The utility of systemic immune-inflammation index and systemic immune-response index in the prediction of adverse outcomes in pregnant women with coronavirus disease 2019: Analysis of 2649 cases.

AIM: To investigate the association of systemic immune-inflammation index (SII) and systemic immune-response index (SIRI) with adverse perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19). METHODS: The cases were divided into (1) the Mild-moderate COVID-19 group (n = 2437) and (2) the Severe-critical COVID-19 group (n = 212). Clinical characteristics, perinatal outcomes, SII (neutrophilXplatelet/lymphocyte), and SIRI (neutrophilXmonocyte/lymphocyte) were compared between the groups. Afterward, SII and SIRI values were compared between subgroups based on pregnancy complications, neonatal intensive care unit (NICU) admission, and maternal mortality. A receiver operator characteristic analysis was performed for the determination of optimal cutoff values for SII and SIRI in the prediction of COVID-19 severity, pregnancy complications, NICU admission, and maternal mortality. RESULTS: Both SII and SIRI were significantly higher in complicated cases (p < 0.05). Cutoff values in the prediction of severe-critical COVID-19 were 1309.8 for SII, and 2.3 for SIRI. For pregnancy complications, optimal cutoff values were 973.2 and 1.6. Cutoff values of 1045.4 and 1.8 were calculated for the prediction of NICU admission. Finally, cut-off values of 1224.2 and 2.4 were found in the prediction of maternal mortality. CONCLUSION: SII and SIRI might be used in combination with other clinical findings in the prediction of poor perinatal outcomes.

The influence of COVID-19 pandemic on intrauterine fetal demise and possible vertical transmission of SARS-CoV-2.

OBJECTIVE: The impact of COVID-19 on intrauterine fetal demise (IUFD) and vertical transmission of the SARS-CoV-2 from the mother to the fetus are crucial issues of the COVID-19 pandemic. In the current study, we aimed to detect the pandemic's influence on the IUFD and evaluate the vertical transmission of the SARS-CoV-2 through analysis of placental tissues collected from PCR positive women with IUFD above 20 weeks of gestation. MATERIALS AND METHODS: The pregnant women above 20 weeks of gestation and had a fetus intrauterine demised during pandemic were included in the study. The pregnant women screened for COVID-19. Vertical transmission searched from placental tissues of COVID-19 positive women by RT-PCR tests for the presence of SARS-CoV-2 RNA. The number of IUFD before the pandemic and during the pandemic compared to assess the influence of the COVID-19 pandemic on the IUFD ratio. RESULTS: Among 138 pregnant women with IUFD, 100 of them could screen for COVID-19 status. RT-PCR test results of 6 of the screened pregnant women were positive for SARS-CoV-2. Placental tissues of these six women were analyzed, and one test result was positive for SARS-CoV-2 RNA. The IUFD ratio was significantly increased during the pandemic. CONCLUSION: It is clear that COVID-19 increases the IUFD ratio. Previous data for vertical transmission of SARS-CoV-2 during the second trimester is limited. We present the third case of literature that has positive placental results for SARS-CoV-2 RNA in the second trimester of pregnancy.

An evaluation of the results of convalescent plasma therapy applied to pregnant women diagnosed as COVID-19- positive in a pandemic center: A prospective cohort study.

BACKGROUND: Convalescent plasma (CP) might be an additional treatment modality in COVID-19. The aim of this study was to compare CP-related clinical characteristics and perinatal outcomes in pregnant women with mild or moderate-severe COVID-19. METHODS: This prospective cohort study included 36 pregnant women (12 mild and 24 moderate-severe), who underwent CP therapy. The CP obtained from recently recovered donors was transfused to patients together with maximum supportive care and antiviral agents. The groups were then compared in respect of clinical characteristics, laboratory parameters, obstetric complications, and neonatal outcomes. RESULTS: Significant differences were determined between the groups in respect of systemic corticosteroids in COVID-19 treatment (41.7%, 87.5%, p = 0.004), oxygen (O2) support (0%, 91.7%, p < 0.001), chest imaging (41.7%, 58.3%, p = 0.02), intensive care unit admission (0%, 20.8%, p = 0.03) and length of hospitalization (5.5 versus 9.5 days, p < 0.001). The O2 saturation levels before and after administration of CP were significantly lower in the moderate-severe COVID-19 group (p < 0.05). The O2 therapy time before and after administration of CP and total O2 therapy time were significantly lower in the mild COVID-19 group (p < 0.05). Platelet, plateletcrit and lymphocyte counts were significantly higher in both the mild and moderate-severe COVID-19 groups after treatment compared to the pretreatment values (p < 0.05). DISCUSSION: Although data on the results of CP treatment in pregnant women are somewhat limited, it has been suggested that early CP treatment may be associated with improvements in laboratory and ventilatory parameters in pregnant women with mild and moderate-severe COVID-19. Nevertheless, there is a need for further, randomized controlled studies on this subject with the inclusion of greater numbers of patients.

