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The Royal College of Obstetrics and Gynaecology advocated replacing OGTT with HbA1c for gestational diabetes (GDM) screening for women with risk factors during the Covid-19 pandemic. HbA1c >=48mmol/mol/random plasma glucose (RPG) >=11.1mmol/l at booking indicated diabetes, and 41-47mmol/ mol/9-11mmol/ l prediabetes or possible GDM. Testing was repeated at 26 weeks if normal previously, with HbA1c >=39mmol/mol, fasting PG >=5.6mmol/l, or RPG >=9mmol/l diagnostic for GDM. A) At her clinic booking visit at 10 weeks gestation, 36 year-old South Asian female had HbA1c 55mmol/mol/RPG 9.5mmol/l suggesting undiagnosed type 2 diabetes. Initially managed with dietary advice and home blood glucose monitoring, metformin was added when self-monitored glucose above pregnancy targets (fasting and pre-meal <5.3mmol/l or 1 h post meal <7.8mmol/l) but insulin was required later. Metformin and insulin were stopped after delivery at 38 weeks with HbA1c 50mmol/mol three months postpartum, supporting the earlier diagnosis of type 2 diabetes. B) 32 year-old White Caucasian female was screened for GDM on booking at 11 weeks as BMI 38 kg/m2. HbA1c 44mmol/mol and RPG 6.9mmol/l confirmed GDM which was managed by dietary/lifestyle changes with glucose and pregnancy targets achieved until 28 weeks when metformin added. Normal delivery at 40 weeks with HbA1c 40mmol/mol three months postpartum triggered advice on long-term dietary/lifestyle changes and annual HbA1c checks. HbA1c was useful during the pandemic but most centres reverted to OGTT for GDM screening due to a significant fall in diagnoses using HbA1c >=39mmol/mol at 26 weeks. But, HbA1c testing was advantageous at booking to diagnose type 2 diabetes earlier.
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The present study investigates the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the vaginal swabs of female patients diagnosed with coronavirus disease 2019 (COVID-19) based on a positive real-time reverse transcription polymerase chain reaction (RT-PCR) test on a combined throat and nasopharyngeal swab.This study included 48 female patients hospitalized in two tertiary hospitals diagnosed with COVID-19 based on a positive RT-PCR test of the combined throat and nasopharyngeal swab samples, along with clinical and radiological findings. The IBM SPSS software package was used for the statistical analysis of the study data.SARS-CoV-2 positivity was detected in only one patient (2.08 %) in the present study from RT-PCR tests of vaginal swab samples. This patient was a 64-year-old, postmenopausal woman who tested positive for SARS-CoV-2 in a RT-PCR test of a vaginal swab sample six days after having tested positive in an RT-PCR test of a combined throat and nasopharyngeal swab. The patient's partner also tested positive for SARS-CoV-2 in an RT-PCR of a combined throat and nasopharyngeal swab.The present study is the first to report the presence of SARS-CoV-2 in vaginal secretions in Türkiye. The authors believe there is a need for studies investigating the presence of SARS-CoV-2 in the semen samples of the male partners of female patients to establish whether the presence of SARS-CoV-2 in vaginal secretions can play a role in the transmission of the virus. [ FROM AUTHOR] Copyright of Turkish Journal of Biochemistry / Turk Biyokimya Dergisi is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Aims: The Covid-19 pandemic and subsequent restrictions impacted both health outcomes and clinical practice. We explored the impact on the diabetes antenatal clinic (DANC) attendance and outcomes. Method(s): Pre and during pandemic periods were defined as January 2019 to February 2020 and March 2020 to March 2022, respectively. DANC attendance, maternal and perinatal data were analysed. Adverse neonatal outcomes included stillbirth, neonatal hypoglycaemia, jaundice, shoulder dystocia and respiratory distress. Result(s): DANC attendance increased in the pandemic compared to the pre-pandemic period (297 (Interquartile range (IQR) 269-358) vs 196 (IQR 176-211) monthly, p < 0.001) with 36.7% (IQR 33-49) virtual appointments, representing a 34% overall increase. Body mass index (BMI) increased (29.7 kg/m2 (IQR 26.4-32.2) vs 31.4 kg/ m2 (IQR 26.5-34.2)) during the pandemic (p = 0.007), but maternal age and parity remained unchanged. There was no difference in gestational age at delivery;however, induction rates reduced from 58.5% to 37.5% (p = 0.0009) and spontaneous vaginal deliveries increased from 13.7% to 34.5% during the pandemic (p = 0.0004). Instrumental deliveries reduced from 21.5% to 11.3% (p = 0.03) but there was no change in number of caesarean sections including emergency ones. There was no difference in the rates of macrosomia or neonatal admissions. There was an overall reduction in adverse neonatal outcomes (37/102 (36.2%) vs 33/142 (23.2%) p = 0.03). Conclusion(s): Clinic numbers and maternal BMI increased during the pandemic. However, delivery and perinatal outcomes improved. Out data are reassuring and align with other studies indicating maternity outcomes did not deteriorate during the pandemic, possibly explained by improved care provision and organisation culture under crisis.
