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Objective: The current study aimed to describe the clinical characteristics of mild SARS-CoV-2 infected pregnant women with abnormal liver function (ALF), explore the association between ALF with maternal and fetal outcomes. Method(s): This retrospective analysis included 87 pregnant patients with mild SARS-CoV-2 infection admitted and treated from December 1, 2022, to 31, 2022 in the department of Obestircs at Beijing Obstetrics and Gynecology Hospital. We evaluated patients for demographic and clinical features, laboratory parameters and pregnancy complications. Result(s): 27 Patients in this cohort had clinical presentations of ALF. Compared with the control group, the peripheral blood platelet (PLT), D-dimer quantitative determination (D-Dimer), lactate dehydrogenase (LDH), total protein (TP), albumin (ALB), indirect bilirubin (DBIL), gamma- glutamyltranspeptidase (GGT) and total bile acid (TBA) showed significantly differences (p<0.05). 12 cases (44.44%) complicated with pregnancy induced hypertension (PIH), 14 cases (51.85%) complicated with intrahepatic cholestasis of pregnancy (ICP), 2 cases (7.4%) complicated with acute fatty liver during pregnancy (AFLP) and 5 cases (14.81%) complicated with postpartum hemorrhage in patients with abnormal LFT were significantly higher than those in the control group (p<0.05). Compared with the control group, the incidence of premature delivery (22.22%) and fetal distress (37.04%) in the experiment group were significantly higher (p<0.05), and the incidence of neonatal asphyxia was not significantly different (p>0.05). Conclusion(s): Pregnant women are generally susceptible to mild SARS-CoV-2 and may induce ALF. ALF is associated with increased risk of mother and infant. The maternal and infant outcomes of those who terminated pregnancy in time are acceptable. Therefore, pregnant women with COVID-19 who received antiviral treatment should be closely monitored for evaluating liver function and relevant indicators. The long-term outcomes in the future are worth to further study.Copyright © 2023
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Background: COVID-19 infection is a contemporary global concern with serious ramifications. This disease is caused by a virus belonging to the Coronaviridae family named SARS-CoV-2. Immunologic and physiologic changes during pregnancy make pregnant women more susceptible to viral infection, especially COVID-19. Objective(s): The present study aimed to identify the clinical manifestations, radiologic findings, indications for cesarean delivery, underlying conditions, and the critical outcome of mothers and newborns regarding COVID-19 women who had cesarean sections and terminated pregnancies. Method(s): This cross-sectional study was conducted on the mortality and morbidity rates of 98 women with terminated pregnancies infected with COVID-19 at the time of their cesarean delivery. The demographic, clinical, and pregnancy data were collected from Razi Teaching Hospital between March 2020 and March 2021 and analyzed using SPSS version 24. Result(s): The mean age was 31.31 +/- 7.16, and the mean gestational age was 36.45 +/- 3.334 weeks. The most prevalent cause of cesarean section was fetal distress (28%), followed by preeclampsia and meconium aspiration. The most common symptoms were sore throat, cough, fever, nausea, diarrhea, and weakness;moreover, hypothyroidism and diabetes mellitus were the most predominant underlying diseases. The mean duration for hospitalization was 5.21 +/- 4.584 days, the maternal death rate was 5.1%, and the neonatal death rate was 2%. Conclusion(s): The majority of women infected with COVID-19 had cesarean sections and terminated pregnancies in the third trimester. This highlights the need for better care and education for mothers in this period. The body mass index (BMI) level and obesity are strongly associated with COVID-19 severity. Furthermore, healthcare workers should pay more attention to underlying diseases during pregnancy.Copyright © 2023, Author(s).
