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Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Method(s): This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Result(s): Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion(s): MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.
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Background: As a quality service improvement response since elexacaftor/ tezacaftor/ivacaftor (ELX/TEZ/IVA) became available and the yearly average number of cystic fibrosis (CF) pregnancies (n = 7 pre-2020, n = 33 in 2021) increased significantly at an adult CF center (~600 people with CF), a monthly multidisciplinary CF-maternal health virtual clinic was established with antenatal virtual CF exercise classes dedicated to providing adaptive, specialist support to this cohort, aswell as outreach guidance and education to local obstetric teams. Method(s): This was a single-center retrospective reviewof Royal Brompton Hospital CF-Maternal Health multidisciplinary team clinic records and a patient survey from March 2020 to March 2022. Result(s): Of 47 pregnancies in 41 women (median age 30;) eligible for ELX/ TEZ/IVA at start of pregnancy, 40% (n = 19) were unplanned, and 19% (n = 9) used assisted conception. Three women with a history of infertility conceived naturally, having required assisted conception for previous pregnancies, and five women had multiple pregnancies during the study period. ELX/TEZ/IVA was continued in 60% (n = 28), delayed in 28% (n = 13), and stopped in 13% (n = 6) of pregnancies through maternal choice and careful clinical counselling. Pre-pregnancy pulmonary status was poorer in women who continued than in those who delayed or stopped (Table 1). Of those who stopped, 85% (n = 5) restarted because of pulmonary deterioration by the third trimester. Prenatal CF complications included at least one episode of minor hemoptysis in 21% (n = 9/41) of women, at least one infective exacerbation in 55% of pregnancies (n = 26/47), and noninvasive ventilation in one woman. Other pregnancy-associated complications included one case of ovarian hyperstimulation syndrome, one case of sub-segmental pulmonary embolism, and two cases of pregnancy-induced hypertension. Excluding 10 first trimester terminations, 10 current pregnancies, and one patient relocation, obstetric outcomes available for 26 pregnancies confirmed a live birth rate of 85% (n = 22/26) and a 15% first-trimester miscarriage rate (n = 4). Obstetric complications included preterm delivery rate of 23% (n = 6/26), including two cases of COVID infection resulting in two neonatal intensive care unit admissions, one case of endometritis after cesarean section, and a fourthdegree perineal tear. There were no ectopic pregnancies, maternal or neonatal deaths, or reports of infant cataracts or congenital malformations. Median gestational age was 37/40 weeks (range 29-40). Mode of delivery was via cesarean section in 45% (n = 10/22, of which twowere emergency) and vaginal in 55% (n = 12/22), of which 83% (n = 10/12) were via induction of labor for diabetes (CF or gestational) indication. Deliveries were supported and occurred equally at local obstetric units and in tertiarycare obstetric hospital settings (50%, n = 11/22). Patient-experience survey responses cited high levels of confidence in health optimization and prioritization during pregnancy and praised excellent inter-health care provider communication and peer-to-peer emotional support provided among expectant mothers in the virtual prenatal exercise groups. Table 1. Baseline demographic and clinical characteristics of elexacaftor/tezacaftor/ivacaftoreligible expectant mothers according to therapeutic decision (Table Presented) Conclusion(s): In the absence of clinical trial safety data, the novel approach of a dedicated CF-maternal health multidisciplinary team clinic with local obstetric outreach support has ensured regular specialist clinical and emotional peer-to-peer support for this cohort of women eligible for ELX/ TEZ/IVA to ensure optimal outcomes and experiences of their pregnancies, where appropriate, close to home.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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BACKGROUND/AIMS: To investigate the effects of treatment choices in ectopic pregnancy (EP), either surgery or single-dose methotrexate approaches, to see whether it leads to the incidence of coronavirus disease-19 (COVID-19) disease after discharge, as well as to determine any correlations in changes in cell blood counts (CBC) with the progress of COVID-19 infections.MATERIALS AND METHODS: This study was conducted with 95 patients who were diagnosed as having EP at University of Health Sciences Turkiye, Etlik Zubeyde Hanim Gynaecology Training and Research Hospital. COVID-19 swabs were taken from the patients with EP before hospitalization. Demographic parameters, CBCs, post-discharge COVID-19 disease