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The COVID-19 pandemic is a challenge for health practitioners, where there are many suspected and confirmed patients with COVID-19, including obstetric patients. Perioperative treatment of COVID-19 patients must be under applicable standards, for both patients and the medical personnel. Personal protective equipment is essential for health workers who treat patients with COVID-19 to prevent the transmission of the virus. The method of delivery ideally should be adapted to the clinical condition of the patient. At the same time, the management of anesthesia for patients with cesarean sections should also be adjusted to the patient's clinical condition by taking into consideration the availability of facilities and infrastructure that we have. Through this report, we want to show how we manage COVID-19 in obstetric cases using the available resources in a third-world country.Copyright © 2021 Bali Journal of Anesthesiology. All rights reserved.
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Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.
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Introduction: Peripartum women are at increased risk for severe illness with coronavirus disease (Covid-19) infection. Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies and its long-term effects.1-5 Objective: This case series aimed to observe the clinical course of peripartum women with confirmed Covid-19 admitted to a critical care unit in the North-west of England. Method(s): Since the start of the pandemic, all pregnant women with Covid-19 infection admitted to the critical care unit were monitored and followed up. Demographic profile, medical co-morbidities, treatment received, respiratory support and vaccination status were noted. Result(s): From March 2020 until February 2022, 8 women in our practice were shifted to the critical care unit post-partum in view of worsening work of breathing & increasing oxygen requirement after initial management in the delivery suite. All admissions were during the 3rd wave of the pandemic in the UK, between June to October 2021. 5 patients underwent Caesarean section under spinal anesthesia & 3 were shifted post normal vaginal delivery. Mean age in the study population was 33.25 years (SD +/- 3.99) and mean length of stay in the ICU was 6.62 days (SD +/- 3.99). Only one woman required intubation & mechanical ventilation for 10 days and the rest were managed on High Flow Nasal Cannula (HFNC) or Continuous Positive Airway Pressure (CPAP) hood and self-proning manoeuvres. 50% of the patients received Tocilizumab. All women were discharged home and there were no maternal deaths. Pre- admission none of the women were vaccinated, but on follow up 5 out of the 8 had completed their vaccination. All women were emotionally distraught due to being isolated from their family and new born. When reviewed at 12 weeks, one patient experienced post traumatic stress disorder (PTSD) and one had features of long Covid syndrome. On follow up, all new born babies were doing well. Conclusion(s): From the limited amount of data available, psychological stress was common to all patients. Being isolated from their new-born and family was the most difficult emotional aspect for the mothers in addition to finding it difficult to breathe and uncertainty about the future. Most mothers and new-born babies were discharged from the hospital without any serious complications. However, further observation and long term follow up is imperative. Use of guidelines in peripartum patients will aid in appropriate escalation of care. Key words: COVID-19, Pregnancy, Peri-partum, Long Covid syndrome.