Decreased fetal cardiac output in pregnant women with severe SARS-Cov-2 infection.

AIM: We aimed to examine fetal cardiac output (CO) in patients who recovered from severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. MATERIALS: This prospective study included 48 pregnant women recovered from SARS-CoV-2 infection and 50 control cases. SARS-CoV-2 infection was diagnosed by polymerase chain reaction (PCR) test in patients. Fetal echocardiographic evaluations were performed at 24-37 weeks of gestation in pregnant women who recovered from the infection and control group. RESULTS: The median value of ultrasound evaluation was 34 (2.6) weeks of gestation in the recovery from the SARS-CoV-2 infection (RSI) group, and 32 (7.6) weeks in the control group (p = .565). Left cardiac output (LCO) z score was significantly lower in the RSI group than the control group (p = .041). LCO and combine cardiac output (CCO) z score were significantly lower in the severe disease group than mild, moderate disease groups, and controls (p = .019 and p = .013). CCO (ml/min/kg) was decreased in the severe disease group when compared with control and mild disease groups (p = .044). CONCLUSION: In the present study, fetal cardiac output in pregnant women who recovered from SARS-CoV-2 infection was found to be significantly reduced in those with severe disease, while there was no significant difference in mild and moderate cases. Placental dysfunction and inflammatory cytokines might cause fetal cardiac changes. Further studies could be clarified on the impact of SARS-CoV-2 infection on fetal cardiac function.

Post-COVID-19 fetal cardiac evaluation in moderate infection group of pregnant women.

PURPOSE: To determine the long-term fetal cardiac effects of the SARS-CoV-2 infection in pregnant women recovered from moderate COVID-19 with fetal echocardiography (ECHO). METHODS: Forty-five pregnant women that recovered from moderate COVID-19 (CRG) 4 weeks after the infection confirmation, were compared with 45 gestational and maternal age-matched control groups (CG) in terms of demographic features fetal cardiac morphological (sphericity index, cardiothoracic ratio), and functional (myocardial performance index, mitral E/A, tricuspid E/A, mitral and tricuspid annular plane systolic excursion) parameters. RESULTS: There was no difference in demographic features between the groups. Fetal cardiac morphologic parameters were found to be similar between the two groups. When the fetal cardiac functional assessment of the two groups was compared, only mitral E/A ratio results were found to be statistically significantly lower in the CRG than in the control group (p = 0.030). CONCLUSION: The fetal heart does not seem to be negatively affected by COVID-19 after recovery from moderate infection. These results about the fetal effect of SARS-CoV-2 may improve our limited knowledge of the utility of fetal ECHO in pregnant women who recovered from COVID-19.

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases.

PURPOSE: To compare the clinical features and perinatal outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-variant and post-variant periods. METHODS: This prospective cohort study includes pregnant women with SARS-CoV-2 who were followed-up at Ankara City Hospital between 11, March 2020 and 15, September 2021. Demographic features, clinical characteristics and pregnancy outcomes were compared between the pre-variant (n = 1416) and post-variant (n = 519) groups. RESULTS: The rates of severe and critical cases significantly increased in the post-variant group (9.7% vs 2%, p < 0.001). The rates of respiratory support (26.8% vs 7.3%, p < 0.001), ICU admission (12.9% vs 1.8%, p < 0.001) and maternal mortality (2.9% vs 0.4%, p < 0.001) were significantly higher in the post-variant group. A significant increase was observed for pregnancy complications in the post-variant group (45.6% vs 18.8%, p = 0.007). The rates of preterm delivery (26.4% vs 4.4%, p < 0.001) and NICU admission (34% vs 18.8%, p < 0.001) were significantly higher in the post-variant group. Positive, weak, statistically significant correlations were observed between the post-variant period, disease severity and maternal mortality (r = 0.19, r = 0.12 and p < 0.001). CONCLUSION: Post-variant COVID-19 period was associated with a severe course of the disease and increased rates of adverse obstetric outcomes in pregnant patients.

Influence of Covid-19 infection on fetal thymus size after recovery.

