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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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SARS-CoV-2 infection during pregnancy has significant implications for both mothers and their offspring. Pregnant individuals are more likely to progress to severe or critical COVID-19 than nonpregnant reproductiveaged women. Similarly, COVID-19 is associated with a number of pregnancy complications including preterm birth, hypertensive disorders of pregnancy, and cesarean delivery. These adverse outcomes and the morbidity for pregnant people with COVID-19 are closely linked to the severity of COVID-19, and the variant of SARS-CoV-2. Recent data demonstrate that the worst maternal and fetal outcomes were present during the time period of the Delta variant of SARS-CoV-2. Specifically, there was an increase in stillbirth observed in association mostly with the Delta variant due to placental damage, and a greater risk of intensive care unit admission when compared to time periods when other non-Delta strains were predominant. Like other populations, pregnant individuals with other comorbidities such as obesity and chronic hypertension are at increased risk of more severe disease. Early in the pandemic, pregnant patients were much less likely than the general population to be vaccinated, due to a lack of data for vaccine efficacy and safety in pregnancy. As reassuring data have emerged, the vaccination rate of the pregnant population has increased, resulting in decreased disease severity and improved maternal outcomes. Vaccination also has beneficial implications for early neonatal health. The long-term implications of SARSCoV- 2 infection during pregnancy for both mothers and their children remain largely unknown and are a subject of ongoing investigation.
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Background: SARS-Cov-2 infection during pregnancy causes adverse effects on the maternal and foetal outcome. In order to minimize the adverse outcomes of COVID-19 infection, Government of India recommends COVID-19 vaccination during antenatal period with Covaxin and Covishield. Despite the recommendation of vaccination by the Government of India, there are few clinical trials and still there exists a gap in the knowledge and awareness of outcome of pregnant women after COVID-19 vaccination during pregnancy. Material(s) and Method(s): This is a prospective observational study conducted in 50 antenatal women who were already vaccinated at a tertiary care hospital in Southern India from August 2021 to October 2021. All antenatal women who were already vaccinated and attending the OPD were considered for further follow-up. Result(s): This study was conducted among 50 antenatal women who received COVID-19 vaccination during pregnancy. Among these antenatal women, 27 (54%) were multigravida, 23(46%) were primigravida, 32(64 %) completed 2 doses of covid vaccination, and 18(36%) took a single dose in antenatal period. Among the vaccinated 27(54%) pregnant women had no symptoms after vaccination. Though 23(46%) women had symptoms after vaccination, symptoms are mild and resolved within 48 hours. All vaccinated antenatal women were observed till delivery, among them 46 (92%) had term deliveries, 4(8%) had preterm deliveries and 8[16%] new-born babies required NICU admission. Conclusion(s): COVID-19 vaccination was not associated with adverse immediate pregnancy outcomes or new born complications. Hence COVID-19 vaccination is strongly recommended in antenatal period.Copyright © 2023 Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.
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COVID-19 has affected the population worldwide drastically with a tremendous impact on obstetric population which has led to serious concerns regarding maternal and fetal outcomes. Although there are recommended guidelines regarding delivery and management of complications, due to changes in characteristics of COVID-19 infection, they are constantly changing and evolving. Method(s): Prospective cohort study done during the covid pandemic from 1st April 2020 to 15th Feb 2022 in the department of Obstetrics & Gynecology, SKIMS MCH Srinagar J&K. The parameters measured were severity of covid disease, maternal age, gestational age, parity, blood investigations, mode of delivery, APGAR score, neonatal infection status and post-delivery complications. Result(s): A total of 311 pregnant covid 19 positive patients were included in the study who were actively managed.239 (76.85%) were delivered by casearean section and 72 (23.15%) by NVD. 92% patients had mild symptoms only, 8% had severe symptoms with 1.6% rate of ICU admission and 1.2% mortality rate. 83% delivered at term, 17% had preterm deliveries.8% patients had pneumonitis with positive findings on CT scan.24% patients had anemia, 12% had GDM, 10% had PIH, 10% had IHCOP, 5% had PPH, 1.6% had APH. All the neonates were negative for covid 19. 80% babies had an APGAR score of >= 8/10 at 1 min of birth with a mean birth weight of 2400 g +/- 500. No postdelivery complication was noted. Conclusion(s): Our study concludes that SARS-CoV-2 infection can lead to unfavorable maternal and perinatal outcomes.