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Natural therapeutic microorganisms provide a potent alternative healthcare treatment nowadays, with the potential to prevent several human diseases. These health-boosting living organisms, probiotics mostly belong to Gram-positive bacteria such as Lactobacillus, Bifidobacterium, Streptococcus, Saccharomyces, Bacillus and Enterococcus. Initiated almost a century ago, the probiotic application has come a long way. The present review is focused on the potential therapeutic role of probiotics in ameliorating multiple infections, such as upper respiratory tract infections and viral respiratory infections, including Covid-19; liver diseases and hepatic encephalopathy; neurological and psychiatric disorders; autoimmune diseases, particularly rheumatoid arthritis, systemic lupus erythematosus and multiple sclerosis. Apart from these, the therapeutic exacerbations of probiotics in urinary tract infections have been extremely promising, and several approaches are reviewed and presented here. We also present upcoming and new thrust areas where probiotic therapeutic interventions are showing promising results, like faecal microbial transplant and vaginal microbial transplant.
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RESUMEN Introducción . La pandemia por coronavirus 2019 (COVID-19) se ha extendido en más de 100 países. La información específica sobre su comportamiento en el embarazo y parto sigue siendo limitada. Objetivo. Describir las características materno perinatales de pacientes gestantes con COVID-19 en un hospital terciario. Métodos . Estudio descriptivo. Se seleccionó todas las gestantes hospitalizadas por el servicio de emergencia de gineco-obstetricia entre el 24 de marzo y el 07 de mayo del 2020 y que tuvieron diagnóstico de infección por SARS-CoV-2, mediante la prueba rápida o la prueba RT-PCR. Se revisó la historia clínica y registros hospitalarios buscando variables sociodemográficas, antecedentes, manifestaciones clínicas, serología materna, complicaciones obstétricas, vía de parto y aspectos perinatales. Resultados . Se encontró 41 casos de pacientes con diagnóstico de SARS-CoV-2. Un 9,2% tuvo resultado de prueba rápida positiva, Los síntomas más comunes fueron tos en 84,6%, fiebre en 76,9% y dolor de garganta en 61,5%. Un 68.2% estuvo asintomática, 19,5% tuvo enfermedad leve y 7,3% moderada. Dos casos de neumonía severa requirieron ventilación no invasiva. No se registró muerte materna. 21,7% de los partos fue vía vaginal y 78,3% por cesárea. Hubo un caso de neonato por parto vaginal con PCR positivo al octavo día de vida. Conclusiones . Hubo un alto porcentaje de pacientes gestantes PCR positivas asintomáticas. Es necesario implementar el tamizaje universal en parturientas en el protocolo de flujo de gestantes en cada institución.
ABSTRACT Introduction : The pandemic of coronavirus disease 2019 (COVID-19) has spread to more than 100 countries. Specific information about its behavior in pregnancy is still limited. Objective: To describe the maternal and perinatal characteristics of pregnant patients infected with COVID-19 and their newborns in a tertiary referral hospital. Methods : Descriptive study. Subjects were all pregnant patients admitted to the OB/ GYN Emergency Department of the Edgardo Rebagliati Martins National Hospital from March 24 to May 7, 2020, who were diagnosed with SARS-CoV-2 infection by rapid test or by RT-PCR test. Medical and hospital records were reviewed to retrieve sociodemographic data, patient's history, clinical manifestations, maternal serology, obstetric complications, delivery mode and perinatal aspects. Results : 41 patients diagnosed with SARS-CoV-2 were identified. 9.2% of all admissions had a positive rapid test. The most common symptoms were cough in 84.6%, fever in 76.9% and sore throat in 61.5%. 68.2% of the patients were asymptomatic, 19.5% had mild illness and 7.3 %, moderate. 2 cases progressed to severe pneumonia requiring non-invasive ventilation. No maternal deaths were recorded. 21.7% were vaginal deliveries, while 78.3% were C-sections. One baby born in a vaginal delivery had a positive PCR result on day 8. Conclusions : A large percentage of asymptomatic pregnant patients had a positive PCR test. Implementing universal screening among patients in labor as part of the pregnant patient flow protocol is necessary for all institutions.