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Intro: COVID-19 pandemic era makes quality of obstetric triage care including caesarean section in obstetric true emergency cases delayed. Maternal fetal triage index (MFTI) score is an instrument used to define true emergency in obstetric cases. Decision to delivery interval (DDI) is time interval from caesarean section decision to delivery within <30 minutes standard in emergency cases.This study was designed to evaluate the decision to delivery time interval and its effect on perinatal outcomes and the associated factors during category-1 emergency caesarean section deliveries. Method(s): A prospective observational descriptive study was conducted from 2020-2022 at Kariadi tertiary Hospital. A total of 40 clients who were undergone category-1 emergency caesarean section were included in this study. This is a indepht analysis pregnant women confirmed with COVID-19 infection and had true emergency cases based on MFTI score (stat-priority 1). Finding(s): Among 346 pregnant women with COVID-19, total 160 C-section cases with 40 eligible data were included in this study. Gestational age mostly in their second and third trimester. Maternal comorbidities were diabetes in pregnancy, HIV, pre eclampsia, SLE and thyroid disease. This study showed that DDI <30 minutes were found in 34 cases (85%), DDI 30-60 minutes as many as 6 (15%), and no (0%) DDI >60 minutes. Emergency cases with the shortest DDI were umbilical cord prolapse 3 (100%), fetal distress 14 (93%), placental abruption 5 (83%), impending uterine rupture 5 (83%), and antepartum hemorrhage 7 (70%). Perinatal outcome were Apgar score lower than 7 at 1 minutes (25%) and stillbirth (5%). Conclusion(s): Most of DDI in this study met the recommendation of <30 minutes, but some cases did not meet the standard. This can be caused by multifactorial factors such as advice from the doctor in charge, patient transfer distance, operating room preparation, and anesthetic preparation due to COVID-19.Copyright © 2023
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Our case is a 21 y/o pregnant female, 26weeks gestation who presented to OB triage with COVID-19. She was admitted to OB/GYN unit in acute hypoxic respiratory failure and started on steroids and remdesivir. On hospital day 6, she underwent an emergent c-section for fetal distress due to increasing hypoxia and severe ARDS. As her arterial blood gas being ph 7.17/81/40/29.6/-0.4, lactate 6.8nmol/L with escalating vasoactive medication and ventilator settings;ECMO was decided. However, all adult ECMO resources were limited, even within other adult facilities in Central Florida. Through multidisciplinary discussions amongst OB/GYN, adult ICU, and our pediatric ECMO activation team, it was decided to transfer the patient to our free-standing pediatric hospital. The patient was successfully transferred and cannulated for VV-ECMO. Total ECMO run was 413 hours. On ECMO day #12 patient underwent a tracheostomy. On ECMO day # 17, patient developed headaches and seizure activity in which CT revealed a subdural hemorrhage. She was taken off ECMO and underwent an emergent decompressive craniectomy with hematoma evacuation by our pediatric neurosurgical team. Once stable enough, she was discharged post ECMO day #15 (PICU day #32) to rehabilitation center. Two weeks later she had her bone flap replaced, trach removed, and she walked out of our unit home. This case exudes two key points for discussion. The first point of understanding ECMO physiology allows a team to treat many different patient populations. Although this patient was unusual to our pediatric bedside providers being post-partum, our team knew we could help. The second key point is excellent multidisciplinary teamwork and that communication is essential. At Orlando Health Arnold Palmer Hospital, our ECMO activation team consists of surgeons, pediatric intensivists, CT surgeons, perfusionists, nursing, and administration. We meet virtually to discuss how to execute initiation and daily ECMO treatment plans. There were some on the virtual call that were hesitant in accepting care of this adult due to variety of reasons, saying no would have been the easier answer, but not the right thing to do. What we learned from this case may seem so obvious and simple but very difficult to execute;multidisciplinary teamwork, humility, and open communication gave this patient the ability to walk out of the hospital with her baby. Other pediatric ECMO teams can learn from this case is they too can help in extraordinary times such as during a pandemic when adult recourses are limited.
