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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.
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Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women. Aim(s): to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy. Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020-2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1-57 patients with asymptomatic and mild form of verified COVID-19;Group 2-50 patients with COVID-19 of moderate and severe course;Group 3-52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19. Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries - 54 (94.7 %) and 38 (76.0 %) (chi2 = 7.76) respectively, as well as a significantly lower number of premature births - 3 (5.3 %) and 12 (24.0 %) (chi2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births - 33 (57.8 %) and 42 (80.8 %) (chi2 = 6.63) respectively, but a greater rate of caesarean section - 24 (42.0 %) and 10 (19.2 %) (chi2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) - 16 (28.1 %) and 2 (6.3 %) (chi2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia - 5 (8.8%) and 42 (84.0%) (chi2 = 61.2;p < 0.001) respectively, increased aspartate aminotransferase - 4 (7.0 %) and 38 (76.0 %) (chi2 = 53.15;p < 0.001), lactate dehydrogenase (LDH) - 0 (0.0 %) and 12 (24.0 %) (chi2 = 15.41;p < 0.001), C-reactive protein (CRP) - 6 (10.5 %) and 49 (98.0 %) (chi2 = 81.58;p < 0.001), creatinine reduction - 0 (0.0 %) and 11 (22.0 %) (chi2 = 13.98;p < 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase;a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level. Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity. Copyright © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.
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BACKGROUND: The presence of COVID-19 caused by SARS-CoV-2 during pregnancy increases the incidence of adverse perinatal outcomes, which are manifested in more frequent spontaneous miscarriages, premature births, antenatal fetal deaths, and fetal growth retardation, as well as in the development of intraamniotic infection and respiratory distress syndrome of the newborn. The most likely cause of premature birth can be considered severe respiratory failure of the mother with hypoxemia, which leads to circulatory disorders in the hemodynamic system of the mother-placenta-fetus. Currently, there is no single expert opinion on pregnancy prolongation tactics, as well as the timing and methods of delivery in patients with COVID-19, which is decided individually by an interdisciplinary consultation of the experts, taking into account the severity of the patient's condition, gestational age and fetal condition. AIM: The aim of this study was to analyze perinatal outcomes of pregnancy and childbirth in the presence of moderate and severe COVID-19. MATERIALS AND METHODS: We carried out a retrospective analysis of perinatal outcomes in patients with the novel coronavirus infection in a specialized level III infectious hospital in St. Petersburg, Russia in 2020–2021 (from the first to the fourth wave of COVID-19) based on the birth histories of 50 patients with moderate (n = 31) and severe (n = 19) forms of the disease. RESULTS: Most of the patients suffered from chronic somatic diseases, with the course of pregnancy and childbirth complicated by premature rupture of amniotic fluid and progressive fetal hypoxia (fetal distress). In severe COVID-19, preterm labor prevailed and the proportion of operative abdominal delivery more than doubled that of vaginal delivery. The course of the postpartum period was determined by the COVID-19 positive dynamics. The majority of patients in the study groups showed significant changes in laboratory parameters such as anemia, an increase in the level of neutrophilic leukocytes with a subsequent decrease in their count, lymphopenia followed by lymphocytosis, and an increase in the levels of C-reactive protein and the activities of lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase. The study of the relationship between the most characteristic laboratory parameters in the disease dynamics showed the presence of statistically significant correlations between inflammation markers and metabolic markers, which allowed for assessing the severity of the patient's condition. Antenatal diagnosis of the fetal functional status based on cardiotocography, ultrasound and Doppler sonography data revealed a predominantly compensated fetal condition in the study groups. The condition of newborns in all patients with moderate COVID-19 and in most of patients with the severe form of the disease was satisfactory. In severe COVID-19, the birth of children with moderate asphyxia was due to prematurity and antenatal hypoxia resulted from decompensation of chronic placental insufficiency. The histopathological patterns of the afterbirth in the study groups were represented by inflammatory changes and chronic placental insufficiency. CONCLUSIONS: The data obtained suggest that the basis for favorable perinatal outcomes is an adequate assessment of the condition of the pregnant woman and the fetus with timely delivery before the onset of irreversible organ damage. © Eco-Vector, 2022.