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Plasmid-mediated quinolone resistance (PMQR) genes confer low resistance to Fluoroquinolones (FQs). This study aims to detect five PMQR genes among FQs-resistant Klebsiella pneumoniae isolated from various clinical specimens. Out of 120 K. pneumoniae isolates, 68 FQs-resistance K. pneumoniae were included in a molecular study. Standard microbiological tests were used for identification and antimicrobial susceptibility. For the detection of PMQR genes, conventional polymerase chain reaction was used. A molecular study revealed that (73.5%) of samples harbored PMQR genes, and among them, 58% were co-carriages of PMQR gene variants. Aac (6')-Ib-cr gene was predominant (47.1%) among samples, and qepA had the lowest percentage (11.8%), qnr genes were (32.4%) (29.4%) (20.6%) qnrS, qnrB, and qnrA respectively. Overall, high percentages of PMQR genes were detected, and almost all of samples were phenotypically resistant to ciprofloxacin. As well, there was a significant statistical relationship between phenotypically ESBL-producers and qnrB and qepA genes.Copyright © Abdulkareem MM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Case report We present a rare case of a right-sided diaphragmatic herniation of the ascending colon, in a 76-year-old asthmatic patient with a non-congenital diaphragmatic hernia, no history of trauma, surgery, or radiation. The patient presented at the emergency room with dyspnea, non-productive cough, wheezing, tachypnea, tight chest, respiratory failure. This patient has a 40-year history of severe persistent extrinsic asthma, treated with high doses of inhaled corticosteroids and LABA. Before the pandemic, this patient was hospitalized 3-4 times a year for her asthma attacks, but in the last 2 years, due to Covid-19, the patient was not hospitalized, resulting in uncontrolled asthma with daily symptoms. During the hospitalization, chest radiography was performed where the hernia was suspected and confirmed by a CT Scan. Despite the diagnosis of diaphragmatic herniation, she was clinically better with the proper asthma treatment and after consulting with her family she refused the intervention to correct the hernia. She has had two vaginal deliveries, no malignancies, no trauma, no intervention in her life. In this case, the only possible cause for the herniation of the colon is persistent cough combined with advanced age, chronic steroid use, and obstructive lung disease. Non-traumatic, right-sided diaphragmatic hernia of the colon in adults is very rare. Persistent cough with other predisposing conditions of this patient is the cause of this herniation. The chest X-ray and CT were essential for making the diagnosis. Rare hernias like this should be kept in mind when coming to a diagnosis.
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Background Vaginal bleeding is a common complication that may occur at any time during pregnancy. Up to 22% of women asked at delivery reported that vaginal bleeding occurred at some time during pregnancy. Preterm delivery is the delivery before 37 weeks of gestation, which involves approximately 12% of all pregnancies. If vaginal bleeding happens during pregnancy, some adverse outcomes including mortality before and after birth, low birth weight and preterm delivery will be increased. Vaginal bleeding is associated with two-fold increased risk of preterm delivery. Methods This prospective cohort study included 60 cases of pregnant female with first or second trimester vaginal bleeding at Obstetrics& Gynecology Department, Faculty of Medicine, of Damanhur Medical National Institute. The duration of the study was from April 2021 to April 2022. In the study 4 cases refused to complete the study and other 56 completed. Results There was significant decrease in birth weight and Apgar score with increase severity of vaginal bleeding. There was significant increase in neonatal intensive care unit (NICU) admission, intrauterine growth restriction (IUGR) occurrence and preterm labor with increase severity of vaginal bleeding. There was significant positive correlation between vaginal bleeding and IUGR and NICU admission. There was significant negative correlation between vaginal bleeding and Birth weight and APGAR score. Conclusion It seems that previous COVID-19 infection does not affect greatly pregnancy outcomes associated with vaginal bleeding. Vaginal bleeding was the main parameter affecting pregnancy outcomes.Copyright © 2022 Authors. All rights reserved.