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Aim: to asses an opportunity for predicting an unfavorable perinatal and maternal pregnancy outcome in severe novel coronavirus infection (NCI) COVID-19. Materials and Methods. A retrospective comparative study of the course and outcomes of pregnancies was performed in 40 patients with a gestational age of 22-42 weeks who had severe and extremely severe COVID-19 in 2021. The main group included 21 cases with an extremely severe course of the disease resulting in maternal mortality;the comparison group consisted of 19 patients with severe COVID-19 who successfully completed pregnancy. The diagnosis of NCI COVID-19 was confirmed in all cases by identifying SARS-CoV-2 RNA by polymerase chain reaction in a nasopharyngeal swab. During the study, all patients (during hospitalization, at the peak of the disease and before death/discharge from the hospital) underwent a comprehensive anamnestic, clinical and laboratory-instrumental examination. There were analyzed clinical blood test, biochemical parameters - lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase, creatinine, glucose, total bilirubin, total protein;coagulation parameters - prothrombin level according to Quick and fibrinogen, activated partial thromboplastin time, international normalized ratio;the level of C-reactive protein, procalcitonin, D-dimer, interleukin-6 (IL-6);ultrasound examination was performed during pregnancy (fetometry, placentometry), dopplerometry of uteroplacental blood flow and ultrasound of the pelvic organs, as well as pathomorphological placenta examination. Results. In patients who died from extremely severe NCI COVID-19 (main group), the course of the infection was accompanied by developing of respiratory distress (RD) degree III (chi2 = 12.84;p <= 0.05), and a progressive deterioration in mother's condition and/or fetal distress was an indication for emergency delivery by caesarean section (CS). The course of severe NCI COVID-19 in patients with a favorable outcome (comparison group), as a rule, was accompanied by the development of RD grade I and/or II;most of them were also delivered by CS on an emergency/urgent basis. Predictors of rapid progression of severe NCI COVID-19 in the main group were identified: subfebrile body temperature at the initial stages skewing to high fever during treatment instead of rapid temperature normalization (chi2 = 5.41;p <= 0.05;odds ratio (OR) = 5.0;95 % confidence interval (CI) = 1.23-20.3);lack of leukocytosis at the initial stages (chi2 = 4.91;p <= 0.05;OR = 50;95 % CI = 5.43-460.54) with rapidly increased leukocyte count with persistent stagnation in dynamics until death (chi2 = 19.79, p <= 0.05, OR = 50;95 % CI = 5.43-460.54);severe lymphopenia (chi2 = 8.09;p <= 0.05;OR = 7.29;95 % CI = 1.74-30.56), neutrophilia (chi2 = 10.17;p <= 0.05;OR = 10.29;95 % CI = 2.21-47.84);high LDH values (chi2 = 17.99;p <= 0.05;OR = 31.88;95 % CI = 5.09-199.49);increased IL-6 level at the peak of the disease (chi2 = 9.66;p <= 0.05;OR = 18;95 % CI = 1.99-162.62) and in dynamics, as well as stably high D-dimer values (chi2 = 9.53, p <= 0.05;OR = 11.33;95 % CI = 2.07-62.11). Conclusion. Significant changes observed in clinical and laboratory examination were identified, which reliably reflect the degree of patients' state, to be interpreted as predictors of adverse pregnancy outcomes during NCI COVID-19 and as a potentially justified serious reason for making a decision in the light of timely delivery aimed at a favorable outcome for mother and child. Timely delivery, carried out within the time limits for enabling adequate compensatory capabilities of the pregnant woman's body, demonstrates a rapid normalization of the main laboratory parameters.Copyright © 2023 IRBIS LLC. Pravo. All rights reserved.
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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.
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Objective. We described three cases of SARS-CoV-2 positive new-borns with both symptomatic and asymptomatic mothers. Materials and Methods. Placentas were analyzed in the pathology department and showed chronic histiocytic intervillositis with presence of CD68+ macrophages, syncytiotrophoblast necrosis and positivity of the syncytiotrophoblast for SARS-CoV-2 antigen or RNA. Results. The first case dates back to March 2020, when a symptomatic COVID-19 positive patient gave birth to a healthy neonate at 37.6 weeks of gestation. Skin to skin contact was not permitted but breastfeeding with a face mask was allowed. The newborn, that remained asymptomatic throughout the entire hospital stay, resulted positive to SARS-CoV-2 immediately after birth, at 24 hours of life and after 7 days. The second was delivered at 35.1 weeks of gestation by caesarean section for non-reassuring fetal status. The mother presented with fever, cough and a positive COVID-19 swab test. The newborn resulted positive on day 7, despite not having contact with the mother. No neonatal complications were observed. The third positive mother was admitted asymptomatic to the obstetric department in September 2021 due to preterm premature rupture of membranes at 20 weeks of gestation in a high-risk twin pregnancy. At 21.4 weeks of gestation her clinical conditions deteriorated, and she delivered two stillborn fetuses: SARSCoV- 2 was detected in all tissues samples. The lung of the first fetus only showed interstitial pneumonia features. Conclusions. We detected SARS-CoV-2 in placentas of both the second and third trimester, implying the passage of the virus through the placenta to the fetuses as the presence of SARSCoV- 2 RNA was demonstrated in swabs and foetal tissues.