occurrence rates, and infection progress were evaluated.RESULTS: Ninety-five patients with tubal EP were separated into two groups;20 patients who underwent surgical intervention (Group 1), and 75 patients who underwent single-dose methotrexate treatment (Group 2). There was no difference between the groups in terms of their demographic characteristics (p>0.05). The mass size was measured using transvaginal ultrasound and the mean mass diameter in Group 2 was significantly smaller than in Group 1 (Z=4.123;p<0.001). The hospital stay of Group 2 was longer than in group 1 (Z=4.451;p<0.001). No patients were infected with COVID-19 before the hospitalization period;however, three (3.1%) patients were COVID-19-positive in the 90-day post-treatment period, two of whom had surgical treatment, and the other who received medical treatment. The patient who had medical treatment went into self-isolation and used favipiravir medication at home and completely recovered. By contrast, the patients who had surgical treatment needed hospital care. The mean neutrophil-lymphocyte ratio (NLR) values were significantly higher for those patients with EP in Group 1 compared with Group 2, both pre-treatment and post-treatment (Z=4.108, p<0.001;Z=4.783;p<0.001). Also, significant differences were detected between the groups regarding their haemoglobin levels, and white blood cell, platelet, and neutrophil counts (p=0.005 p=0.001, p=0.008, and p=0.001 respectively).CONCLUSION: Variances in EP treatment modalities and durations of hospitalization days did not increase the transmission of disease or mortality scores. It was concluded that methotrexate treatment could be chosen as the first-line treatment for ectopic pregnancy during the COVID-19 pandemic for patients. However, healthcare professionals must be aware that medical or surgical treatment approaches for patients with EP may change the NLR, which is an independent prognostic factor in COVID-19.
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Aim: The emergence of coronavirus disease 2019 (COVID-19) has not only create international concern, but also caused panic, fear, and an increase in mental health problems among individuals. Fear of COVID-19 Scale (FCV-19S), developed by Ahorsu, was previously reported as a valid psychometric instrument for the assessment of COVID-19 fear among individuals. Validation of the scale among other high-risk groups like pregnant women may help obstetricians develop better coping skills during the pandemic. Material(s) and Method(s): This cross-sectional methodological study included 277 pregnant women admitted for routine follow-up at the outpatient obstetrics clinic of Liv Ankara Hospital, Turkey. Participants were asked to complete the Turkish version of the Hospital Anxiety and Depression Scale (HADS) and FCV-19S. Statistical analysis was performed using SPSS 25 software. Result(s): The mean FCV-19S score was 19.2+/-5.7 (range: 7-35). Cronbach's alpha for internal consistency evaluating the reliability of FCV-19S, was 0.857, revealing a satisfactory internal consistency. According to the correlation matrix analysis, all items of FCV-19S showed positive and strong correlations with total FCV-19S scores (p<0.001), and positive and moderate correlations with HADS scores (p<0.001). Discussion(s): Turkish version of FCV-19S is a valid and reliable clinical tool to assess the anxiety of pregnant women during the COVID-19 pandemic in Turkey.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Background: Pregnant women experience physiological changes that make them more susceptible to respiratory infections, including COVID-19. Given the potential impact of COVID-19 on pregnancy, it is crucial to continue to investigate the effect of the pandemic on pregnant women and their infants. This information will be important for informing for all the stakeholders including clinical care, and public health policies. Method(s): This study is a retrospective observational analytical study conducted in the Department of Obstetrics and Gynecology at SMGS hospital, Jammu. The study included 180 pregnant females who reported to emergency Obstetrics and Gynecology from 1st April to 30 June 2020. The sample size of 180 patients was divided into two groups: Group 1 included 90 COVID-19 positive pregnant females and Group 2 included 90 COVID-19 negative pregnant females. Result(s): No significant differences were found in age, parity, gestational age, comorbidities, mode of delivery, maternal complications, neonatal Apgar scores, or birth weight. The prevalence of comorbidities and maternal complications was similar in both groups, and most neonates had normal Apgar scores and birth weights. Conclusion(s): Therefore, it is suggested that appropriate management and care should be provided to all pregnant women, regardless of their COVID-19 status, to minimize any potential adverse outcomes.Copyright © 2022, Anka Publishers. All rights reserved.
