Assessment of Pregnancy-Related Telehealth Interventions in the United States: A 10-Year Scoping Review.

Introduction: Telehealth use in obstetrics has been demonstrated to improve efficiency, access to care, and pregnancy outcomes. Despite reported successful implementation of these programs, information regarding the program variations and its impact on health care costs and outcomes are scarce. Methods: This is a scoping review of pregnancy-related telehealth studies to understand the current landscape of pregnancy-related telehealth interventions as well as to subset those that are used in high-risk pregnancies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to guide this review. Results: A total of 70 articles were included in this scoping review. Of those, 53 (75.7%) studies included a pregnant population and 17 (24.3%) studies focused on a rural and/or urban population. Most studies (n = 56; 80%) included some form of synchronous interaction between provider and participant. Patient outcomes included maternal/infant health outcomes (n = 41; 44.1%), patient satisfaction (n = 9; 9.7%), and attendance/compliance (n = 5; 5.4%). Provider-level outcomes included knowledge change (n = 11; 11.8%) and self-efficacy (n = 3; 3.2%). Other outcomes included assessment of costs and patient/provider feasibility and acceptability of the intervention. Overall, there has been a growing trend in articles published on pregnancy-related telehealth studies since 2011, with 2018 having the most publications in a single year. Conclusion: This review suggests a steadily growing body of literature on pregnancy-related telehealth interventions; however, more research is needed to better understand outcomes of telehealth for pregnancy-related care, especially related to patient satisfaction, health disparities, and cost-benefit.

Remote blood pressure monitoring in high risk pregnancy - study protocol for a randomised controlled trial (REMOTE CONTROL trial).

BACKGROUND: Pregnant women at high risk for developing a hypertensive disorder of pregnancy require frequent antenatal assessments, especially of their blood pressure. This expends significant resources for both the patient and healthcare system. An alternative to in-clinic assessments is a remote blood pressure monitoring strategy, in which patients self-record their blood pressure at home using a validated blood pressure machine. This has the potential to be cost-effective, increase patient satisfaction, and reduce outpatient visits, and has had widespread uptake recently given the increased need for remote care during the ongoing COVID-19 pandemic. However robust evidence supporting this approach over a traditional face-to-face approach is lacking, and the impact on maternal and foetal outcomes has not yet been reported. Thus, there is an urgent need to assess the efficacy of remote monitoring in pregnant women at high risk of developing a hypertensive disorder of pregnancy. METHODS: The REMOTE CONTROL trial is a pragmatic, unblinded, randomised controlled trial, which aims to compare remote blood pressure monitoring in high-risk pregnant women with conventional face-to-face clinic monitoring, in a 1:1 allocation ratio. The study will recruit patients across 3 metropolitan Australian teaching hospitals and will evaluate the safety, cost-effectiveness, impact on healthcare utilisation and end-user satisfaction of remote blood pressure monitoring. DISCUSSION: Remote blood pressure monitoring is garnering interest worldwide and has been increasingly implemented following the COVID-19 pandemic. However, robust data regarding its safety for maternofoetal outcomes is lacking. The REMOTE CONTROL trial is amongst the first randomised controlled trials currently underway, powered to evaluate maternal and foetal outcomes. If proven to be as safe as conventional clinic monitoring, major potential benefits include reducing clinic visits, waiting times, travel costs, and improving delivery of care to vulnerable populations in rural and remote communities. TRIAL REGISTRATION: The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p, on October 11th, 2020).

A Rare Case Report of Acute Neurologic Sequelae in a Young Primigravida With Recent COVID Pneumonia.

Post-infectious neurological sequelae, particularly in the pediatric population, are a rarely observed and under-explored complication of COVID-19. Few case reports exist detailing severe neurological sequelae following acute infection with COVID-19, such as encephalopathy, stroke, and coma. This case report details the diagnosis and treatment of a 16-year-old primigravida with no past medical history who presented to the emergency department with rhythmic tremors, urinary incontinence, and generalized weakness two weeks following initial COVID-19 diagnosis with admission for pneumonia and sepsis. Vital signs were remarkable for tachycardia and normotension. Shortly following admission, she experienced generalized tonic-clonic seizure activity. Neurologic evaluation was remarkable for electroencephalogram with frontally predominant generalized periodic discharges and magnetic resonance imaging of the head showing bilateral parafalcine restricted diffusion. Cerebrospinal fluid analysis and magnetic resonance imaging of the spine were unremarkable. The patient was ultimately diagnosed with reversible cerebral vasoconstriction syndrome and an anterior cerebral artery stroke. Throughout the patient's recovery, she demonstrated incoherent, delirious, and disinhibited behavior that resolved within several days. She was ultimately discharged to a skilled rehabilitation facility with follow-up in a neurology clinic.