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Introduction: adolescent pregnancies represent a global public health problem associated with multiple consequences on the well-being of young mothers, their babies and general population. The biggest prevalence of adolescent pregnancies in Europe can be found in southeastern countries. Objective(s): to analyze the features and outcomes of adolescent deliveries during the COVID-19 pandemic. Material(s) and Method(s): retrospective, descriptive study of adolescent mothers delivered in the period 01.01.2020-31.12.2021 in two university medical centers: the Emergency Clinical County Hospital of Arad (Romania), and Clinic of Gynecology and Obstetrics of University Clinical Center of Vojvodina (Serbia). Demographic and anthropometric parameters of adolescent mothers, number and way of delivery, birth weight and Apgar score of neonate, COVID-19 status and data about pathologies and complications associated with pregnancy and delivery were collected from medical records and analyzed statistically using IBM SPSS. Result(s): there were total of 458 adolescent mothers, aged between 12 and 17 (average 16.07+/-1.07 year). From urban environment there were 182 (60.3%) cases and from rural 276 (39.7%) cases. Number of previous pregnancies and births ranged from 0-3, with majority of mothers being primiparas (76.2%). Cesarean section was performed in 40.8%, vaginal birth in 59.2%. The most common indications for cesarean section were maternal-pelvic disproportion, transverse lie or deflected cephalic presentation, twin pregnancies, severe fetal distress, preeclampsia, scarred uterus with risk of rupture and premature placental abruption. The average fetal weight at birth was 3010.22g ranging from 860 to 4500 g. The average Apgar score was 8.73. There were 9.66% of premature labors. There were 9 (2%) positive COVID-19 cases at birth and additional 4 (0.9%) cases who had COVID-19 during pregnancy. We observed a very high percentage (73.86%) of pregnancies without adequate prenatal care. Conclusion(s): Adolescent mothers are prone to develop complications compared to general population. The COVID-19 pandemic might have additional negative influence on the addressability of underage mothers to medical care, this phenomenon being the basis of most complications during pregnancy. Effective interventions, better sexual education and social programs are needed to reduce the number of adolescent mothers and to help them get a much better social reinsertion and an increase in the general quality of life.Copyright © 2023
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Objective: To determine relationship of SARS-CoV-2 infection to the risk and severity of preeclampsia, as well as its impact on newborns. Design and method: We performed a systematic search in databases (PubMed, ScienceDirect, ProQuest, and Cochrane Library) for studies examining impact of SARS-CoV-2 infection on pregnancy. Included studies were evaluated for risk of bias based on the Newcastle Ottawa Score. A meta-analysis was conducted using the data extracted from each study. Review Manager (RevMan) 5.4 was utilized to compute the summary of odds ratios (OR), mean differences (MD), and 95% confidence intervals (CI) for the outcomes. Our outcomes of interest are preeclampsia, preeclampsia with severe features, eclampsia, fetal distress and still birth. The other outcomes are preterm birth (< 37 week), instrumental labor, sectio caesaria and birth defect. Results: We identified twenty two observational studies involving 1,025,048 pregnancy patients. Based on the analysis, SARS-CoV-2 infection in pregnancy significantly increased the risk of preeclampsia [OR 2.01(95% CI 1.59-2.53;p < 0.00001;I2 = 82%)], and the severity was based on the high prevalence of preeclampsia with severe features [OR 3.04(95% CI 1.19-7.78;p = 0.02;I2 = 91%)] and eclampsia [OR 17.73(95% CI 13.83-22.72;p < 0.00001;I2 = 0%)]. Poor outcome in newborns in terms of incidence of preterm birth [OR 1.65(95% CI 1.54- 1.76;p < 0.00001;I2 = 86%)], fetal distress [OR 19.18(95% CI 17.14-21.45;p < 0.00001;I2 = 99%)] and still birth [OR 2.12(95% CI 1.74-2.59;p < 0.00001;I2 = 0%)], were also significantly associated with SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection during pregnancy increases the risk and severity of preeclampsia and gives a poor outcome in newborn.