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The risk of fetal intrauterine growth retardation (IUGR) is increased in women who have experienced acute infections, as well as in pregnant women with gynecological pathology and endocrine diseases. A woman's lack of nutrition also makes a negative contribution to the development of IUGR. The frequency of IUGR in the population is very variable and depends on a number of reasons. In practically healthy pregnant women, IUGR is registered in 3-5% of cases, in case of complicated obstetric and gynecological diagnosis and complicated pregnancy - in 10-25%. Morphofunctional disorders in the chorion/placenta in pregnant women with COVID-19 on the background of post-covid endotheliitis are the main pathogenetic factor in the development of preeclampsia, ectopic pregnancy, antenatal fetal death, and impaired condition of the fetus and newborns. Sufficient saturation of the pregnant woman's body with the nitric oxide donor L-arginine and L-carnitine (main cofactor of fatty acid metabolism in cells) with the improvement of microcirculation and the correction of hypovolemic disorders in the fetoplacental complex can be considered one of the real ways to prevent IUGR in women in the post-covid period. A review of the scientific literature on pathogenesis, diagnosis, impact on the life and health of a newborn with IUGR in women after COVID-19, as well as the possibilities of medical correction of placental dysfunction during pregnancy was performed. This analysis and our own clinical experience allow us to state the fact that after a coronavirus infection during pregnancy, one of the frequent and threatening for the further development of the child is the formation of placental dysfunction and IUGR. One of the ways to prevent these conditions is to saturate the woman's body with the nitric oxide donor L-arginine from the stage of pre-gravid preparation, which will provide the opportunity for adequate angiogenesis and development of the embryo/fetus. In the case of additional risk factors, such as coronavirus disease, complex therapy blood (Rheosorbilact), in combination with a nitric oxide donor and L-carnitine as an endothelium-protective agent (Tivor-L).Copyright © 2022 Authors. All rights reserved.
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Background: Undiagnosed ectopic pregnancies are among the main gynecological emergencies, and hemorrhage from an ectopic pregnancy is still the leading cause of maternal mortality in the first trimester. During the first lockdown period in Italy (March-April 2020) and in March 2021 restrictive measures were issued by the Italian government, but their impact on the incidence of ruptured tubal pregnancies remains unknown. Method(s): The purpose of this study was to evaluate the impact of restrictive measures for the COVID-19 outbreak on the incidence of ruptured tubal pregnancies at our referral center for endoscopic gynecologic surgery. In particular, the primary outcome was the comparison of the incidence of ruptured tubal pregnancies between the lockdown phases and the other months of the pandemic. For this retrospective cohort study we considered all women examined for tubal ectopic pregnancy at our emergency unit from 1 January 2019 to 30 April 2021. We divided patients into three groups according to the period they were referred to our center: 10 March 2019-10 March 2020 (Pre-Covid period);11 March-4 May 2020 and 6 March-30 April 2021 (Lockdown periods);5 May 2020-5 March 2021 (COVID-19 pandemic period without restrictive policies). We compared data acquired during the lockdown phases with data collected both before the COVID-19 pandemic and during the restriction-free COVID-19 period. Result(s): 31 of 85 women were diagnosed with a ruptured tubal pregnancy. The proportion of ruptured ectopic pregnancies was higher during the lockdown period than the other two periods combined (62.5% vs 30.4%, p = 0.016). Mean gestational age and beta-HCG levels showed the same tendency (7.31 +/- 1.25 weeks vs 5.99 +/- 1.28 weeks, p < 0.0001;7392.56 +/- 4337.50 mUI/mL vs 4188.36 +/- 3235.95 mUI/mL, p = 0.001). There were no differences between the proportion of ruptured pregnancies during the whole COVID-19 pandemic and the months preceding it (45.7% vs 25.6%, p = 0.07). Conclusion(s): Our study demonstrated that restrictive lockdown policies for the containment of the COVID-19 outbreak are associated with an increased rate of ruptured extrauterine tubal pregnancies. Copyright: © 2022 The Author(s).