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Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women. Aim(s): to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy. Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020-2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1-57 patients with asymptomatic and mild form of verified COVID-19;Group 2-50 patients with COVID-19 of moderate and severe course;Group 3-52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19. Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries - 54 (94.7 %) and 38 (76.0 %) (chi2 = 7.76) respectively, as well as a significantly lower number of premature births - 3 (5.3 %) and 12 (24.0 %) (chi2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births - 33 (57.8 %) and 42 (80.8 %) (chi2 = 6.63) respectively, but a greater rate of caesarean section - 24 (42.0 %) and 10 (19.2 %) (chi2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) - 16 (28.1 %) and 2 (6.3 %) (chi2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia - 5 (8.8%) and 42 (84.0%) (chi2 = 61.2;p < 0.001) respectively, increased aspartate aminotransferase - 4 (7.0 %) and 38 (76.0 %) (chi2 = 53.15;p < 0.001), lactate dehydrogenase (LDH) - 0 (0.0 %) and 12 (24.0 %) (chi2 = 15.41;p < 0.001), C-reactive protein (CRP) - 6 (10.5 %) and 49 (98.0 %) (chi2 = 81.58;p < 0.001), creatinine reduction - 0 (0.0 %) and 11 (22.0 %) (chi2 = 13.98;p < 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase;a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level. Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity. Copyright © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.
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The article presents the results of the surveillance of severe maternal morbidity (SMM) according to SMM surveillance regulations in the Russian Federation (RF). The study analyzed the SMM Register of the Vertically Integrated Medical Information System of Obstetrics and Gynecology and Neonatology (VIMIS AKU&NEO) and the results of near-miss audit. The analysis included life-threatening maternal conditions without fatal outcome identified according to categories of organ dysfunction using the WHO diagnostic criteria (2011). The study aimed to identify strategies to reduce and prevent maternal mortality (MM) in Saint Petersburg. The authors analyzed the types of SMM registered in level II (51.0%) and level III (49.0%) maternal care providers (MCP) of Saint Petersburg. They also presented characteristics of near-miss cases, of which 12.5% and 83.3% occurred in level II and level III MCPs, respectively. Integral indicators of medical care quality in near-miss groups included near-miss rate, life-threatening condition rate, survival rate index, and mortality rate index. Obstetric pathology, blood pathology, and respiratory pathology were the leading causes of SMM in Saint Petersburg in 2021, which is comparable with the data of SMM registered in the Russian Federation in general. There were no cases of MM in the obstetric pathology group, which was the most frequently registered category of SMM (39.4% of the total number of SMM), including severe pre-eclampsia and eclampsia (83.1% of the group) and uterine rupture (9.6% of the group). The absence of MM in this category of SMM is associated with the implementation of effective and quality medical care in patients at high risk for obstetric and perinatal complications in Saint Petersburg in 2021. Blood pathology was the second most frequently registered category of SMM (36.8% of all SMM, 95.8% of the group);one case of MM was registered in a Level III MCP and one case outside the MCP before ambulance arrival. Both cases were associated with massive blood loss (more than 1000 ml). In 2021, during a pandemic of a novel coronavirus infection (COVID-19) in St. Petersburg, 41 cases of SMM associated with respiratory pathology (9.1% of total SMM) were reported. Of them 39 were identified as near-miss cases (respiratory dysfunction), which accounted for 54, 2% of the total number of near-miss cases with 20 deaths in level III MCPs. These deaths were due to severe or extremely severe bilateral viral or viral bacterial pneumonia complicated by acute respiratory distress syndrome or pulmonary embolism due to COVID-19 (O98. 5, U07.1). The main strategy to prevent and reduce the incidence of near-miss cases and MM based on improving the modern integral model of internal control of the quality of medical care in maternal care providers, near-miss audit, and the introduction into practice of both medical and organizational methodological, including telecommunications and other technologies aimed at improving professional competence. Conclusion: SMM surveillance and near-miss audit allows for a detailed assessment of the nature and quality of medical care to improve pregnancy outcomes.
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The new coronavirus infection, which was identified in Wuhan (Hubei province, China) in late 2019, caused an outbreak of severe pneumonia. The disease quickly spread throughout China and was followed by a dramatic increase in number of new cases in other countries of the world. Certain population groups that require particular attention include pregnant women due to the fact that pneumonia is the third-leading indirect cause of maternal mortality. Among the controversial issues in the management of pregnant women with COVID-19, special attention should be paid to the tactics of prolonging pregnancy and approaches to childbirth. The available scientific and clinical data are currently insufficient to perform a complete assessment of perinatal outcomes in pregnant women with COVID-19. Researchers and practical healthcare specialists have more questions than answers due to the limited time and number of studies, lack of evidence of vertically transmitted infection from mother to fetus, absence of clear understanding of viral pathogenesis during pregnancy, as well as the level and degree of initiation of SARS-CoV-2 pathological processes in the mother and fetus that can have a negative influence on the perinatal This review is devoted to the analysis of pregnancy and childbirth outcomes, presentation of current approaches to the management of women with novel coronavirus infection COVID-19 during pregnancy and childbirth on the basis of the available literature data in the domestic and foreign clinical guidelines.