ABSTRACT
Background: Coronavirus disease 2019 (COVLD-19), the global pandemic that has spread throughout the world, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the limited scientific evidence on the manifestations and potential impact of this virus on pregnancy, we decided to report this case. Case presentation: The patient was a 38 year-old Iranian woman with a triplet pregnancy and a history of primary infertility, as well as hypothyroidism and gestational diabetes. She was hospitalized at 29 weeks and 2 days gestational age due to elevated liver enzymes, and finally, based on a probable diagnosis of gestational cholestasis, she was treated with ursodeoxycholic acid. On the first day of hospitalization, sonography was performed, which showed that biophysical scores and amniotic fluid were normal in all three fetuses, with normal Doppler findings in two fetuses and increased umbilical artery resistance (pulsatility index [PI] > 95%) in one fetus. On day 4 of hospitalization, she developed fever, cough and myalgia, and her COVID-19 test was positive. Despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses leading to the rapid development of absent umbilical artery end-diastolic flow. Finally, 6 days later, the patient underwent cesarean section due to rapid exacerbation of placental insufficiency and declining biophysical score in two of the fetuses. Nasopharyngeal swab COVID-19 tests were negative for the first and third babies and positive for the second baby. The first and third babies died 3 and 13 days after birth, respectively, due to collapsed white lung and sepsis. The second baby was discharged in good general condition. The mother was discharged 3 days after cesarean section. She had no fever at the time of discharge and was also in good general condition. Conclusion(s): This was a complicated triplet pregnancy, in which, after maternal infection with COVID-19, despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses, and the third fetus had a positive COVID-19 test after birth. Therefore, in cases of pregnancy with COVID-19 infection, in addition to managing the mother, it seems that physicians would be wise to also give special attention to the possibility of acute placental insufficiency and subsequent fetal hypoxia, and also the probability of vertical transmission.Copyright © 2022 Goldstein and Associates. All rights reserved.
ABSTRACT
Purpose/Objectives: <Most used lower respiratory tract models consist of cell monolayers which lack of tissue and organ level response and of in-vivo phenotype. Ex-vivo lung tissues have short viability and limited availability. Lung organoids, which recapitulates better the 3D cellular complex structures, architecture, and in-vivo function, fail to reach maturity even after 85 -185 days of culture. Therefore, these models have a limited use to study fetal lung diseases. Other lung models, consist of only one structure of the lower track, such as bronchial tubes or alveoli, but fail to recapitulate the whole organ structure. In this work, cell microenvironment was used to promote the self-organization of epithelial and mesenchymal cells into macro-structures, aiming to mimic the whole and adult lower respiratory tract model> Methodology: <Different parts of the microenvironment were considered to create a compliant matrix. Alginate-Gelatin hydrogels were used for 3D encapsulation of mesenchymal origin cells. This hydrogel provided a stiffness like the one on the lung. Base membrane zone proteins were used to induce the attachment and guidance of epithelial cells into 3D structures. The interactions between both cell types, further guided them into lung fate. The morphology of resulting organoids was analyzed using immunostaining and confocal microscopy, LSM710, with the purpose of evaluate polarization, protein markers, and different cell populations. Quantitative PCR was performed to evaluate and compare the expression of lung fate genes with traditional cell monocultures.> Results: <The engineered microenvironment and protocol development done in this work resulted in macro-scale structures, in which branching morphogenesis occurred at day 21. Different structures were identified in the organoid including bronchial tube, bronchioles, and alveoli. Polarization of the organoids was confirmed by visualization of E-cadherin, and ZO-1. Expression of Surfactant Protein B and C into the organoids confirmed the presence of alveolar type II cells, which are only present in the later development stage. Surfactant Protein B, Transmembrane protease, serine 2, TMPRSS-2, and Angiotensin-converting enzyme 2, ACE2 were found to be significantly higher expressed into the organoids in comparison with traditional epithelial cells monolayers.> Conclusion/Significance: <Growth factors are normally used to induce the fate of stem cells into lung organoids;however, these fail to reach maturity. Here, we developed a new methodology to induce the formation of the organoids based on the cell microenvironment. The resulting organoids require less time for development. The initial stage of adult cells can be modulated through culture conditions induce a 3D structure like the adult lung. As such, these organoids have the potential to be used for modeling adult diseases and to develop specific models from patient cells, which is one step forward to personalized medicine. SFTPB is one of the main proteins which facilitates the breathing process. Its high expression into our model may indicate that breathing occurs into our lung organoids. The higher expression of TMPRSS-2 and ACE2 into the organoids has a major significance in the field of virology since both proteins are the mainly entrance of SARS-CoV-2, and influenza H1N1.>.
ABSTRACT
Background: Adverse perinatal outcomes in patients with novel coronavirus infection (COVID-19) have been described in isolated cases. The ongoing effect of the virus on the body necessitates the accumulation of information on the causes of complications during the gestation period, especially in mild and moderate disease forms that do not lead to severe respiratory and multiple organ failure, which is important for managing pregnancy and developing measures to prevent adverse perinatal outcomes in patients with COVID-19. Case report: The paper describes 2 cases of antenatal fetal death in pregnant patients with mild and moderate COVID-19 and a familial history of non-developing pregnancies that occurred in the third wave of the epidemic process. One patient was recorded to have antenatal fetal death that occurred at 37–38 weeks’ gestation with a birth weight of 2670 g and the other patient had that at 23–24 weeks’ gestation with a birth weight of 520 g in the late stages of the disease (days 9 and 13, respectively). These patients are described to have placental morphological alterations;there was a preponderance of the signs of severe maternal vascular malperfusion as thrombosis in the intervillous space with massive fibrin deposits;large hematomas and infarcts, extensive numerous areas of fibrinoid villous agglutination and an inflammatory reaction. At the same time, the standard methods were used to detect viral RNA in the tissues of the placenta, fetal lungs, and maternal nasopharynx. Conclusion: The analysis of each antenatal fetal death case in pregnant patients with COVID-19 is the basis for the formation of recommendations for the prevention of perinatal complications.
ABSTRACT
Aim: The aim of the article was to emphasize the need for a fetal medicine unit at tertiary care hospitals. Background: The incidence of Rh-negative in India is 5–10%. The issue of Rh incompatibility arises when the mother is Rh-negative and the fetus is Rh-positive. Rh alloimmunization can lead to fetal anemia, hydrops fetalis, and even intrauterine death. It leads to perinatal loss of 1–2.5%. Fetal anemia is a serious complication in pregnancy and is associated with perinatal morbidity and mortality. Intrauterine transfusion (IUT) is a good treatment option for fetal anemia due to Rh incompatibility. Intravascular transfusion offers the best chance of survival to fetuses severely affected with Rh isoimmunization, overall survival exceeding 80%. In the cases with detectable antibodies, prenatal monitoring of maternal antibody titers and fetal middle cerebral arterial-peak systolic velocity (MCA-PSV) Doppler ultrasound assessment helps to plan fetal blood sampling and IUT procedures. Thus, the establishment of fetal medicine unit at tertiary care centers in India is need of the hour. Case description: We report a case of 32-year-old G4P3L1END1IUD1 with Rh-negative sensitized pregnancy with fetal anemia, managed successfully with IUT. Clinical significance: Early diagnosis of fetal anemia by serial MCA-PSV measurements and referral to fetal medicine unit are important for improving the outcome in Rh-negative sensitized pregnancies. Conclusion: Establishment of fetal medicine unit at tertiary care centers is the need of the hour to improve the fetal outcome in high-risk pregnancies like Rh-negative pregnancy.