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Background: Coronavirus (COVID-19) infection is a pandemic caused by SARS-CoV- 2, appeared in Wuhan, in November 2019 and in March 2020 in Argentina. Initially it predisposes patients to thrombotic disease. Pregnancy is a hypecoagulable state and the optimal thromboprophylaxis in pregnancy is unknown. We work with the available information adapted to our hospital requirements. Aim(s): To describe 1. Venous thromboprophylaxis in hospitalized pregnant women with COVID-19 infection. 2. Maternal outcome. Method(s): 108 pregnant women were hospitalized between April 2020-july 2021 (6 in the Intensive Care Unit (ICU), 4 required mechanical ventilation, 6 in Medical Clinic Unit and the rest in the Obstetrics Unit, patients were not vaccinated). Median age 29 (range 16-41). Trimester 1st 3.7%(4);2nd 15.7%(17);3rd 79.7%(86) (>37 weeks: 47);postpartum 0.9%(1). Treatment: We elaborated local guides and low molecular weight heparin (LMWH) enoxaparin 40 mg/d was prescribed to all pregnant women with COVID-19 when hospitalized, 8 received intermediated doses and those more than 37 week received unfractionated heparin (UFH). Outpatient prolongation of thromboprophylaxis depends on risk stratification, those admitted to ICU continue with enoxaparin until delivery. Result(s): 41 patients were discharged pregnant and 64 postpartum, 1 ectopic pregnancy and 2 abortions. There were neither maternal deaths nor venous thromboembolism (VTE) during the acute period of infection or during hospitalization. One women that was admitted to de ICU and require ARM with a BMI >40 and with LMWH developed a deep vein thrombosis 2 months later at 34 week of gestation and was anticoagulated with full doses of LMWH. Conclusion(s): During the first period of COVID 19 infection in our country, hospitalized women received either LMWH enoxaparin at fixed doses of 40 mg/day or UFH if near delivery. No VTE or maternal death were observed during hospitalization. We suggest to continue VTE prophylaxis during the antenatal period in those patients admitted to ICU until delivery.
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Differentiation between intramural ectopic pregnancy and molar ectopic pregnancy is very difficult because of their exceptional rarity. Herein, we present a misdiagnosed case of intramural pregnancy and invasive trophoblastic disease on ultrasound. A 45-year-old female patient was admitted to our tertiary referral hospital due to abdominal pain and unusual ultrasonography findings. Initially, a diagnosis of intramural ectopic pregnancy was identified based on transvaginal color Doppler ultrasonography, 3-dimensional ultrasound, and serial serum beta-human chorionic gonadotropin, thus the patient underwent laparotomy with hysterectomy. However, the histopathological endpoint showed an invasive trophoblastic disease. Clinically, this pathology should be included in the differential diagnosis of intramural ectopic pregnancy since an imaging scan remains quite unclear.
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STUDY OBJECTIVE: To demonstrate a laparoscopic technique to remove a scar pregnancy. DESIGN: Stepwise demonstration of the surgical technique. SETTING: Santa Croce and Carle Hospital, Cuneo. INTERVENTION: Patient B.B. is a woman referred to our center for a suspected cesarean scar pregnancy (CSP) at 9 weeks gestation. CSP occurs approximately in 6% of all ectopic pregnancies. The estimated incidence is reported to be 1:1800 to 1:2500 in cesarean deliveries. Depending on its location, CSP can be categorized as either type 1, if the growth is in the uterine cavity, or type 2, if it expands toward the bladder and the abdominal cavity. If inadequately managed, it can lead to severe complications; most of them are hemorrhagic and can threaten the woman's life. There are several therapeutic approaches: local excision seems to be the most effective choice in type 2 CSP. In expert hands, the laparoscopic approach is perhaps the best surgical choice as tissue dissection, electrosurgical hemostasis, and vascular control can be effectively managed with minimal invasive access. Because severe intraoperative bleeding can occur, retroperitoneal vascular control is mandatory in this surgery. In type 1 CSP curettage, aspiration or hysteroscopic approach can be considered if the CSP is of small dimensions. A hysteroscopic approach can also be helpful in type 2 CSP during the laparoscopic removal, as intrauterine guidance. A potassium chloride local injection can be considered in a preoperative stage in the presence of a fetal heart rate. The systemic administration of methotrexate is usually ineffective as single agent, but it can be useful if administered as adjuvant therapy. Uterine artery embolization can be useful in an emergency setting to manage severe bleeding, but it can lead to complications in subsequent pregnancies and, more rarely, to premature ovarian failure. Considering poor bleeding at presentation, feasible dimensions, and the woman's desire for future pregnancy, ultrasound-guided aspiration and curettage was attempted. Because endouterine removal was incomplete, methotrexate injection was proposed as adjuvant therapy, but the administration was postponed as the patient tested positive for coronavirus disease 2019. A month later, beta-human chorionic gonadotropin level dropped from over 16 000 to 271 mU/mL, so an ultrasound and biochemical follow-up was performed. A month later, despite a low beta-human chorionic gonadotropin value, an increase in dimensions was observed at ultrasound, so surgical laparoscopic removal was offered. In this video article, laparoscopic removal of scar pregnancy is discussed in the following surgical steps: (1) Temporary closure of uterine arteries at the origin, using removable clips. (2) Retroperitoneal dissection to safely manage the scar pregnancy. (3) Dissection of the myometrial-pregnancy interface. (4) Double layer suture on the anterior uterine wall. CONCLUSION: Laparoscopic surgical management is a very effective surgical approach to remove CSP. Knowledge of retroperitoneal dissection and vascular control is necessary to carry out this surgical intervention safely and effectively.