Evaluation of the association between fear of COVID-19 and pregnancy distress

Background: Mental health problems experienced during pregnancy negatively affect both maternal and fetal wellbeing. Objective(s): This study aimed to investigate the relationship between fear of COVID-19 and pregnancy distress in healthy pregnant women living in Turkey. Method(s): A descriptive, relational/cross-sectional study was conducted by interviewing 363 pregnant women in person. Data were collected using a personal information form, the Fear of COVID-19 Scale (FCV-19S), and the Tilburg Pregnancy Distress Scale (TPDS). Result(s): The mean FCV-19S score was 19.03+/-5.65 and the mean TPDS score was 19.97+/-7.97. According to the TPDS cut-off score, 19.0% of the participants were at risk of pregnancy distress. There was a significant positive correlation between FCV-19S and TPDS scores (r = 0.263, p<0.05). According to the regression analysis, age (beta=-0.217), years of education (beta=-0.272), and number of births (beta= 0.502) were associated with fear of COVID-19, and fear of COVID-19 was associated with TPDS scores (beta= 0.369) (p<0.05). Conclusion(s): The pregnant women in this study had moderate fear of COVID-19. Compared to the literature data, the prevalence of pregnancy distress was slightly higher than pre-COVID-19 reports but quite low compared to other studies conducted during the pandemic.Copyright © 2023 Mamuk R et al.

Association of social capital with mental health and quality of life among low- and high-risk pregnant women.

INTRODUCTION: Social capital means having resources and support in relationships and social ties. It can affect the individual's quality of life and mental health. The present study investigated the association between social capital with psychological status and quality of life among low-risk and high-risk pregnant women. METHODS: The present cross-sectional study was conducted with the participation of 394 pregnant women receiving prenatal care in urban comprehensive health centers in Qazvin, Iran. Two-stage sampling was used to select comprehensive health centers by random cluster sampling and then pregnant women randomly. Social capital, quality of life (QoL), psychological status, and demographic and obstetric characteristics were assessed. Uni-variable and multivariable linear regression models were used to analyze the data. RESULTS: Among the participants, 267 had low-risk pregnancies (67.77%) and the remainder were high-risk. The mean age of participants was 27.94 years (SD=5.86), the mean gestational age was 23.63 weeks (SD=7.71). The mean overall quality of life score among low-risk pregnant women was 32.00 (SD=5.27) and among high-risk pregnant women was 29.70 (SD=3.65). High-risk pregnant women experienced significantly higher anxiety and depression and fear of COVID-19. Social capital had a significant and weak relationship with anxiety among low-risk pregnant women (r = 0.22, p < 0.001). Also, a weak and significant relationship between social capital and anxiety (r = 0.24, p = 0.007), depression (r = 0.24, p = 0.007) and fear of COVID-19 (r = 0.27, p = 0.002) was found among high-risk pregnant women. CONCLUSION: Women with high-risk pregnancies experienced lower quality of life, higher anxiety and depression, and greater fear of COVID-19. There was also a weak relationship between social capital and the aforementioned variables among high-risk pregnant women. Designing and implementing interventions to increase quality of life and reduce anxiety and stress among high-risk pregnant women appears to be warranted.