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Introduction: Pregnancy-related acute kidney injury (PR-AKI) in India is largely showing a declining trend due to improved and accessible obstetric care. Nevertheless, PR-AKI continues to cause significant maternal and fetal morbidity and mortality. This study was taken up with the intention to study the incidence and clinical spectrum of AKI in pregnancy in recent times and assess maternal and neonatal outcomes Methods: All pregnant women admitted in the Department of Obstetrics and Gynecology at St John's Medical College Hospital, Bengaluru between January 2018 to June 2020 were screened for AKI with the following criteria 1. Increase in serum creatinine to >0.8mg/dL and/or a sudden increase in serum creatinine by more than 50% when prior renal function was normal. 2. Oligo-anuria 3. Need for renal replacement therapy Women with preexisting CKD were excluded. Patient's clinical and laboratory details recorded. Dialysis support was provided if indicated. The clinical profile and renal outcome of the mother and fetal outcome was assessed at the time of discharge. Mothers' were also followed up at the end of 3 months of postpartum period. Recovery was categorized as Complete recovery- normal serum creatinine (<0.8 mg/dL) or a previously known baseline and no proteinuria /hypertension at the end of 3 months Partial recovery- renal function improved but serum creatinine did not return to normal range and patient was dialysis independent. No recovery- patient continued to require dialysis at the end of 3months. Result(s): Of the 2650 deliveries in the study period 42 women (Mean age 26.9 +/-3.6 years) were diagnosed AKI during pregnancy (1.58%). Baseline characteristics and outcomes are depicted in table 1. Majority of women (n=37) were referred from peripheral hospitals. Hypertension and decreased fetal movements were the common reasons for referral. Third trimester was the most common time of presentation (76.1%). Severe Preeclampsia and HELLP syndrome was the leading cause of AKI (59.5%).ATN secondary to obstetric complications, sepsis and hemolytic uremic syndrome were the other causes. One case each of cortical necrosis, acute fatty liver of pregnancy and COVID 19 associated AKI was seen. Mean duration of hospital stay was 12.1+/-6.9 days. More than one third patients' required ICU stay (35.7%).12 patients (28.5%) required renal replacement therapy. Of them, 3 were dialysis dependent at the end of 3 months and 4 had partial renal recovery. 3 patients expired during hospital stay. Fetal survival was 69.04%.13 babies' required NICU care (44.8%). Neonatal outcomes are summarized in table 2. Close to one third of the pregnancies with AKI were associated with intrauterine fetal demise (28.5%). Low birth weight and prematurity were the common reasons for NICU admission with mean NICU stay of 8.2 +/-2.3 days [Formula presented] [Formula presented] Conclusion(s): Severe preeclampsia was the most common cause of AKI in our study. PR-AKI continues to be a significant problem in the peripheries of developing countries where availability of health care facilities is meager, with late referral to tertiary care centers. One third of the patients required ICU stay & dialytic support. Women who required dialysis had poorer renal prognosis. There was 30% fetal loss seen in PR-AKI and also a higher incidence of low birth weight and prematurity. No conflict of interestCopyright © 2023
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The novel coronavirus infection (COVID-19) is a global public health emergency. Since its outbreak in Wuhan, China in December 2019, the infection has spread at an alarming rate across the globe and humans have been locked down to their countries, cities and homes. As of now, the virus has affected over 20 million people globally and has inflicted over 7 lac deaths. Nevertheless, the recovery rate is improving with each passing day and over 14 million people have recuperated so far. The statistics indicate that nobody is immune to the disease as the virus continues to spread among all age groups, newborns to the elders, and all compartments including pregnant women. However, pregnant women may be more susceptible to this infection as they are, in general, highly vulnerable to respiratory infections. There is no evidence for vertical transmission of the COVID-19 virus among pregnant women, but an increased prevalence of preterm deliveries. Be-sides this, the COVID-19 may alter immune response at the maternal-fetal interface and affect the well-being of mothers as well as infants. Unfortunately, there is limited evidence available in the open literature regarding coronavirus infection during pregnancy and it now appears that certain pregnant women have been infected during the present 2019-nCoV pandemic. In this perspective, we study the impact of the COVID-19 infection on vertical transmission and fetal outcomes among pregnant women.Copyright © 2022 Bentham Science Publishers.