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Aim and objective: To present a rare case of abdominal wall fungal coinfection with Mucormycosis in a patient of COVID-19. Materials and methods: A 33-year-old female operated case of laparoscopic ectopic pregnancy removal with salpingectomy and tubectomy, at postoperative day 5 had redness and pus discharge from the operative site and was diagnosed with abdominal wall cellulitis. She underwent local exploration and wound wash. On postoperative day 21, the patient came to the emergency room with cellulitis, and pain at the port insertion site. On examination, we highlight BP 90/50 mm Hg and blood test analysis with HB-8.3, leucocyte count 29.91 × 109/L, CRP 333 mg/L. Results: CT scan revealed necrotizing fasciitis. She underwent wide local excision and debridement. Post debridement the next day during dressing, the wound showed a cotton fluffy appearance at the edges and part of the base with black necrotic areas. A wound swab was sent for fungal culture, KOH mount, pus culture, and tissue for histopathology. In the meantime, she was started on empirical antifungal amphotericin B, meropenem, and minocycline antibiotics. On history, the patient remarked that she did have fever, sore throat, and cough for 5 days, 4 weeks before laparoscopic ectopic pregnancy removal. Also one of her family members had tested positive for COVID-19. COVID antibodies test was done which were reactive: 1.96. Tissue histopathology revealed mucormycosis. MRI abdomen findings showed a 15 cm large defect involving the entire thickness of subcutaneous fat. A high degree of suspicion and promptness in starting antifungal treatment prevented the fatal outcome. Conclusion: COVID-19 is associated with immune dysregulation and consequently life-threatening infections. The prolonged and indiscriminate use of steroids for the treatment of COVID-19 could contribute to this problem of fungal superinfection of mucormycosis. It seems prudent to have a very high suspicion supplemented with thorough clinical examination and low threshold for imaging in order to diagnose secondary fungal infections, such as mucormycosis. Early so that the treatment can be instituted as soon as possible.
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Design: Training in gynaecological skills has been significantly impacted by the COVID-19 pandemic. The RCOG recommended a training impact assessment of trainees as part of the gynaecological surgery recovery plan. A regional survey was designed in Northern Ireland (NI) to assess trainee's attitudes and exposure to current training in gynaecology and future plans for advanced training in gynaecology. Methods: The RCOG gynaecology recovery plan was discussed at the NI deanery school board meeting and an online training impact survey was developed. The survey was then sent to all obstetrics and gynaecology trainees within NI. The results were reviewed and presented back to the NI deanery school board. All units within NI were given access to the results with the aim to adopt a regional approach to improving training opportunities in gynaecology within NI. Results: 39 responses have been received to date from all levels of trainees and all 8 training units within NI. The results for rating current training in gynaecology were;very poor 8%, poor 44%, fair 36%, good 6% and very good 6%. An average of 3 gynaecology clinics were attended in the previous 8 weeks. Only 14% felt their skills were appropriate for their training grade. For attendance in gynaecology theatre sessions;44% <1 per month, 36% 1-2 per month, 17% 1 per week and 3% >1 per week. For proportion of time spent as the lead operator in gynaecology theatre only 33% of trainees were lead operator for >50% of cases. For procedural competence;50% diagnostic laparoscopy, 17% operative laparoscopy, 11% hysterectomy (abdominal, laparoscopic and vaginal 11% each), 19% vaginal repair and 31% laparoscopic management of ectopic pregnancy;64% required gynaecological summative OSATs in this training year;19% were doing a gynaecological ATSM of which 57% felt they would complete;78% of all responders felt they would not be competent at gynaecological surgery by the end of training. Conclusion: COVID-19 has had a clear effect on training in gynaecology and this is evident in all training units throughout NI for all grades of trainees. Trainees are concerned regarding their exposure to gynaecological training and their competence in the future as consultants. Other methodologies for training could be adopted in this time, including simulation, to help improve opportunities.