Keeping the Pace between Research and Clinical in Covid-19 Pandemic: A Psychological Experience in a High-Risk Pregnancy Ward

Background: From the literature emerges that having a pregnancy and especially a high-risk pregnancy in time of pandemic can lead to an increase of the levels of anxiety, which are usually already higher in relation to maternal-fetal disease. Furthermore, the literature shows that significant organizational and methodological changes have been introduced in the detection of psychological conditions, such as the introduction of telehealth intervention. Particularly in our experience about psychological health screenings there was a period of care interruption (between 11.03.2020 and 04.05.2020) and a clinical activity restructuring on the ward according to the new needs that have accrued. The aim of this experience is to analyze the progress of psychological health perinatal screening in women during the Covid-19. Specifically, we aimed to understand the percentage of positive screening and management compared to the pre-pandemic period. Method(s): Perinatal psychological screening was administered to women with high-risk pregnancy hospitalized in a Obstetric ward in a period between May 2020 to December 2021. The data were then compared with those recorded from September 2019 to February 2020 (pre-Covid-19). Screening consists in the description of the Obstetrical Psychology Service, the case history, the self-administration questionnaire GHQ-12 (General Health Questionnaire- 12) and the assessment interview if necessary. Result(s): A total of 469 screenings were administered during the pandemic, about 30% of which were found to be positive in the screenings (2020-21). Specifically in 2020, the positivity amounted to 28.69%. Of these 64 women, 56 performed the assessment, and in particular 22 were taken to the Psychology Service, 6 were referred to the territorial counseling centers, and 28 didn't receive further treatment indication. In 2021, the positivity was 32.93%. Especially of these 81 women, 32 were taken to the Psychology Service, 10 were sent to the territorial counseling centers and, 16 refused the assessment interview, 6 were already in treatment, 11 didn't receive further treatment indications and 6 cases dropped out. In the pre-pandemic phase the rate of positivity was 27%. Of the 30 women who tested positive at the screening, 5 were taken to the Psychology Service, 9 were referred to family counseling centers in the area, 11 refused the assessment interview, and 5 didn't receive further therapeutic indication. Conclusion(s): The importance of psychological care continuity and the feasibility of administering psychological health screenings clearly emerges in the ward despite the changed health situation due to Covid-19. The results show how the positivity rate for psychological health screening increases over the years (27% from September 2019 to February 2020/pre-Covid-19, 28,69% from May to December 2020 and 32,93% in 2021).

Placental histological findings in COVID-19 term, preterm and metabolic disorders pregnancy

Objective. In the last two years COVID-19 infection has represented a true unknown in the management of pregnancies with maternal COVID-19 positivity. However, it has not represented a serious complication, indeed it has rarely caused premature rupture of the membrane, fetal thrombosis or postnatal complications. Materials and Methods. Our retrospective cohort study included placental samples from 350 patients from San Pietro Fatebenefratelli Hospital collected in a period of 4 months. Inclusion criteria were COVID-19 positivity during childbirth or in the previous two months but also a pregnancy without previous COVID-19 infection. Anamnestic data were carried out for the histological study on each placenta. 59% of patients were COVID-19 positive (15% of these had other associated disorders like gestational diabetes, hypertension, fetal death, preterm birth) 26.5% were preterm and the 14,5% were high-risk pregnancy with COVID-19 negativity. Results. The most frequently represented lesion in a COVID-19 placenta was a mild chronic deciduitis, usually absent in placentas with normal outcome. The same deciduitis was observed in gestational diabetes placentas, although less frequently. Other rare findings were patchy fibrinoid necrosis of capsular decidua, chronic villitis, umbilical cord thrombosis. Severe lesions were rare. Conclusions. COVID-19 does not seem to have a severe impact on the health of the placenta except in rare cases in which predisposing factors coexist and determine a more serious involvement of the fetus and its appendages. COVID-19 determines a constant but mild chronic placental inflammation, that is balanced by the maternal capacity to maintain homeostasis stemming the external injuries.

CLINICAL AND GENETIC DETERMINANTS OF SEVERE COURSE OF COVID-19 IN PREGNANT WOMEN.