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Objective. COVID-19 is a pandemic inflammatory disease where endothelial dysfunction, observed also in mildly symptomatic patients, could affect the placenta and compromise pregnancy outcome. Our aim was to study the pregnancy outcome of patients with previous SARS-CoV-2 infection contracted during gestation. Materials and Methods. This is a retrospective study and patients were enrolled with an anamnestic interview during the puerperium. We enrolled 41 women who contracted SARSCoV- 2 infection before twenty-four weeks of gestational age;87 who contracted the infection after twenty-four weeks of gestational age;and a control group of 159 women, who did not contract infection during pregnancy. Results. Maternal anthropometric, anamnestic and obstetric features were similar in the three groups. There is no relevant difference between the results of the three categories examined in terms of gestational age at delivery (273.54 days vs 273.73 days vs 274.39 days, p = 0.84), mode of delivery (vaginal delivery 53.66% vs 58.62 % vs 58.49 %;operative vaginal delivery 5.88% vs 9.19% vs 8.80%;cesarean section 41.46% vs 32.18 % vs 32.71 %;p = 0.49), fetal weight at birth (3224.02 g vs 3276.65 g vs 3235.57 g, p = 0.75) admission in neonatal intensive care (0 % vs 2.2 % vs 4.4%, p = 0.30). Conclusions. The SARS-CoV-2 disease with mild symptomatology, contracted during pregnancy, regardless of the gestational age at the time of infection, does not apparently impact on the fetal outcome in any significant way.
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To evaluate the effects of inadequate antenatal care (ANC) caused by the COVID-19 pandemic on pregnant women. In this retrospective study, pregnant women were divided into two groups as those presenting during the pandemic and non-pandemic periods. The pandemic period was selected as March 11, 2020- December 10, 2020 and the pre-pandemic period as March 11, 2019- December 10, 2019 corresponding to the same period a year earlier. Pregnant women receiving ANC three times or less was defined as inadequate ANC. The pregnant women were evaluated in terms of obstetric complications, including premature rupture of membranes, premature birth, placental abruption. gestational diabetes mellitus (GDM), preeclampsia, fetal or neonatal death, and maternal death. The study included 276 patients presenting during the pandemic period and 229 patients presenting during the non-pandemic period. When the pandemic and non-pandemic periods were compared, it was determined that the rates of fetal death, preeclampsia and GDM statistically significantly increased in the former. The rate of adequate ANC was 72.5% (n=166) in the non-pandemic period and 58.3% (n=161) in the pandemic period. When pregnancy complications were compared according to ANC during the pandemic, it was observed that the rates of fetal death, preeclampsia and GDM were higher among the pregnant women with inadequate ANC. Complications due to inadequate ANC may have more significant consequences than complications caused by a possible COVID-19 infection. During the pandemic period, healthcare professionals should ensure that women receive safe and effective care during both pregnancy and childbirth. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
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Background: Pregnancy is one of the most important phase in the life of a woman. She has to go through various physical as well as psychological changes during this period. These psychological changes makes her prone to the mental health problems like depression, stress and anxiety. And the pandemic has just added to the possibility of these problems in the antenatal women. The aim of the present study was to identify the evidence on the psychological impact of COVID-19 among antenatal women which can benefit the health care professionals. Method(s): Literature for the study was obtained from online databases like Pub med, Science Direct, Wiley online library and google Scholars and other resources such as Research Gate, other direct website. Result(s): The reviewed articles report that there was increased prevalence of the psychological problems during Covid-19. Conclusion(s): The study suggests that there is a need to focus on the mental health of the antenatal women to protect their mental health and improve the foetal outcome. Copyright © 2022, Anka Publishers. All rights reserved.
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BACKGROUND: Pregnancy state affects the immune regulation including physical barrier, innate, and adaptive immunity-related to susceptibility of infections and increasing risk for severe to critical case of COVID-19. Further, high risk of thrombosis becomes a challenge in the management of COVID19 in pregnancy due to the strong association with worse outcome. CASE REPORT: Here, we present three cases of pregnant women infected with COVID-19 pneumonia with different outcomes in maternal and fetal condition related to high-risk thrombosis. Serial inflammatory markers were needed to the early detect the disease progressivity in pregnant women with COVID-19. Further, complete assessment of fetus including reverse transcriptase-polymerase chain reaction and chest X-ray must be performed to the early diagnosis of COVID-19 in neonatal whose mother was infected by SARS-CoV-2. CONCLUSION: Pregnancy state affects the immune regulation including physical barrier, innate, and adaptive immunity-related to susceptibility of infections and increasing risk for severe to critical case of COVID-19. Further, high risk of thrombosis becomes a challenge in the management of COVID19 in pregnancy due to the strong association with worse outcome. Although fetal transmission of COVID-19 to fetus remains unclear, complete assessment of fetus including RT-PCR, and chest X-ray must be performed to the early diagnosis of COVID-19 in neonatal whose mother was infected by SARS-CoV-2.
