same as for non-pregnant patients, and a multidisciplinary, expert team approach is essential to ensure optimal care. During pregnancy, treatment with corticosteroids should be modified to use non-fluorinated glucocorticoids. Il-6 inhibitors and monoclonal antibodies, together with specific antiviral therapies, may also be considered. Prophylaxis against venous thromboembolism is important. Women may require respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position (either awake or during invasive ventilation), intubation and ventilation, and extracorporeal membrane oxygenation (ECMO). Pregnancy is not a contraindication for any of these supportive therapies, and the criteria for providing them are the same as in the general population. Decisions regarding timing, place, and mode of delivery should be taken with a multidisciplinary team including obstetricians, physicians, anesthetists, and intensivists experienced in the care of covid-19 in pregnancy. Ideally these decisions should take place in consultation with centers that have experience and expertise in all these specialties.

COVID-19 in pregnancy.

Pregnant women with COVID-19 are less likely to be symptomatic than non-pregnant counterparts. Risk factors for severe disease include being overweight or obese, greater than 35 years old, and having pre-existing comorbidities. Those who develop severe disease have increased rates of admission to an intensive care unit, requiring invasive ventilation and pre-term birth.Pregnant and breastfeeding women with COVID-19 should be investigated as of outside pregnancy and should receive proven therapies (such as corticosteroids and tocilizumab) on a risk/benefit basis. Admitted women should receive multidisciplinary care with input from senior decision makers and early escalation where required. There are no safety concerns -surrounding the COVID-19 vaccination and fertility or pregnancy, and so it should be offered to women based on their age and clinical risk group, in line with non-pregnant women.

Endocrine complications of immunotherapies: a review.

Use of immune checkpoint inhibitors in cancer treatment has increased vastly over the past decade, as both single and combination agent therapies. While having a positive impact on survival rates, adverse effects have been noted, with endocrine effects in around 10% of patients. Thyroid disease and hypophysitis are the most commonly encountered, with diabetes mellitus and primary adrenal insufficiency also reported, as well as more rare endocrinopathies. Patient and clinician education to raise awareness of these effects, as well as regular monitoring to enable early recognition, diagnosis and prompt treatment of the immune side effects, are key. In this review, we discuss the aetiology, presentation and management of the endocrine complications of immunotherapies that are relevant to the general physician, as well as highlighting important areas where further research is still needed.