Objectives: to determine the clinical and genetic determinants of the severe course of COVID-19 in pregnant women in order to identify a risk group and search for therapeutic targets. Materials and methods. 21 patients (group 1) with a severe course of COVID-19 who required intensive care in the Anesthesiology and Intensive Care Unit (AICU) and 126 pregnant women with moderate severity treated in the Infectious-Obstetrics Unit (IOCU) were examined (group 2). Genomic DNA for molecular genetic analysis of gene variants ACE (I/D, rs 4340), PGR (Alu insertion), ESR1 (A351G, rs 9340799), PON1 (C108T, rs 705379) was isolated from the peripheral blood of patients using a commercial Quick-DNA Miniprep Plus Kit (Zymo Research, USA). Variants of ACE and PGR genes were determined using allele-specific polymerase chain reaction;polymerase chain reaction followed by restriction analysis was used to determine ESR1 and PON1 gene variants. Results. Severe course of COVID-19 is observed in 18.2% of pregnant women, critical condition in 7.5%. A third of AICU patients are over 35 years old. Somatic anamnesis was complicated in 23.8% of patients;thyroid gland pathology (14.3%) and varicose disease (19.0%) prevailed. A significant factor in the severe course of COVID-19 is obesity of the III-IV degree in 28.5% cases. The severe course of the disease was associated with complications of pregnancy (oligohydramnios - 52.4%, ahydramnios - 14.3%, fetal growth retardation syndrome - 33.3%, circulatory disorders - 57.1%, fetal distress - 47.6%, preeclampsia - 14.3%), labor (caesarean section - 57.1%, premature birth - 28.6%), disorders of newborns state (asphyxia - 35.6%). These patients are characterized by anemia (58.7%), thrombocytopenia (23.8%), leukocytosis (33.3%), lymphopenia (90.5%), a shift of the leukocyte formula to the left (an increase of rod-nuclear leukocytes by 85.7%). There were significantly increased levels of transaminases: alanine aminotransferase in 47.6%, aspartate aminotransferase in 76.2%. Prothrombotic changes are indicated by a decrease in prothrombin time and activated partial thromboplastin time in 66.7%, which is confirmed by an increase in D-dimer in 85.7% of patients up to the maximum 15,000 ng/ml in 9.5% of women. An increase in inflammation markers (C-reactive protein and interleukin-6 in all AICU patients, procalcitonin in 66.7%) is a reflection of the destructive effect of inflammatory processes. The genetic determinants of the severe course of COVID-19 in pregnant women can be the ID genotype of the ACE I/D rs4340 polymorphism (81.0%), the T2/T2 PROGINS genotype (19.0%), the ESR1 A351G rs9340799 GG genotype (28.5%). Conclusions. The use of separate clinical, laboratory and genetic indicators in pregnant women with COVID-19 will contribute to the selection of the risk group of a coronavirus severe course and the determination of targets of therapeutic impact.Copyright © 2022 Trylyst. All rights reserved.

Repeat Doses of Sotrovimab for Recurrence of COVID-19 in a High-Risk Pregnancy

Background: Myasthenia gravis (MG) is an autoimmune disorder leading to variable degrees of skeletal muscle weakness. During pregnancy, infections can trigger exacerbations and should be treated promptly and aggressively.(1) Sotrovimab is a monoclonal antibody used as monotherapy in high-risk, symptomatic non-hospitalized patients at risk of developing COVID-19 disease. (2) It is thought to have retained activity against SARS-CoV-2 omicron variant. (3) Limited data are available on its use in pregnancy. Case: A 39-year-old woman with severe generalized MG, was referred to our joint neuro-obstetric multidisciplinary service. Her two previous pregnancies were complicated by severe exacerbations of MG necessitating intensive care admissions, and preterm labour. Her long-term therapy included high dose steroids, intravenous immune globulin (IVIG) and plasma exchanges. In this pregnancy, she additionally received rituximab in the first-trimester, allowing her prednisolone to be weaned to 20 mg daily, with ongoing 3-weekly IVIG. She received 3 doses of the Pfizer COVID-19 vaccine. At 19 weeks she developed mild coryzal symptoms, sore throat and myalgia. Lateral flow and polymerase chain reaction tests in the community confirmed infection with SARS-CoV-2. She was treated with sotrovimab with uneventful recovery at home. At 31 weeks, she again tested positive for SARS-CoV-2, after reporting mild COVID-19 symptoms. She received a second dose of sotrovimab and had a quick recovery. Subsequent SARS-CoV-2 genotyping indicated she had contracted the Omicron-BA.2 variant. Fetal surveillance for growth (SARS-CoV-2) and arthrogryposis (MG) did not raise concerns. At 35+3 weeks, she went into spontaneous labour and was delivered by caesarean section for evolving chorioamnionitis, with uneventful recovery for mother and baby. Discussion(s): We report a case of repeated treatment with sotrovimab (in second and third trimesters) of a high-risk, non-hospitalized pregnant woman, who was re-infected with SARS-CoV-2. We identified no immediate maternal, fetal or neonatal complications following two doses of sotrovimab for mild COVID-19.