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Introduction: The management of the obstetric patient is a matter of great importance, since it is necessary to guarantee the termination of the pregnancy with satisfactory results for the mother and the child, thus avoiding possible maternal or infant deaths. The general objective of our study was to describe obstetric morbidity and mortality in the emergency department of the Ambato Regional Teaching Hospital during the peak of the COVID-19 pandemic. Methodology: Hospital emergency care records were studied in the period January-September 2020, through an observational, retrospective, descriptive study. In this work, emphasis is placed on the obstetric patient in the period during pregnancy and around childbirth, including the immediate puerperium. Results and Conclusion(s): it was evidenced that in the emergency service of the Ambato Regional Teaching Hospital of a total of 1082 patients treated in the emergency room, 92 of these corre-sponded to obstetric patients. The highest morbidity corre-sponded to eutocic deliveries with 39 patients. In the emergency department, 126 Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests were performed, 92 of them on all the obstetric patients seen in the emergency department, resulting in the virus being identified in 46 patients. The most affected age group in COVID patients was 18 to 33 years old, with overall age of 27 years. COVID morbidity predominated in obstetric patients, in the third trimester of pregnancy, 11 of them with fetal distress. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
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Objective: To determine the frequency of COVID-19 in pregnant women and its effects on feto-maternal outcomes at a tertiary care hospital. Method(s): Present cross-sectional study was conducted at the department of gynae and OBS, at Ziauddin University and Hospital Karachi, from April, 2020 to August 2020. All the pregnant women at term who were admitted for delivery in maternity unit, aged more than 18 years old, and of either parity, were included. After taking written and verbal informed consent women were offered to be tested for SARS-COV2 via Nasopharyngeal PCR swab test. Those women who tested positive for the COVID-19 test were treated according to the severity of the symptoms, and asymptomatic and clinically sound patients were shifted to isolation rooms. Women who presented in spontaneous labour were treated as SARS COV2 positive for safety purposes. SPSS version 22 was used to perform the analysis, all of the data. Result(s): A total of 454 pregnant females were tested for SARS-CoV2 via a nasopharyngeal PCR swab test, and 12 (3%) women tested positive. Out of the 12 women testing positive, 4 were preterm births, and no significant association was found between COVID PCR being positive (p=0.00) and preterm birth (p=0.112). Five out of 12 women testing positive had an episode(s) of leaking. There was a strong association between COVID PCR being positive and episodes of leaking (p=0.001). Three out of 12 women testing positive had fetal distress, while 19 out of 454 women testing negative had fetal distress (p=0.004). There were no cases of APH or PPH reported in women testing positive;however, out of 442 women testing negative, 1 APH and 3 PPH were reported. There was no mortality in either of the patients, mother or neonate. Conclusion(s): As per the study conclusion, the frequency of COVID-19 among women during pregnancy was observed to be only 3%, which was significantly linked to the pneumonia, leaking, and fetal distress. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Introduction: With the rise in COVID-19 cases round the world, we have the problem of COVID-19 positive pregnancies at hand. Various case series and reports around the world have shown a high incidence of cesarian deliveries in these patients. We have attempted to study the factors predicting an increase in cesarean section (CS) rates in COVID-19 positive pregnancies admitted to our institution. Methods: Retrospective analysis of all deliveries of COVID-19 affected pregnancies in a tertiary care center in north Kerala from 15 April 2020 to 31 October 2020. There were 253 deliveries during this period with 183 cases of cesarean and 70 vaginal deliveries. The data were entered in Microsoft Excel and analyzed with appropriate statistical software. Results: There was 71.42% cesarean section rate in women below 35 years of age compared to 100% in those above 35 years. The rate was higher among nullipara (77.77%) compared to 67.32% among multipara. There was also a positive correlation between cesarean with obesity [prepregnancy body mass index (BMI) more than 30]. There were 70.22% term cesareans compared to 89.28% in preterm. Induction of labor also seemed to increase rate of cesarean. Fetal growth restriction (88.88%) contributed more to cesarean rates unlike those without (71.06%) preterm rupture of membranes (PROM) and meconium staining of amniotic fluid (MSAF) was also seen to increase the possibility of cesarean. Cardiotocogram abnormalities (13.83%) were another important contributing factor. A total of 100% of patients with abnormal cardiotocogram (CTG) underwent cesarean section when compared to only 67.88% in those with normal CTG. In patients delivered while still positive, the incidence of cesarean section was 77.63%, while this reduced to 63.04% in those whom delivery was delayed till seronegativity achieved. A total of 75.95% cases were done in the morning. There were 19.67% cases of fetal distress which added to the cesarean numbers. Conclusions: We found increased maternal age, obesity, nulliparity, fetal growth restriction, PROM, MSAF as factors which contributed to increased cesarean section rates in COVID-19 positive pregnancies. Hence these pregnancies need careful monitoring. © The Author(s).