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BACKGROUND/AIM: During the COVID-19 pandemic, concerns regarding theoretical risks of surgery contributed to changes in clinical management to prevent contamination. We looked at the effect the pandemic had on the management of ectopic pregnancy. Our review compares published data on pre-COVID to COVID management of ectopic pregnancies and evaluates the differences where Early Pregnancy Unit (EPU) structures exist. MATERIALS AND METHODS: We performed a systematic review of the published evidence using a keyword strategy. The "Population Intervention Comparison and Outcome" (PICO) criteria were used to select studies. Three independent reviewers agreed on the data extracted after screening of the literature. The total population analysed included 3122 women. A meta-analysis of the included studies was completed using a random or fixed effect model depending on the heterogeneity (I2). Our outcomes were the following: type of management of ectopic pregnancy (EP), incidence of ruptured EP and rate of complications. We compared units with and without EPU infrastructure. RESULTS: We included every study which recruited women diagnosed with ectopic pregnancy and compared the type of management during and prior the COVID-19 peak. Our literature search yielded 34 papers. 12 were included using the PRISMA guidelines. We observed no difference in the type of management (surgical versus non-surgical) [OR=0.99 (0.63-1.55), p=0.96, I2=77%] in the pre-Covid vs. Covid cohorts overall but a reduction of surgical management in EPU structures. There was no difference in the ectopic rupture rate within the EPU branch [OR=0.66 (0.33-1.31), p=0.24, I2=37%]. In contrast, in non-EPU (NPEU) structures there was a clear increased risk of ruptured ectopic pregnancy [OR=2.86 (1.84-4.46), p<0.01 I2=13%] and complications [OR=1.69 (1.23-2.31), p=0.001, I2=45%]. CONCLUSION: The risk of ruptured ectopic and complications was significantly higher in the absence of EPU structures. This worldwide trend was not reflected in the UK, where EPU systems are widespread, suggesting that EPU structures contributed to prompt diagnosis and safe management. In the post-COVID era, healthcare systems have come to realise that pandemics might become the norm and thus the onus is to identify services that have worked seamlessly.
Subject(s)
COVID-19 , Pregnancy, Ectopic , COVID-19/epidemiology , Female , Humans , Incidence , Pandemics , Pregnancy , Pregnancy, Ectopic/epidemiology , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapyABSTRACT
OBJECTIVE: To evaluate the accuracy of a modified bedside test in ruling out an ectopic pregnancy. The test is based on a lateral flow immunoassay for alpha-fetoprotein (AFP). It has been shown that a high AFP level in vaginal blood indicates the passage of fetal tissue, suggestive of a miscarriage [1].We hypothesized that high AFP levels in sampled intrauterine tissue, assuming non-heterotopic pregnancy, rules out the presence of an ectopic pregnancy. MATERIALS AND METHODS: This is a prospective cohort study. The study included pregnant women undergoing a dilation and curettage (D&C) for pregnancy loss or termination, women with pregnancy loss or an ectopic pregnancy presenting with vaginal bleeding, and non-pregnant women with vaginal bleeding. Vaginal blood was collected on gauzes, sanitary pads, and cotton swabs. Samples were then tested for AFP levels using a commercial kit (ROMplus, Laborie, USA) originally designed to detect leakage of amniotic fluid. This kit contains a lateral flow immunoassay strip capable of detecting the presence of AFP. Positive samples for AFP were retested at a later date (after 3 to 20 days) to ascertain the stability of AFP and reliability of the test. Official sonograms, pregnancy tests, and final pathology results were obtained to confirm pregnancy status as well as the presence or absence of fetal tissue in the vaginal blood. A sensitivity and specificity analysis was performed against these final results to validate the accuracy of the test strip in ruling out an ectopic pregnancy. RESULTS: A total of 30 vaginal blood samples were tested for AFP. All pregnant women who had a miscarriage or D&C had detectible AFP in their vaginal blood (n=13). On retesting the samples 3 to 20 days later, these results remained the same (positive test strip). The remaining 17 vaginal blood samples were from 4 women with ectopic pregnancies and from 13 non-pregnant women with vaginal bleeding. All 4 ectopic pregnancies had no AFP detected in the vaginal blood and only 1 out of 13 non-pregnant