Coping strategies in pregnant women with high risk pregnancies during COVID-19 pandemic

Objective. Evaluation of coping strategies in pregnant women with high risk pregnancies during COVID-19 pandemic. Materials and Methods. This was an observational study of pregnant women with high-risk pregnancy admitted for inpatient antenatal monitoring. Women were asked to fill in the Italian version of the Coping Orientation to the Problems Experienced (COPE-NVI). The questionnaire included 5 different dimensions: 1) Social support;2) Avoidance strategies;3) Positive attitude;4) Problem solving;5) Turning to religion. We planned to evaluate the COPE-NVI score according to the different maternal or fetal complications. 100 women filled out the questionnaire and were included in the study. Results. 37 were admitted for preeclampsia, 15 for diabetes, 5 for intrahepatic cholestasis, 14 for hyperemesis gravidarum, while 29 had severe intrauterine growth restriction requiring monitoring. The mean COPE-NVI score for social support was 31.5 +/- 8.6, for avoidance strategies 25.1 +/- 6.7, for positive attitude 31.7 +/- 7.3, for problem solving 30.5 +/- 7.5, and for turning to religion 24.9 +/- 5.3. No statistically significant differences were found for the COPE-NVI score within the different maternal or fetal complications, apart for turning to religion, where the score was higher for women with preeclampsia and lower for women with intrahepatic cholestasis (p = 0.01). Conclusions. Women with high risk pregnancies admitted for antenatal inpatient monitoring have a high score at coping strategies.

Perinatal Outcomes of COVID-19 in Pregnancy in a Tertiary Care Center in South India

Aim: In light of the severe acute respiratory syndrome by a coronavirus-2 (SARS-CoV-2) pandemic, it was proposed that a variety of complications have occurred in women during pregnancy, which has further extended to the fetus, causing higher rates of morbidity and mortality. The objective of this study was to identify the complications that arose due to the coronavirus and asses how it impacted the pregnancy, the fetus, and the neonate. Materials and methods: Our study was a descriptive and observational study, which investigated the various aspects, obstetric, fetal and neonatal outcomes, and the complications arising in mothers affected with by SARS-CoV-2 virus. All women who tested positive after 20 weeks of gestation were included in the study and their pregnancy was followed up till delivery, and neonatal outcomes were noted. Results: About 220 women infected with SARS-CoV-2 were studied and outcomes were illustrated. The mean age of the study population was 26.87 years [±4.96 Standard Deviation (SD)]. About 90% of the study population had a mild illness. The main obstetric outcomes noted were preterm labor, preeclampsia, eclampsia, intrauterine growth restriction (IUGR), and intrauterine fetal demise (IUD). Only 4.1% required a cesarean section for worsening conditions. Neonatal intensive care unit (ICU) admissions were also noted to be higher, with a possibility of vertical transmission in six babies. Conclusion: Severe acute respiratory syndrome by a coronavirus-2 can have serious implications and can pose a great risk in pregnancy if not caught and treated early. Therefore, it is vital to screen those at high risk for the virus to prevent severe complications from taking a toll on the mother and fetus. Clinical significance: By identifying the main complications occurring in pregnancy, we can prevent the same by anticipating and monitoring carefully, thereby reducing mortality and morbidity rates.