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Background: The most common benign neoplasms of the placenta are non-trophoblastic tumours. They include chorioangioma, teratoma, leiomyoma and hepatocellular adenoma. Chorioangioma is the most common subtype. The incidence of chorangioma is 0.5-1.0%. Small chorangiomas are clinically insignificant. Giant chorioangioma is rare tumours, measuring more than 4 cm in diameter and seen in association with elderly primi, twin pregnancy, hypertension, diabetics, and female fetus. Giant chorioangioma is associated with complications that can affect the mother, fetus, or neonate. Aim(s): This is a retrospective study of chorangioma cases seen at Institute of Pathology, Medical faculty, Skopje during a 10-year period from 2012 to 2021. Method(s): Macroscopic findings, gestational weeks at delivery, maternal age and outcome of pregnancy were evaluated. Histological and immunochistochemical analyses of the placental chorangiomas were preformed. Results & Conclusion(s): In period of 10 years 6 causes of placental chorangioma were clinically identified and histopathologically confirmed. Four cases were giant chorangiomas measuring from 8 to 13 cm. One of the cases was identified as chorangioma of the umbilical cord. Three of the cases shows potential maternal risk factors like primary infertility, extreme obesity and post COVID status. The median gestational age of delivery was 33 + 6 weeks and 39.6 weeks, respectively. The maternal age range was between 25 to 34 years. Four of the pregnancies had favourable outcome with no complications during and after birth. One was with foetal distress and one with premature delivery. Microscopic examination of the mass showed numerous proliferative thin walled capillaries lined by flattened endothelium and separated by fibrous stroma. This was further confirmed by IHC for CD34, which showed strong reactivity of endothelial cells.
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Introduction: The emergence of the COVID-19 pandemic in 2020, have similar effect on pregnant women as influenza or other coronavirus infections. The impact of the COVID-19 pandemic is likely to be context specific and differ depending on a variety of country-specific factors. A global pandemic is likely to only reveal its consequences after significant time passes, and literature published before or immediately after policies are implemented may not capture all relevant outcomes. Material(s) and Method(s): The study was conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal. It included all antenatal COVID 19 patients which reported to the hospital during April 2020 to May 2021, 1st wave from April 2020 to December 2020 and second wave from Jan 2021 to May 2021 after taking due informed consent. The detailed history and full clinical and general examination were performed using a predesigned proforma. The antenatal patients were categorized into mild, moderate and severe COVID. Data on clinical manifestations, laboratory tests, maternal and perinatal outcomes were extracted and analysed. The comparisons of 1st wave and second wave was done. Result(s): There were 210 confirmed pregnant women with coronavirus disease (COVID-19). 26 maternal deaths occurred from these confirmed cases. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of maternal complications and caesarean section. In initial months (April 20 to December 20) there were 89 confirmed cases of covid 19 and 4 maternal mortality and from January 21 to May 21 there were 121 cases and 22 maternal deaths. The second wave has taken greater toll on life of pregnant women. Conclusion(s): In the second wave, pregnant women with severe or critical coronavirus disease were admitted to the ICU, intubated if they require mechanical ventilation, and were at increased risk of composite morbidity. Thus, the second wave affected the pregnant women in a much serious way and the maternal as well as fetal outcome were very poor. Copyright © 2022, Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.
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Recent studies have reported that Coronavirus Disease 2019 (COVID-19) can be the cause of peripheral facial paralysis and neurological symptoms may be the only manifestation of the disease. Hereby, the authors report an interesting case of a pregnant COVID-19 positive female with Bell's palsy, in third trimester of pregnancy. A 33-year-old female, G3P0L0A2, presented with left-side deviation of angle of mouth, excessive lacrimation and redness of right eye for the past three days. She had involuntary drooling on right and left side labial commissural deviation, absence of forehead frowning, inability to close her right eye (positive Bell’s phenomena), and ipsilateral lagophthalmos. No lesions were seen on the external ear and otoscopy was normal. She was confirmed to have right-sided facial nerve palsy. She had an uneventful course of pregnancy till term and underwent caesarean section at 40 weeks, in view of foetal distress. Pregnancy and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, both are immunocompromised state, and hence could be a risk factor for Bell’s palsy. But larger studies with more cases are required to prove the causal association.