patient samples had AFP detected. The ROMplus test strip correctly detected AFP in all samples tested containing fetal tissue (n=13) resulting in a test sensitivity of 100%. ROMplus correctly identified the absence of AFP in 16 out of the 17 samples lacking fetal tissue, a 94% test specificity. CONCLUSIONS: ROMplus has the potential to accurately and reliably detect the presence of AFP, and hence fetal tissue, in vaginal blood samples. This could be a vital non-invasive aid in ruling out an ectopic pregnancy at the bedside (currently off-label use). Furthermore, it could limit the amount of invasive testing and visits needed in cases of pregnancies of unknown location. IMPACT STATEMENT: In light of the recent COVID-19 pandemic, a simple non-invasive bedside test to rule out an ectopic pregnancy is highly desired given its potential for reducing the number of visits, investigations performed, and personnel involved in the workup of a pregnancy of unknown location.
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Introduction: Corona Virus Disease 2019 (COVID-19) is an infectious disease caused by SARS-COV-2. First identified in December 19 in Wuhan, China On March 12,2020, WHO announced corona virus outbreak as pandemic. Till September 14, in India >48,50,887 confirmed cases, >9,90,502 active cases, >37,79,927 recovered cases reported. In karnataka 4,59,445 confirmed, 99,203 active, 3,52,958 recovered, 7265 death reported. Aim: To study maternal and fetal outcome in COVID-19 positive pregnant patients admitted in MIMS, Mandya (from 1s t wave to 3r d wave). Materials and methods: This is a prospective study conducted in the Department of OBG, MIMS, Mandya, of a study period of 15 months from June 2020 to November 2021. All cases of confirmed COVID- 19 patients admitted in the Department of OBG are included in the study period ,using medical case records, OT registered - age ,parity ,mode of presentation, investigations, management and outcome of delivery were observed among the COVID-19 patients Results: Out of 216 admissions in 1 s t wave 139 cases delivered and in these 84 (60.4%) vaginal deliveries and 55 (39.5%) c-section ,among which 1 VBAC, 1 breech, 1 vaccum, 3 PPH, 2 IUD, 1 maternal death and 40 NICU admissions and among which 4 babies were positive and 1 neonatal death. During 2nd wave, out of 355 admissions 168 delivered and in these 98(58.3%) vaginal deliveries and 70 (41.6%) c-section, among them 8 vaccum deliveries, 4 IUD, 1 breech, 1 VBAC, 4 PPH , 1 MRP, 5 MVA and 1 ectopic pregnancy and 10 maternal death and 15 NICU admissions among them 8 COVID-19 positive babies and 1 neonatal death. In the emerge of 3r d wave 1 case we have documented and it is LSCS on 2/11/21 baby COVID-19 negative. Conclusion: Compared to 1st wave and 2nd wave there is increase in disease severity and number of cases. Burden of disease has drastically increased. Early diagnosis and prompt treatment can reduce the mortality rate in COVID-19 patients.
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Background: Ectopic pregnancy is a potential cause of morbidity and mortality among women and is a common diagnosis for women presenting to the emergency room. During the height of the COVID-19 pandemic in New York City (NYC) in the spring of 2020, emergency room visits for all non-COVID related health problems appeared to decrease. We examined visits for ectopic pregnancies and pregnancies of unknown location (PUL) in the emergency department (ED) of three NYC hospitals during the height of the early pandemic and compared them to the same months in the prior year. Methods: Our study is an IRB-approved retrospective chart review of all patients who presented to the ED with a positive pregnancy test during the months of March–June 2020 (pandemic period) and March–June 2019 (pre-pandemic). Demographic data, history, labs, imaging, number of visits and treatment and outcomes were measured. Results: We found that there were 324 ED visits for PUL in 2019 (pre-pandemic) compared to 195 in 2020 (pandemic). Ectopic pregnancies remained somewhat stable and were diagnosed in 59 patients in 2019 and 51 patients in 2020. The percentage of patients diagnosed with ectopic pregnancy increased from 25.1% of all patients with PUL in 2019 to 39% of all patients diagnosed with PUL in 2020. Rates of complications were similar between the two cohorts. Conclusion: Although the number of visits to the ED for PUL fell dramatically from the pre-pandemic to the pandemic time period, the number of patients actually diagnosed with ectopic pregnancy was similar between the two time periods.