OBJECTIVES: To investigate the long-term effects of the SARS-CoV-2 infection on the fetal immune system by fetal thymus size measurements with ultrasound (USG). METHODS: This prospective study was conducted in the Turkish Ministry of Health Ankara City Hospital between November 1, 2020 and April 1, 2021, with recovered, pregnant women, four weeks after they had been confirmed for the SARS-CoV-2 infection by real-time polymerase-chain-reaction (RT-PCR). COVID-19 recovered (CR) pregnant women compared with age-matched pregnant controls in terms of demographic features, fetal thymic-thoracic ratio (TTR), and laboratory parameters. RESULTS: There was no difference in demographic features between the two groups. TTR found significantly lower in the CR group than the control group (p=0.001). The fetal TTR showed a significant and moderate correlation with maternal monocyte counts, monocyte to lymphocyte ratio (MLR), and red cell distribution width (RDW); while it did not correlate with lymphocyte counts, c-reactive protein (CRP), and procalcitonin levels. CONCLUSIONS: The 2019 novel coronavirus disease (COVID-19) reduces fetal thymus size in pregnant women with mild or moderate symptoms after recovery from the infection.

Factors affecting the acceptability of COVID-19 vaccine in the postpartum period.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread rapidly around the world, causing massive morbidity and mortality. Vaccination during puerperium protects both the mother and the newborn and is important to keep the pandemic under control. METHODS: Women who gave birth at Ankara City Hospital between February 11, 2021 and March 21, 2021 were included. Data were collected through a face-to-face questionnaire. RESULTS: We asked 412 postpartum women were surveyed about their acceptance of the COVID-19 vaccine; 137 (33.3%) of them wanted to be vaccinated, while 275 (66.7%) of them did not want to be vaccinated. Reasons for vaccination rejection; 209 (76%) of them stated that there was not enough information about the safety of the vaccine for the postpartum period, and 89 (32.4%) of them thought that the vaccine would not be effective for the disease. Three of the answers in the survey were found significantly different in high-risk pregnancy (HRP) group compared to low-risk pregnancy (LRP) group; 1) Having their babies to be vaccinated, 2) To be vaccinated if it will be recommended to the puerperal women, and 3) Feeling anxious about being infected by SARS-CoV-2 (p < .05). CONCLUSIONS: Health authorities recommend the COVID-19 vaccine to breastfeeding mothers. However, a relatively low vaccination acceptance rate was observed in the present study. For newly developed vaccines, concern over vaccine safety is the biggest obstacle to vaccine administration. Therefore, the reasons that influence acceptance or refusal of vaccines are important for developing targeted communication strategies and healthcare policies.

Fetal pulmonary artery Doppler evaluation in pregnant women after recovery from COVID-19.

OBJECTIVE: To evaluate fetal lung development using pulmonary artery Doppler in pregnant women who had recovered from COVID-19. METHODS: The prospective case-control study included 41 pregnant women who had recovered from COVID-19 and 43 healthy pregnant women (control group). All the women in the study group had been diagnosed with COVID-19 and had completed a quarantine period. RESULTS: The demographic data of patients were similar in the groups (P > 0.05). Main pulmonary artery peak systolic velocity was higher and pulsatility indices were lower in pregnant women who recovered from COVID-19 compared to the controls (P < 0.001, P = 0.001). Acceleration time, ejection time, and acceleration/ejection time ratio (PATET) of the fetal MPA Doppler were significantly decreased in pregnant women who recovered from COVID-19 (P < 0.001, P = 0.036, and P = 0.002, respectively). The patients who had recovered from COVID-19 were divided into two groups: those treated with expectant management and those treated in hospital. The pulmonary artery acceleration time and PATET ratio were significantly lower in the group treated in the hospital (P = 0.023 and P = 0.045, respectively). CONCLUSION: Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID-19 disease.

COVID-19 vaccine acceptance in pregnant women.

OBJECTIVE: To determine vaccine acceptance and hesitancy attitudes toward coronavirus disease 2019 (COVID-19) vaccines in pregnant women. METHODS: Three hundred pregnant women were surveyed face to face with 40 questions. Sociodemographic characteristics, vaccination history, perception of risk for the COVID-19 pandemic, the impact of the COVID-19 pandemic, and acceptance of and attitude toward future COVID-19 vaccination were prospectively evaluated. RESULTS: Among all participants, 111 (37%) stated their intent to receive the vaccine if it were recommended for pregnant women. Most common refusal reasons were lack of data about COVID-19 vaccine safety in pregnant populations and possibility of harm to the fetus. There was a weak positive correlation between COVID-19 vaccine acceptancy and number of school-age children. Pregnant women in the first trimester expressed higher acceptance of COVID-19 vaccination than those in the second and third trimesters. CONCLUSION: The present study reported low acceptance of COVID-19 vaccination in a sample of pregnant women. Concern about vaccine safety was the major reason for hesitancy. Identifying attitudes among priority groups will be useful for creating vaccination strategies that increase uptake during the current pandemic.