Maternal risk factors of COVID-19-affected pregnancies: A comparative analysis of symptomatic and asymptomatic COVID-19 from the Q-PRECIOUS registry.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has had consequences on the pregnant population, as disease severity is associated with the quality of maternal health and pregnancy complications, increasing maternal and neonatal morbidity. Worldwide descriptive data help describe risk factors that could predict symptomatic and severe COVID-19 in pregnancy. OBJECTIVES: To describe demographic features and risk factors of pregnant women with COVID-19 in Qatar and compare symptomatic versus asymptomatic disease. STUDY DESIGN AND METHODOLOGY: Clinical characteristics and risk factors of pregnant women with COVID-19 in Qatar from March 2020 to March 2021 was retrospectively reviewed, comparing the cohort with the general pregnant population. Crude and adjusted odds ratios (aORs) were computed, comparing symptomatic versus asymptomatic infection. RESULTS: Of the 500 women, 347 reported at least one symptom at diagnosis (347/500; 69.4%). The majority fell in the 30-39 years age group (241/500; 48%), with more than half in the obese body mass index (BMI) category. The cohort was 66% (332/500) Qatari women, compared with the 26% expected in the population (26.4% vs 66.4% p < 0.001). Compared with the 2019 national statistics, the number of women was higher in the >40 years age group (5% vs 7.6%, p = 0.027) and grand multiparous group (5.4% vs 13.6%, p < 0.001). The symptom most commonly reported by the symptomatic group was cough (276/500; 55%), followed by fever, fatigue, and myalgia. In the adjusted analysis, the symptomatic group had 2.7 times higher odds of being asthmatic (OR = 2.67, 95% CI 1.1-6.7, p = 0.037). Women aged >40 years had 6.6 times higher odds of symptomatic disease (aOR = 6.6, 95% CI 1.08-39.73, p = 0.041). A history of contact with a patient with symptomatic COVID and earlier gestational age at diagnosis increased the odds (aOR = 2.06, 95% CI 1.2-3.54, p = 0.009; aOR = 0.73 95% CI 0.57-0.96; p = 0.017). CONCLUSIONS: This study cohort included significantly more Qatari women, older women, grand multiparous women, a higher proportion with pre-existing and gestational diabetes, and higher BMI than national data. In addition, contact to a patient with symptomatic disease, history of asthma, older age, and earlier gestational age at diagnosis were significantly associated with symptomatic disease.

Racial/ethnic differences in low-dose aspirin use for preeclampsia risk reduction

Objective: There are significant racial/ethnic disparities in development of preeclampsia and perinatal morbidity and mortality due to preeclampsia. Low-dose aspirin (LDA) is the only strategy proven effective for preeclampsia risk reduction among high-risk patients. This study aims to determine if there are racial/ethnic differences in use of LDA for preeclampsia risk reduction among patients who meet criteria based on ACOG/SMFM recommendations. Study Design: This is a secondary analysis of a retrospective cohort study of all pregnant patients who delivered at 33 US hospitals in 14 states in 2019 and 2020. Patients were included if they had an indication for LDA for preeclampsia risk reduction. Exclusion criteria were missing or other race/ethnicity, missing LDA use, and positive SARS-CoV-2 test. Indications for LDA were defined per ACOG/SMFM recommendations: >= 1 high risk factor (history of preeclampsia, multiple gestation, chronic hypertension, pregestational diabetes, kidney disease, lupus) or >= 2 moderate risk factors (nulliparity, obesity, age >= 35 years, in vitro fertilization). This study was performed before the recommendations were updated in 2021. All data were ed from the medical record by trained and certified perinatal research staff. The primary outcome was LDA use during pregnancy. Multivariable logistic regression adjusted for clinical site. Result(s): A total of 6,853 patients were included: 26.5% non-Hispanic Black (NHB), 47.6% non-Hispanic White (NHW), 4.0% non-Hispanic Asian (NHA), and 21.7% Hispanic. NHB patients were most likely to use LDA (38.7%) followed by NHW (29.6%), Hispanic (27.5%), and NHA (24.7%), p< 0.001. NHB patients had 1.5 times the odds of using LDA compared to NHW patients (95% CI 1.33-1.69);this persisted when adjusting for clinical site (aOR 1.44, 95% CI 1.26-1.64). Conclusion(s): Among pregnant patients at high risk for preeclampsia per ACOG/SMFM guidelines, overall rates of LDA use were low. NHB patients had increased odds of LDA use compared to NHW patients. Future research should seek strategies for increasing LDA use among all patients with high-risk pregnancies. [Formula presented] [Formula presented] Copyright © 2022

Explaining the Psychological Distress of Women with High-Risk Pregnancies in Iran: A Qualitative Study.

