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Am J Obstet Gynecol MFM ; 3(4): 100373, 2021 07.
Article in English | MEDLINE | ID: covidwho-1525658


Approximately 4% of pregnant patients with coronavirus disease 2019 require intensive care unit admission. Given the practical implications of advanced ventilatory and circulatory support techniques, urgent or emergent delivery for nonreassuring fetal status frequently presents a logistical impossibility. This article proposes a protocol for obstetrical management of patients in these situations, emphasizing coordinated preparation among obstetrical, anesthesiology, and intensivist teams for planned preterm delivery at gestational ages when neonatal outcomes are likely to be favorable.

COVID-19 , Premature Birth , Female , Gestational Age , Humans , Infant, Newborn , Intensive Care Units , Pregnancy , SARS-CoV-2
Obstet Gynecol ; 137(3): 431-433, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1135905


BACKGROUND: Pregnant women with coronavirus disease 2019 (COVID-19) infection are at risk for a variety of COVID-19 complications. CASE: We report a case of acute pancreatitis in a pregnant patient hospitalized for COVID-19 pneumonia. Comprehensive evaluation ruled out other etiologies of acute pancreatitis. Preterm labor developed at 33 5/7 weeks of gestation, and the patient delivered a liveborn male neonate; neonatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening was negative. The patient improved significantly postpartum and was discharged home on postpartum day 3. CONCLUSION: Coronavirus disease 2019 may present in pregnancy with a myriad of clinical symptoms other than respiratory. Acute pancreatitis represents an infrequent complication of primary COVID-19 infection.

COVID-19/diagnosis , Pancreatitis/etiology , Pregnancy Complications, Infectious/diagnosis , COVID-19/therapy , COVID-19 Testing , Female , Gestational Age , Humans , Infant, Newborn , Male , Pancreatitis/therapy , Pregnancy , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome , Premature Birth , SARS-CoV-2 , Young Adult
Mayo Clin Proc ; 95(8): 1750-1765, 2020 08.
Article in English | MEDLINE | ID: covidwho-436499


The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has been associated with worse outcomes in several patient populations, including the elderly and those with chronic comorbidities. Data from previous pandemics and seasonal influenza suggest that pregnant women may be at increased risk for infection-associated morbidity and mortality. Physiologic changes in normal pregnancy and metabolic and vascular changes in high-risk pregnancies may affect the pathogenesis or exacerbate the clinical presentation of COVID-19. Specifically, SARS-CoV-2 enters the cell via the angiotensin-converting enzyme 2 (ACE2) receptor, which is upregulated in normal pregnancy. Upregulation of ACE2 mediates conversion of angiotensin II (vasoconstrictor) to angiotensin-(1-7) (vasodilator) and contributes to relatively low blood pressures, despite upregulation of other components of the renin-angiotensin-aldosterone system. As a result of higher ACE2 expression, pregnant women may be at elevated risk for complications from SARS-CoV-2 infection. Upon binding to ACE2, SARS-CoV-2 causes its downregulation, thus lowering angiotensin-(1-7) levels, which can mimic/worsen the vasoconstriction, inflammation, and pro-coagulopathic effects that occur in preeclampsia. Indeed, early reports suggest that, among other adverse outcomes, preeclampsia may be more common in pregnant women with COVID-19. Medical therapy, during pregnancy and breastfeeding, relies on medications with proven safety, but safety data are often missing for medications in the early stages of clinical trials. We summarize guidelines for medical/obstetric care and outline future directions for optimization of treatment and preventive strategies for pregnant patients with COVID-19 with the understanding that relevant data are limited and rapidly changing.

Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious/virology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Female , Humans , Perinatal Care/methods , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome , Prognosis , SARS-CoV-2