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Aim: Coronavirus disease 2019 (COVID-19) pandemic is an ongoing emergency with limited data on perinatal outcomes. The aim of the study was to describe key maternal, perinatal, and neonatal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from low–middle income settings. Materials and methods: We conducted a retrospective observational study in a tertiary level public hospital in India. All pregnant women admitted from May 2020 to July 2020 were included in the study. Maternal demography, medical and obstetric complications, clinical characteristics, and investigations were described. Symptomatic infected women were compared with the asymptomatic group for important outcomes. Key perinatal outcomes such as early pregnancy losses, fetal distress, stillbirths, and placental changes were evaluated. Neonatal characteristics of SARS-CoV-2 positive and negative pregnancies were described and compared. Results: Among the 702 pregnant women enrolled, the incidence of SARS-CoV-2 infection was 16.2%, with the majority being asymptomatic. Infected women had an increased mortality, while symptomatic women had a significant risk of stillbirth. Mean placental weight of infected women was significantly higher. Neonatal infection rate was 9.1%, with 50% manifesting mild respiratory symptoms without any mortality. Conclusion: This study provides a comprehensive description of important antenatal, intrapartum and neonatal complications and outcomes in a low–middle income setting characterized by high disease burden and an overwhelmed health care system. Clinical significance: Incidence of SARS-CoV-2 infection in pregnancy was 16.2%. The symptomatic infected women had increased stillbirth and mortality. Neonatal transmission was seen in 9.1% with good survival.
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Introduction: Tuberculosis (TB) is an airborne infectious disease caused by the Mycobacterium tuberculosis (MTB) complex. It attacks the lungs and other extra-pulmonary sites. It remains a major public health concern in Malaysia with incidence of 79/100,000 in 2015. Case Description: We report a case of a 29-year-old lady, presented with a complain of generalised abdominal pain for 2 months. Patient had Covid-19 infection in pregnancy 8 months ago and underwent lower segment caesarean section at term for fetal distress. In 2018 she had TB screening for contact tracing which turned out to be negative. In this current presentation, a Computerized-Tomography (CT) Abdomen-Pelvis scan reported a left ovarian lesion with pseudomyxoma peritonei and omental caking. Diagnostic laparoscopy showed dense adhesions between peritoneal wall and surrounding organs with multiple pockets and fluid collections seen. Whitish friable lesion seen over the peritoneum. Samples sent for histopathology, culture and sensitivity and MTB PCR. Histopathology sample returned as caseating granuloma;suggestive of extrapulmonary tuberculosis. Microscopically, acid fast bacilli seen in Ziehl-Neelsen staining. Peritoneal fluid was transudative in nature. The diagnosis of peritoneal tuberculosis was established, and patient was referred to Infectious Disease team for treatment of active TB. Discussion: Reactivation of latent TB may be explained by immune-suppressive state associated with Covid-19 may be implicated in the progression of latent to active TB in a similar manner to HIV. Very few cases post Covid-19 activation of latent TB have been reported. This is one such a case.
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Introduction: Morbidly adherent placenta (MAP) refers to any placental implantation with abnormally firm adherence to myometrium. The American College of Obstetricians and Gynecologists cites the incidence be as high as 1 in 533 deliveries. There are three degrees of morbidly adherent placenta: placenta accreta, increta and percreta. The rate of morbidly adherent placenta with previous caesarean section scar and unscarred uterus also increased significantly. Previous caesarean section and co-existing placenta previa remained the major risk factors. We report a case of an adherent placenta in the absent of prior risk factors and discuss modalities of management options available. Case Description: A 46-years-old female patient without history of scarred uterus, gravida 8, para 7, pregnant at 39 weeks admitted for Covid-19 positive in active phase of labour with foetal distress, hence the indication for an emergency caesarean section. The diagnosis of adherent placenta is made during the caesarean. She was successfully managed surgically with subtotal hysterectomy in view of age and parity of the patient. Discussion: Morbidly adherent placenta often associated with severe maternal morbidity and mortality. Hence, early detection, high index of clinical suspicion and timely decision may reduce patient morbidity as the surgeon strategizes on the best management of the case, mainly in anticipating the difficulty that may be encountered during surgery.
