ABSTRACT
Background. Pregnancy does not appear to increase susceptibility to acquiring Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but pregnant people with the infection appear to be at increased risk for developing severe disease. Furthermore, infected pregnant people, especially those who develop pneumonia, appear to have an increased frequency of preterm birth and cesarean delivery, alternatively to other causes of peripheral infection. Case presentation. The aim of this report is to describe a case of a third trimester pregnant woman with severe acute respiratory syndrome COVID-19, undergoing endotracheal intubation with invasive mechanical ventilation due to respiratory distress with a 12-hour daily cycle of pronation. The patient was the first case in Sicily treated with convalescent plasma and underwent urgent preterm cesarean section. Conclusions. Several agents are being evaluated for treatment of COVID-19, with minimal or no information on safety in pregnancy. Our data confirmed that pregnant women can be safely pronated with clinical improvement and blood gasses findings. Instead, after the use of convalescent plasma, we had only a partial and transitory improvement of patient’s condition. Certainly, the timing of delivery should be discussed by a multidisciplinary team of obstetricians, anesthetists and neonatologists. In the future other studies on larger numbers of pregnant women with COVID-19 need to be conducted to better understand the correct maternal and fetus care and the effectiveness of the treatments available also for a specialized specific approach on the long-covid effects. © 2022, EDRA S.p.A. All rights reserved.
ABSTRACT
INTRODUCTION SARS-CoV-2 pandemic has having brought about profound changes in the socio-health sector, especially in the provision of the main levels of hospital and territorial assistance, with consequences of public health. To date, the management path of pregnant women, CoV-2 affected, and of their newborns is also well defined: in the absence of defined risk factors and/or in presence of good general clinical conditions of the woman, the completion of the pregnancy with caesarean section is not recommended, such as preterm labor (<37 weeks) is not justified in the absence of ascertained conditions that could endanger the pregnant or the fetus. Vertical transmission of the new coronavirus infection (intrauterine, intrapartum or peripartum) is very rare, and postnatal horizontal infection is more likely. In the event that a newborn were to become infected, most of them are asymptomatic and do not require ventilatory support;the main risk factors for severe disease are being preterm and having severe underlying medical conditions. Since the likelihood of having a SARS-CoV-2 positive rhino-pharyngeal swab is similar between infants separated from their mother at birth, compared to those in rooming-in (where preventive measures are implemented), current guidelines of the Italian Society of Neonatology approve the maintenance of the mother-child dyad, unless the mother is unable to care for her newborn. UOC of Neonatology with NICU of 'Vincenzo Cervello' hospital in Palermo, responsible for the management of COVID-19 positive births in Western Sicily, has conducted a study to identify how many children were born from CoV-2 affected mothers, the number of vertically infected newborns, the number of preterm births, underling how these data relate to the epidemiological curve of infection. METHODS This cross-sectional study was conducted over a period of 12 months, from March 2020 to March 2021, plotting the data on a histogram. The percentages of preterm births and positive newborns in the first 48-72 h of life (likely vertical transmission) were also calculated. RESULTS The percentage of preterm births (about 7.4%) appears to be slightly lower than the average of the national and international data (10%), probably linked to the small number of the sample, the main limitation of this study. The rarity of vertical transmission is evidenced by the only case of a positive birth from a positive mother (0.8% of the total). The greatest number of related COVID-19 births took place on the 19th of November 2020, when there was a peak of 1837 cases of new infected in a single day, with over a third of cases recorded in the provinces of Palermo and Trapani (Figure 1). The second peak has occurred on the 15th of January 2021, with 1945 new cases of infected people without a concomitant trend in pregnant women. CONCLUSIONS From the results obtained it is evident that the births-COVID curve partially follows the local epidemiological one (Figure 2): many factors can influence the epidemiological curve's trend such as the basic seasonality in births. Further studies are necessary to underline if a real correlation is present or not.