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Introduction: Prepubertal vaginal bleeding outside the neonatal period is always abnormal and is very alarming to both parents and physicians. The variable etiologies of vulvovaginitis are the most common causes of vaginal bleeding during the prepubertal period. We report a series of three cases observed during covid" period of 2020-2022. Case report: two patients 8 and 9 year -old girls, were refered to pediatric secondary center due to of external vaginal bleeding. Hormonal levels were pre-pubertal and bone age was not advanced. Both girls were hospitalized and sellar X-ray and pelvic MRI were done during further course, not revealing the etiology of bleeding. Six months after the first bleeding, they were reffered to a pediatric gynecologist where foreign bodies (grass seed) were found during vaginoscopy. Third patient, a 3-year- old girl, was examined by her pediatrician because of heavy bleeding. Hormonal analysis and bone age were not suggestive of precocious puberty. Additional analyses revealed elevated alpha fetoprotein level (>5000 IJ,), which led to the diagnosis of yolk sac tumor in vagina wall, which was then confirmed by vagionoscopy and biopsy. It is important to perform vaginoscopy in premenarchal girls with repeated vaginal bleeding because in patients older than five years, a common reason for vaginal bleeding is foreign body but in younger patients, the primary goal is to exclude a malignant tumor.Copyright © 2023
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Introduction: During the Covid-19 pandemic, isolation, fear of contagion, changes in care circumstances, and suspended or restricted visitor access impacted the psychological wellbeing of puerperae. As shown in literature [1,2], Covid-19 pandemic increased depressive and post-traumatic stress related symptoms in mothers in the postnatal period. Moreover, it could determine serious psychological challenges for pregnant and postpartum women, with potential "short" and "long" term consequences for the health of mothers and their children [2]. Healthcare providers should guarantee easy access to mental health services, as a primary strategy to support the health of both mothers and children [2]. After the worldwide spread of Covid-19 the organization of every hospital ward changed, including the obstetric and neonatal units. Compared to the pre-pandemic period, a reduction of the average length of stay in hospital for the new mothers was instituted [3]. This was the result of a reduction of the hospital beds, mostly because of the need to allocate mothers tested positive for Covid-19 in a separate area and to lower the risk of Covid-19 transmission in hospitals. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia started a screening program for the wellbeing of the perinatal period in 2018, with a gradual development and improvement of the organization of this activity [4]. Screening was suspended during the first wave of Covid-19 pandemic from 6th of March to 4th of May 2020. Nevertheless, it was necessary to cope with the Covid-19 pandemic changing demands and methods in order to continue with the screening of women admitted in obstetrics ward. Method(s): A screening of psychological perinatal wellbeing was performed in puerperae admitted to the Second Department of Obstetrics at Spedali Civili hospital in Brescia. Screening consisted in a psychological consult, during which the psychologist illustrated the Obstetric Psychological Service to the woman and identified her psychological need, without using tests. This was eventually followed by an assessment consultation, specialist care and referral to the out-of-hospital psychological services, if required by the woman or considered necessary by the psychologist. It was made a comparison between data collected from October 2019 to January 2020 and from May 2020 to December 2021. Result(s): Compared to the pre-pandemic period, average length of stay in the Second Division of Obstetrics was reduced. In particular, starting from March 2020, the expected discharge of the puerpera was about 24 hours after vaginal birth and 48 hours after cesarean delivery, if no complications occurred for both mother and newborn. Previously, discharge was expected after about 48 hours and 72 hours, respectively. Discharge that occurs 24 hours after vaginal birth is named "Early discharge" and requires the activation of the out-of-hospital services, with home visits by an obstetrician. From October 2019 to January 2020, 470 admitted women were screened, of which 23 (4,9%) demanded a further psychological consultation[4]. Between May 2020 and December 2021, 5145 screening were performed. Among them 550 (10.7%) demanded a further psychological consultation. From those data we can affirm that there was an increase in psychological consultations (from 4.9% to 10.7%), after exhibiting a psychological need during the postnatal screening. Conclusion(s): Covid-19 pandemic changed the care conditions of the woman during the pregnancy and the immediate post-partum. The reduction of the average length of hospital stay of the women in the postpartum did not stop the Psychological Service prevention program. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia implemented his activity increasing the pace of work, to be able to screen as many admitted women as possible. It was noticed that, after the Covid-19 first outbreak, the demand for psychological consultation after the screening consult was more than doubled in comparison to the pre-pandemic perio . This emphasized the benefit of an early interception of the psychological need of the women in the immediate post-partum period, especially during the Covid-19 pandemic.