Background: Psychological Distress (PD) is one of the most common mental disorders during pregnancy and involves stress, anxiety, and depression. According to the literature, High-Risk Pregnancy' (HRP) is a major physiological risk factor associated with PD during pregnancy. The main purpose of this study was to explore the perception and experience of women with HRP who, based on standard questionnaires, had moderate-to-severe stress and anxiety scores. Materials and Methods: This qualitative study was conducted using conventional content analysis from December 2020 to June 2021. To this aim, 16 women with HRP were purposefully selected from Imam Khomeini Hospital in Ahvaz, Iran, with maximum diversity. In-depth, semi-structured, individual interviews were conducted to collect the data. The MAXQDA software was used for data analysis. Results: Data analysis led to the extraction of two main categories and nine subcategories. "Disrupted peace" and "inefficient adaptation to the situation" were the two extracted categories. The former included the five subcategories of concerns about pregnancy complications, concerns about the parenting process, concerns about the couple's relationship, fear of Covid-19, and occupation-related stress. The latter included the three subcategories of unpleasant feelings, current pregnancy experiences, and previous pregnancy experiences. Conclusions: This study highlighted a wide range of psychosocial factors involved in the PD of women with HRP. These findings can be used to design appropriate prevention strategies to manage the mental health problems of these women in order to turn their pregnancy into a pleasurable experience.

Trends in Caesarean Section Rate According to Robson Group Classification among Pregnant Women with SARS-CoV-2 Infection: A Single-Center Large Cohort Study in Italy.

BACKGROUND: Since there is no available data on temporal trends of caesarean section (CS) rates in pregnant women with COVID-19 through the pandemic, we aimed to analyze the trends in caesarean section rate in a large cohort of pregnant women with COVID-19, according to the Robson Ten Group Classification System of deliveries. METHODS: We prospectively enrolled pregnant women with a diagnosis of COVID-19 who delivered in our center between March 2020 and November 2021. Deliveries were classified, according to the Robson group classification, and according to three time periods: (1) deliveries from March 2020 to December 2020; (2) deliveries from January 2021 to April 2021; (3) deliveries from May 2021 to November 2021. We compared pregnancy characteristics and incidence of caesarean section, according to the Robson category in the total population, and according to the three time periods. RESULTS: We included 457 patients matching the inclusion criteria in our analysis. We found that overall CS rate significantly decreased over time from period 1 to period 3 (152/222, 68.5% vs. 81/134, 60.4% vs. 58/101, 57.4%, χ2 = 4.261, p = 0.039). CS rate significantly decreased over time in Robson category 1 (48/80, 60% vs. 27/47,57.4% vs. 8/24, 33.3%, χ2 = 4.097, p = 0.043) and Robson category 3 (13/42, 31% vs. 6/33, 18.2% vs. 2/22, 9.1%, χ2 = 4.335, p = 0.037). We also found that the incidence of induction of labor significantly increased over time (8/222, 3.6% vs. 12/134, 9% vs. 11/101, 10.9%, χ2 = 7.245, p = 0.027). CONCLUSION: Our data provide an overview of the temporal changes in the management and obstetric outcome of COVID-19 pregnant women through the pandemic, confirming that standards of obstetrical assistance for pregnancies complicated by SARS-CoV-2 infection improved over time.

The Impact of Elevated Liver Enzymes and Intrahepatic Cholestasis of Pregnancy on the Course of COVID-19 in Pregnant Women.

This study aims to investigate the perinatal outcomes in COVID-19 pregnant women with intrahepatic cholestasis of pregnancy (ICP) and elevated liver enzymes. Present study was carried out on pregnant women with COVID-19 between March 11, 2020, and August 11, 2021. Patients with liver enzyme levels higher than twice the upper limit of the reference range for aspartate aminotransferase(AST) and/or alanine aminotransferase (ALT) were included. Patients with unexplained pruritus and elevated fasting biliary acid (FBA) levels were considered ICP. The remaining cases were used as the control group. There were a total of 1751 patients in the study period. Among them, 126 had elevated liver enzymes. Nineteen of these cases had also ICP. AST and ALT values were statistically higher in the ICP group. Demographic features, clinical characteristics, and perinatal outcomes were similar between the groups. The rate of ICP in pregnant women with COVID-19 was similar to the literature in this study. Although the preterm delivery rates for both groups were higher than in the current literature, the preterm delivery rates in the study and control groups were similar. Elevated liver enzymes can be observed in pregnant women with COVID-19 with higher rates of preterm delivery compared to the previous literature. However, the diagnosis of ICP in addition to elevated liver enzymes seems to have no significant impact on the perinatal outcomes. Future studies conducted on larger populations are necessary to confirm these results.

