ABSTRACT
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
ABSTRACT
Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Maternal physiological adaptations in pregnancy, and the physiological state of relative immune suppression, place pregnant women at increased risk of infection [1,2]. The present study is important due to the tremendous impact Covid 19 has on people at large, especially expectant mothers. In our study, we collected information on pregnant women with confirmed SARS-CoV-2 infection. Aim and Objective: 1) To estimate clinical features, maternal and perinatal outcome of Covid 19, during first, second and third wave of covid pandemic 2) To compare the Obstetric outcome in first and second wave with third wave. 3) To estimate vertical transmission to new born child in this institution as evidenced by test positivity. Method(s): Retrospective observational study was designed to examine the clinical characteristics and outcome of covid positive pregnancies admitted in our institution. Result(s): In our study of 266 pregnant women with covid, it was noticed that the mean age of the patients was found to be 27.55 years with a standard deviation of +/-4.99 years. 55.64% of cases belonged to category B1, 33.08% in B2 and 11.28% in C. 2nd wave had more patients in category C. Gestational diabetes complicated 28.95% and hypertension in 17.29% of study population. Inflammatory markers were more elevated in 2nd and 3rd wave. There was a total maternal death of 11 patients. Out of this, 10 was (91%) due to covid pneumonia and ARDS. Breast feeding was given for 88.7% of the babies and for 88% of the babies rooming in was practiced. Only 2.6% of the babies turned positive within a week. Conclusion(s): Our study shows that expectant mothers were more severely affected in the second wave. Maternal mortality was associated with increased maternal age (> 35 years), raised CRP levels (> 75mg/L) and higher D dimer levels (> 3000 ng/ml) and is found to be statistically significant. There is no evidence to show any vertical transmission of the disease as only 2.1% of the neonates (7nos) were affected within a week. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
ABSTRACT
Introduction: EROS (Enhanced Recovery after Obstetric Surgery) protocols have become a mainstay in many UK obstetric units since 2015 [1]. As part of our local EROS pathway we had awell-established face-to-face caesarean delivery preparation class for mothers and birthing partners. It utilised an MDT approach involving midwifery, physiotherapy and anaesthetics to share information that embeds EROS principles and empowers mothers with confidence and knowledge about delivery and recovery. The COVID-19 pandemic challenged us to find new ways to deliver this information safely. The class was relaunched on a digital platform. We assessed whether we could achieve the same standard and patient satisfaction with this online format. Methods: We collated feedback from 40 mothers and birthing partners attending the online class and compared it to those who attended face-to-face classes before the pandemic. Data were descriptive free-text answers to questions and a 10-point rating scale measuring confidence pre and post class attendance. A further 25 responses evaluating the online class were obtained following improvements suggested by the first online cohort. Results: A total of 90 patients provided feedback. For the face-to-face class, median confidence score increased from 7 pre-class to 9 after the class, and for the digital class it increased from 6 to 9 (P = 0.0005). 67% of mothers felt more confident about their delivery after the face-toface class and 92% after the digital one. (Figure Presented) Discussion: Both face-to-face and digital classes are effective at increasing confidence in delivery and recovery from caesarean delivery, with data suggesting that online sessions were able to do this more effectively. The most commonly reported strengths of digital sessions were that they provided comprehensive information in an easy-to-understand format, particularly around recovery and mobilisation, and that the relaxed nature encouraged questions. Initially, we experienced some technical difficulties with the digital platform and this was noted as an area of improvement from the first round of feedback. Several respondents noted missing the in-person element and opportunity to meet other expectant mothers. We are now assessing the feasibility of a hybrid class.
ABSTRACT
Purpose of Study Today's mechanical ventilators require adjustments of respiratory rate, inspiratory time, expiratory time and tidal volume to maximize O2 delivery and CO2 removal. Pranayam was first recorded about 7000 years ago, and shows similar results to ventilation. Involving conscious inhalation, exhalation and holding of breath, Pranayam is held prominent in the Yoga Sutra (historical authoritative text on Yoga). Pranayam includes three primary principles: Puraka, Rechaka and Kumbhaka, and the techniques of Kapalbhati and Bhastrika. Slow breathing stimulates the vagus nerve and parasympathetic nervous system, easing inhibition of the sympathetic 'fight or flight' response. Pranayam also enhances nitric oxide (NO) production. Recent studies using NO for COVID-19 treatment via inhaler show promising results in shortening the course, symptom severity and resulting damage. When practiced regularly, Pranayam enhances cellular gas exchange, increasing O2 levels and enhancing detox. This study draws parallels between Pranayam and modern ventilation in management of obstetric and pediatric conditions. Methods Used Literature search of ancient Indian texts (Upanishads and Yoga Vasishta, Bhagavad Gita, Patanjali Yoga Sutras) and recent publications on modern ventilation and its clinical applications. Summary of Results Several therapies in allopathic medicine show similar principles to Pranayam in prevention and management of ailments. Maximizing O2 delivery and CO2 removal is accomplished through low tidal volumes and high rates in conventional mechanical ventilators, and extremely low tidal volumes in high frequency oscillators and jet ventilators. These can be compared to high frequency breaths in Pranayam with air exchange improvement and positive alteration of acid/base balance, aiming to avoid lung injury from high distending pressures, especially for infants. Ventilatory strategies such as high pressure and low rate also have their equivalent in Pranayam. Conclusions Breath manipulations in modern medicine and the ancient technique of Pranayam have a positive impact on preventing many human ailments, especially in the fields of perinatology and pediatrics. Breathing exercises can prevent anxiety episodes, mountain sickness and asthma exacerbations. They are also taught to expectant mothers to reduce labor pain during contractions. Human trials show increased pulmonary function and endogenous NO by regular practice of these techniques, which have been used as an adjuvant in COVID-19 patient care. These parallels between Pranayam and ventilatory techniques show a synthesis of ancient and modern therapy. (Figure Presented).