Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience.

OBJECTIVES: This study aimed to present perinatal outcomes, clinical challenges, and basic ICU management in pregnant women with severe-critical COVID-19 at our tertiary referral center. METHODS: In this prospective cohort study, patients were divided into two groups, whether they survived or not. Clinical characteristics, obstetric and neonatal outcomes, initial laboratory test results and radiologic imaging findings, arterial blood gas parameters at ICU admission, and ICU complications and interventions were compared between groups. RESULTS: 157 of the patients survived, and 34 of the patients died. Asthma was the leading health problem among the non-survivors. Fifty-eight patients were intubated, and 24 of them were weaned off and discharged healthfully. Of the 10 patients who underwent ECMO, only 1 survived (p<0.001). Preterm labor was the most common pregnancy complication. Maternal deterioration was the most common indication for a cesarean section. Higher neutrophil-to-lymphocyte-ratio (NLR) values, the need for prone positioning, and the occurrence of an ICU complication were important parameters that influenced maternal mortality (p<0.05). CONCLUSIONS: Overweight pregnant women and pregnant women with comorbidities, especially asthma, may have a higher risk of mortality related to COVID-19. A worsening maternal health condition can lead to increased rates of cesarean delivery and iatrogenic prematurity.

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.

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.

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.

Impact of vitamin D on the course of COVID-19 during pregnancy: A case control study.

OBJECTIVE: We aimed to evaluate the vitamin D status of pregnant women with COVID-19, and the association between vitamin D level and severity of COVID-19. METHODS: In this case control study, 159 women with a single pregnancy and tested positive for SARS-CoV-2, and randomly selected 332 healthy pregnant women with similar gestational ages were included. COVID-19 patients were classified as mild, moderate, and severe. Vitamin D deficiency was defined as 25-hydroxycholecalciferol <20 ng/mL (50 nmol/L), and 25-OH D vitamin <10 ng/mL was defined as severe vitamin D deficiency, also 25-OH D vitamin level between 20-29 ng/mL (525-725 nmol/L) was defined as vitamin D insufficiency. RESULTS: Vitamin D levels of the pregnant women in the COVID-19 group (12.46) were lower than the control group (18.76). 25-OH D vitamin levels of those in the mild COVID-19 category (13.69) were significantly higher than those in the moderate/severe category (9.06). In terms of taking vitamin D supplementation, there was no statistically significant difference between the groups. However, it was observed that all of those who had severe COVID-19 were the patients who did not take vitamin D supplementation. CONCLUSION: The vitamin D levels are low in pregnant women with COVID-19. Also, there is a significant difference regarding to vitamin D level and COVID-19 severity in pregnant women. Maintenance of adequate vitamin D level can be useful as an approach for the prevention of an aggressive course of the inflammation induced by this novel coronavirus in pregnant women.