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Aim and objective: Although two-wave pattern of the coronavirus disease-2019 (COVID-19) pandemic was observed in many countries, there is limited information on the impact of both the waves on clinical presentations of ectopic pregnancy (EP) with COVID-19. Therefore, we aimed to understand the impact of the first wave and second wave of COVID-19 pandemic on women with EPs in India. Materials and methods: We conducted a retrospective study at BYL Nair Charitable Hospital (NH), a dedicated COVID-19 tertiary care hospital in Mumbai, India. We analyzed the impact of the first wave and second wave on women with EPs and the challenges encountered for management during the pandemic in our hospital. Results: A total of 1,660 pregnant and postpartum women with confirmed diagnosis of COVID-19 were admitted at NH during the first wave and the second wave of the COVID-19 pandemic. All cases of EP were asymptomatic for COVID-19. During the prepandemic period of 4 years, there were 220 (15.2 per 1,000 births) women with EPs, which was higher compared to seven EPs (6.3 per 1,000 births) during the COVID-19 pandemic. EP rate per 1,000 births during the second wave was found to be 9.6, which is comparatively higher than the first wave (3.8) (p = 0.24). Conclusion: Increased frequency of EPs during the second wave of the COVID-19 pandemic could be due to the new variant of concern B.1.617. 2 (Delta). For ruptured EP, we recommend surgical management with laparotomy as a treatment option as it is useful in reducing the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to healthcare workers. Clinical significance: The COVID-19 pandemic is likely to last longer and hence healthcare providers should ensure that pregnant women have access to medical assistance whenever needed. © The Author(s). 2021.
ABSTRACT
Introduction: The pandemic of coronavirus disease 2019 caused bythe SARS-CoV-2 is affecting many women during pregnancy and inthe postpartum period worldwide. A peculiar characteristic ofCOVID-19 is the release of a large amount of inflammatory cytokines. Some biomarkers have been considered as tools to monitor theevaluation of COVID-19, namely CRP, LDH, D-dimer and ferritin.Currently the neutrophil lymphocyte ratio constitutes a new stronginflammatory marker for the detection of inflammation. Neutrophillymphocyte ratio has also been used as a predictor of complication ofpregnancy, such as pre-eclampsia, gestational diabetes mellitus,hyperemesis gravidarum, premature labour and ectopic pregnancy.Aims &Objectives: To study the neutrophil lymphocyte ratio (NLR)and ferritin levels in COVID-19 positive pregnancy and correlate itwith the severity of the disease.Materials &Methods: This is an observational study conducted inthe obstetrics ward of a tertiary care center. The inclusion criteriawere all the pregnant females admitted in the obstetrics ward with adiagnosis of COVID-19 by RT PCR in the period of 3 months. Theexclusion criteria were patients with non reactive rapid test results.Clinical and demographic data were extracted from electronic medical records.Result: In our study, 32 out of 70 patients showed ferritin valuesabove 400 ng/ml. Lymphocytopenia, increased neutrophil lymphocyte ratio and increased ferritin had all been linked with diseaseseverity or mortality. Decreased lymphocyte value was associatedwith an increased likelihood of receiving oxygen supplementationduring hospitalization. These markers show abnormal values inobstetrics patients and reflects the course of the disease. It suggestedthat additional care should be reserved to patients presenting withdecreased value of these blood cells. Pregnancy is a physiologicanemic state and high levels of ferritin, especially in third trimesterare associated with negative outcomes like preterm delivery andgestational diabetes mellitus.Conclusions: Both neutrophil lymphocyte ratio and ferritin levels canact as independent markers in assessing the disease severity ofCOVID-19 in obstetrics patients.