Safety and efficacy of ketamine-augmented electroconvulsive therapy in third trimester pregnancy complicated by COVID-19.

Major depressive disorder during pregnancy can be detrimental to the fetus and patient. Treatments can include electroconvulsive therapy (ECT) for severe cases. The use of ketamine in ECT can provide symptomatic relief as well as induce anesthesia. Here, we describe the case of a 35-year-old gravid woman with a long-standing history of major depressive disorder who presented with treatment-resistant depression with suicidal ideation after an alteration in her antidepressant medication. After psychiatric evaluation, she was deemed to be a good candidate for ECT augmented with ketamine for symptomatic relief. This was complicated by an positive but asymptomatic COVID-19 status. Despite these factors, the patient experienced significant relief after an eight-treatment course of ECT, with a reduction of her PHQ-9 score from 22/27 to 4/27 points.

Frequency of Meconium-stained Amniotic Fluid in COVID-positive Term Pregnancies and Perinatal Outcome

Aim: To know the frequency of meconium-stained amniotic fluid (MSAF) among COVID-positive term pregnant mothers and to know perinatal outcomes in these neonates. Materials and methods: A retrospective study was conducted of COVID-positive term pregnancies admitted to Vanivilas hospital, Bangalore Medical College, during the study period of 1 year. The study period was from 1st of July 2020 to 31st of June 2021. High-risk pregnancies that confound the occurrence of MSAF were excluded (obstetric risk factors and medical risk factors complicating pregnancy). Data were collected from medical records of patients and parturition register, which are cross-verified with operation theater records and neonatal intensive care unit (NICU) registers. Results: In total, 200 pregnant women were included in the study. About 65% were delivered by cesarean, 34.5% by the vaginal route, and one vacuum-assisted delivery. In total, 199 live births and one fresh stillbirth are reported. About, 26% had MSAF and 6.5% of newborns had meconium aspiration syndrome. Grade I, II, and III cases were 4.5%, 12.5%, and 9% respectively. Low appearance, pulse, grimace, activity, and respiration (APGAR) scores were correlating with the grade of MSAF, which is statistically significant. There were two neonatal deaths in grade III MSAF cases. Conclusion: The frequency of MSAF is increased among COVID-positive mothers, which translates to low APGAR scores and poor perinatal outcomes. Vigilant intrapartum care is recommended for these pregnancies to reduce the risk of poor neonatal outcomes. Clinical significance: The current study is undertaken to know if coronavirus disease-2019 (COVID-19) is associated with an increased frequency of MSAF among COVID-positive pregnant women. Finding MSAF has implications on operative delivery, cesarean rates, and perinatal outcome. There is a lack of studies about MSAF and perinatal outcomes in COVID-positive mothers. Evidence generated by this study helps to counsel the COVID-positive mothers and guides in the management of COVID-positive laboring women.

Anticoagulants: dose control methods and inhibitors

These days, anticoagulants are in great demand. They are used as a prophylaxis for thromboembolic complications in various diseases and conditions in general therapeutic practice, cardiology, neurology, as well as obstetrics to manage high-risk pregnancies. The relevance of anticoagulants competent use has come to the fore in connection with the emergence of a new disease – COVID-19 and its serious complications such as developing thrombotic storm, in which the timely applied anticoagulant therapy is the key to the success of therapy. The risk of bleeding should be considered when using any anticoagulant. Age, impaired renal function and concomitant use of antiplatelet agents are common risk factors for bleeding. Moreover, only vitamin K antagonists and heparin have specific antidotes – vitamin K and protamine, respectively. Inhibitors of other anticoagulants are universal presented as inactivated or activated prothrombin complex concentrate and recombinant factor VIIa. Hemodialysis effectively reduces dabigatran concentration, activated charcoal is effective in the case of recent oral administration of lipophilic drugs. Research on new antidotes of currently available anticoagulants is under way, similar to testing of new types of anticoagulants that are sufficiently effective in preventing and treating thromboembolic complications with minimal risk of hemorrhagic. The main contraindication to anticoagulants use is the doctor's ignorance of the mechanisms of drug action and opportunities for suppressing its effect.