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Aim: Coronavirus disease-2019 has caused a significant health crisis all over the world. This study aimed to compare obstetric and gynecological data during the COVID-19 pandemic period with the previous three years. Material(s) and Method(s): For this purpose, over a 5-year period, from January 2017 to December 2021, patient records from the hospital's electronic data registry were scanned. The extracted data included the number of patients admitted to the outpatient clinic, the number of emergency outpatient visits, the number of patients inserted and removed with an intrauterine device (IUD), abortions, premature rupture of membranes (PROM), intrauterine fetal death (IUFD) and vaginal delivery and cesarean section. Result(s): The number of patients who underwent IUD removal decreased in the last two years. Also, the number of patients who underwent IUD insertion in 2020 was very low compared to other years (p<0.01, for all). It was observed that the number of patients diagnosed with PROM decreased in the last three years (p<0.01, for all). There was a statistically significant decrease in the total number of deliveries in the last two years (p<0.01). Discussion(s): In conclusion, it is seen that the number of outpatients, the number of emergency outpatients, the number of IUDs removed and the total number of deliveries have decreased in the last two years compared to the previous three years. This may be related to the coronavirus infection, which has caused the pandemic for the last two years.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Objective. COVID-19 is a pandemic inflammatory disease where endothelial dysfunction, observed also in mildly symptomatic patients, could affect the placenta and compromise pregnancy outcome. Our aim was to study the pregnancy outcome of patients with previous SARS-CoV-2 infection contracted during gestation. Materials and Methods. This is a retrospective study and patients were enrolled with an anamnestic interview during the puerperium. We enrolled 41 women who contracted SARSCoV- 2 infection before twenty-four weeks of gestational age;87 who contracted the infection after twenty-four weeks of gestational age;and a control group of 159 women, who did not contract infection during pregnancy. Results. Maternal anthropometric, anamnestic and obstetric features were similar in the three groups. There is no relevant difference between the results of the three categories examined in terms of gestational age at delivery (273.54 days vs 273.73 days vs 274.39 days, p = 0.84), mode of delivery (vaginal delivery 53.66% vs 58.62 % vs 58.49 %;operative vaginal delivery 5.88% vs 9.19% vs 8.80%;cesarean section 41.46% vs 32.18 % vs 32.71 %;p = 0.49), fetal weight at birth (3224.02 g vs 3276.65 g vs 3235.57 g, p = 0.75) admission in neonatal intensive care (0 % vs 2.2 % vs 4.4%, p = 0.30). Conclusions. The SARS-CoV-2 disease with mild symptomatology, contracted during pregnancy, regardless of the gestational age at the time of infection, does not apparently impact on the fetal outcome in any significant way.
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Background: Antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis presenting for the first time in pregnancy is very rare, but awareness is important as it can cause significant maternal and fetal morbidity and is potentially life-threatening if not recognised or under-treated. Method and Results:We describe a 19-year-old woman who developed ANCA-associated vasculitis in the second trimester of her first pregnancy. She initially presented with a petechial rash and cough at 25 weeks' gestation, and then developed breathlessness. Significant pulmonary haemorrhage was shown on Cross Sectional imaging of the chest, with a corresponding reduction in haemoglobin. She rapidly improved with prednisolone, cyclophosphamide and plasma exchange. SARS-CoV-2 infection identified on routine screening further complicated the management. At 34 weeks' gestation she experienced a flare, with the possibility of superimposed pre-eclampsia (increase in liver enzymes, creatinine and sFlt/PlGF ratio). After multidisciplinary team discussion she underwent a caesarean section. Postnatally she continued cyclophosphamide and started azathioprine. Conclusion(s): ANCA-associated vasculitis can result in life-threatening complications. The initial features can be non-specific, so a high index of suspicion is required, particularly in women with multisystem abnormalities. Close monitoring for potential complications is advised as urgent imaging may be needed. Aggressive immunosuppressive treatment is recommended as steroids alone are usually insufficient. Cyclophosphamide can be used in later pregnancy and can result in a dramatic improvement, as was seen here. If delivery needs to be expedited, mode of birth (i.e. caesarean delivery vs vaginal birth) is dictated by the obstetric picture, with caesarean delivery being indicated for the usual obstetric reasons.