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Introduction: In the obstetric population, ARDS due to COVID- 19 has been found to have worse outcome. Treatment of severe COVID-19 has been a real challenge world over. This case report is aimed at giving an insight to the management of COVID-19 in a pregnant patient. Case report: A 36-year-old primi with 33 weeks and 2 days of gestation was admitted with fever, cough, and shortness of breath for 4 days. The patient was found to be positive for COVID. The patient was initially admitted in the wards. In view of worsening oxygenation patient was shifted to the ICU. The patient was initiated on high flow nasal cannula with FiO2 100%, but maintained saturation of 82-84% with that. Hence, patient was intubated and initiated on mechanical ventilation. Post intubation patient maintained a saturation of 86-88% with 100% FiO2. Within half an hour of intubation, fetal bradycardia was noted. The patient was taken up for an emergency Caesarian section. At birth, the child did not cry and received two cycles of CPR and positive pressure ventilation and was shifted to the NICU. The baby was extubated after days. Postpartum the mother required 70% FiO2 to maintain 90% saturation which further improved upon proning. The Pplat and inturn the driving pressure improved upon Cesarian section. Patient required one more round of proning on D5 of ICU stay. During the course of hospitalization, the patient had one episode of septic shock and 2 episodes of urosepsis. This was treated appropriately with antibiotics. Bedside sonography revealed right-sided Hydro Uretero Nephrosis which was tackled with DJ stenting. On day 11 of ICU stay, patient was tracheostomised. By the end of 1 month, the mother was decannulated and discharged. Discussion: Pregnancy especially in the final trimester causes changes like reduced functional residual capacity and compliance. Airway edema in pregnancy complicates intubation making it difficult. Proning though not contraindicated may be difficult to achieve in pregnant patients. In our patient, we could prone the patient postpartum with ease. Though Caesarian section was done in view of fetal distress. But postpartum it was easier to ventilate the patient and oxygenation showed steady improvement. AJOG also suggests that a Caesarian section may be considered after 34 weeks in a critically ill COVID-19 patient. We also had the luxury of a neonatal ICU and the neonate could be saved though the mother's well-being was our priority. Pregnancy and gestational diabetes mellitus and receiving steroids made the patient susceptible to multiple infections which we handled by source control and antibiotics. Conclusion: Though the pandemic is on the decline this case report is an attempt to throw light on the management of the critically ill pregnant patient with ARDS. Cesarean section may aid in the management of the pregnant patient with severe ARDS.
ABSTRACT
Introduction: The clinical therapy of COVID-19 infection during pregnancy is still insufficient and limited. The current literature on COVID-19 infection during pregnancy and childbirth is summarized in this article, with a focus on maternal and neonatal outcomes. Material and methods: From June 1 to September 7, 2020, a systematic search of pertinent medical subject heading (MeSH) terms, covered by the electronic databases Web of Science and Scopus, PubMed, Google Scholar, and SID key phrases including coronavirus or COVID-19 and pregnancy was undertaken. The search and selection criteria were restricted to English and Farsi literature. COVID-19 in pregnancy articles of all types were considered in the study. The references of relevant studies were also searched. After deleting duplicate and ineligible items, a total of 21 articles were collected. Result: We found 21 studies with a total of 6,569 pregnant women who had COVID-19 infection: only one publication provided disease severity: 368 (95.6%) mild cases, 14 (3.6%) severe cases, and three (0.8%) serious cases. A total of 6,569 women gave birth more often by caesarean than by vaginal delivery. With multiple organ dysfunction syndromes (MODS), some women developed symptoms that necessitated ICU admission. The most commonly administered treatments for pregnant women with COVID-19 were hydroxychloroquine, Beclomethasone, Calamine, diclofenac sodium, Methylprednisolone, Azithromycin, Ganciclovir, Chinese herbal medicine, and Oseltamivir. The most commonly reported symptoms were fever and cough, followed by rhinorrhea, chest tightness, dyspnea, nasal congestion, and myalgias. Maternal outcomes included premature rupture of membranes, maternal death (21), gestational diabetes, preeclampsia, placental abruption, fetal distress, anemia, preterm birth (< 37 weeks), and fetal growth restriction, miscarriage, hypertension, and influenza. Neonatal intensive care unit (NICU) admission, prematurity, birth weight 2,500 g, preterm delivery (37 weeks), fetal discomfort, neonatal asphyxia, stillbirth (5), and neonatal death (9) were among the outcomes for babies. All of the infants had good Apgar scores. Conclusion: Prenatal and neonatal outcomes appear to be favorable in the majority of cases. Pregnant women and babies should be considered particularly vulnerable populations in terms of COVID-19 preventive and management strategies.