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Perinatal arterial ischemic stroke (PAIS) is a rare cause of neonatal seizures, with an incidence of 1 in 2500 to 4000 live births, globally. This is a case of a neonate with PAIS due to transpla-cental passage of COVID-19 IgG antibodies from the mother. A term, male neonate, born to a primigravida with an unevent-ful antenatal history was presented on the second day of life with multiple episodes of focal clonic seizures involving the right upper and lower limbs. Magnetic resonance imaging revealed an acute infarct in the left frontal lobe, extending into the parietal region, anterior limb, and genu of internal capsule suggestive of arterial ischemic stroke. The known causes of PAIS were evaluated and ruled out. The result of reverse transcription polymerase chain reaction analysis for SARS-CoV-2 antigen was negative for both the mother and the neonate. COVID-19 IgG antibodies in the mother and neonate were elevated. Seizures were controlled with antiepileptics. The neonate had no further seizure episodes and was discharged on oral levetiracetam. The infant was developmentally and neurologically normal at 3 months of age. PAIS is a rare cause of neonatal seizures, and maternal COVID-19 infection may be associated with neonatal stroke.Copyright © 2022, Himalaya Wellness Company. All rights reserved.
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Objective. As the SARS-CoV-2 Pandemic has widely changed pregnancy experience and assessment, the inpatient and outpatient services have had to be re-organized. Since March 2020, Careggi University Hospital (CUH) has provided a dedicated COVID-pathway: spaces for women with unknown swab status and a COVID-19 ward delivery room. The aim of this study is to analyze the inpatient and outpatient COVID-19 related activities in CUH. Materials and Methods. We prospectively collected data from consecutive COVID-19 pregnancies referred from 2020 to 2022, included in the local branch of the ItOSS surveillance. All patients experienced COVID-19 in pregnancy at various stages of severity and gestational ages. Results. From March 2020 to June 2022, 165 COVID-19 deliveries occurred (169 newborns), while 16 pregnant positive women were admitted without delivering. A single emergency C-section (CS) was performed because of Sars-CoV-2 related ARDS, 15 women experienced serious maternal morbidity and 5 needed ECMO. A single maternal death occurred four months after delivery (C-section). Considering ECMO supported cases during pregnancy or postpartum, the first one tested positive for COVID-19 during the second trimester. She developed ARDS and required ECMO for 38 days. She was discharged in good general conditions and a CS at term was performed following obstetric indication. The second patient developed COVID-19-related ARDS at 28 weeks of gestation and experienced a precipitous vaginal delivery at 31 weeks+6 days of gestation while on ECMO. She was discharged 1 month later in good general conditions. The third patient was an obese (BMI 38) 43-year-old woman who had performed an IVF with embryo donation;she tested positive at 38 weeks+2 days of gestation. A CS was performed because of the worsening of her condition. After the delivery she was admitted in ICU and she underwent ECMO. She died 143 days after the CS by sepsis and multiple organ failure (MOF). For all these pregnancies neonatal outcomes were positive. No perinatal death occurred and only one baby tested positive for SARS-CoV-2 infection at nasal swab sampling (case 3). The anesthesiology team performed neuroassial analgesia intrapartum in all the positive women who needed/requested it. Monoclonal Antibodies (mAbs) have been widely used to treat mild to moderate COVID-19 outpatients (NIH and RCOG recommendations) at risk for developing severe disease. Regarding this specifical therapy, an essential role in the management of the pregnant outpatient was played by the Infectious Disease Department. All patients above 28 weeks requiring hospitalization received LMWH prophylaxis, which was administrated under 28 weeks only in presence of additional risk factors (obesity, IVF, etc.). All new mothers received a ten days LMWH prophylaxis. On the outpatient side, we performed 22 teleconsultations, 43 obstetric ultrasounds (including I trimester screening), 90 obstetric checks with clinical evaluation and home therapy management, 32 fetal monitoring and 47 naso-pharingeal swabs. Conclusions. At Careggi Hospital Maternal Department an extensive re-organization of inpatient and outpatient services has been performed in order to guarantee good practice and management of all pregnant women during the SARS-CoV-2 pandemic. This was only possible thanks to a wide multidisciplinary group which enhanced every professional.