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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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Background and Aims: Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of pregnant women. The aim of this study is to examine severity of COVID-19 disease and maternal and foetal outcome among COVID-19 positive pregnant women undergoing caesarean section. Methods: This retrospective observational study was conducted at a tertiary teaching hospital in Karnataka between 1stApril to 31st July 2021, during which 100 COVID-19 positive pregnant women with ASA physical class II, III and IV who have undergone lower segment emergency caesarean section were selected on the basis of simple random sampling method. Results: A total of 100 women who had undergone caesarean section under spinal anaesthesia with positive SARS-CoV-2 PCR tests were assessed. Mean age was 24.45± 4.3 years, eight women were having severe covid-19 infection and overall mortality rate was 5% (5/100) in women and 1 woman had HELPP syndrome and one met with PPH (post-partum haemorrhage). Seven (7%) COVID-19 pregnant women required intensive care in the perioperative period. Eight neonates required NICU admission and had APGAR score less than 7. Fifty-five (55%) women were asymptomatic. While the rate of pneumonia in symptomatic women was 3.6% (8/45), the pneumonia incidence among all SARS-CoV-2 PCR (+) pregnant women was 8% (8/100). Conclusion: In our study, 61% of patients had pulmonary involvement and the mortality rate was 8% among mothers and 1% in neonates.
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Background: Autoimmune haemolytic anaemia (AIHA) during pregnancy is a rare finding, and few is known about maternal and foetal outcomes. AIHA may either develop or relapse during gestation and postpartum or be an issue in a patient on active therapy who becomes pregnant. AIHA management during pregnancy and lactation is not standardized and drug use is often limited by safety concerns. Aims: We studied AIHA impact on pregnancy focusing on disease severity, treatment need and maternal/foetal outcome. Methods: Through a multicentric retrospective cohort study, we identified 38 pregnancies occurred in 28 women from 1997 to 2021 in 10 European centres in Italy, Denmark, France, the Netherlands, USA, and Spain. All included patients had a previous AIHA history or developed/exacerbated AIHA during gestation or postpartum. AIHA was classified according to the direct antiglobulin test. Results: We registered 18 warm AIHA (10 IgG;8 IgG+C3d), 2 cold agglutinin disease, 3 mixed and 5 atypical forms (Table 1). Evans syndrome (i.e., association of AIHA and immune thrombocytopenia or neutropenia) was present in 4. Mean age at AIHA diagnosis was 27 (3-39) and at pregnancy 32 (21-41) years. AIHA diagnosis predated pregnancy in 15 women and had required at least 1 therapy line in all of them, and >2 lines in 12 (rituximab, N=7;cytotoxic immunosuppressants, N=6;splenectomy, N=5). Among these 15 patients, 6 had a relapse during pregnancy, 3 during postpartum and 9 were on active treatment at the time of pregnancy (steroids, N=8;cyclosporine, N=1;azathioprine, N=1;the latter stopped after positive pregnancy test). A patient with a previous AIHA, relapsed as immune thrombocytopenic purpura during pregnancy. Further 8 patients had an AIHA onset during gestation and 2 postpartum. A patient had AIHA onset during the postpartum of the 1st pregnancy and relapsed during the 2nd one. In the 20 women experiencing AIHA during pregnancy/postpartum, median Hb and LDH levels were 6,4 g/dL (3,1 - 8,7) and 588 UI/L (269-1631), respectively. Management consisted in blood transfusions (N=10) and prompt establishment of steroid therapy+/-IVIG (N=20), all with response (complete N=13, partial N=7). After delivery, rituximab was necessary in 4 patients and cyclosporine was added in one. Anti-thrombotic prophylaxis was given in 7 patients. Overall, we registered 10 obstetric complications (10/38, 26%), including 4 early miscarriages, a premature rupture of membranes, a placental detachment, 2 preeclampsia, a postpartum infection and a biliary colic. Apart from the case of biliary colic and one of the two cases of preeclampsia, 8/10 complications occurred during active haemolysis and treatment for AIHA. Nine foetal adverse events (9/38, 24%) were reported: a transitory respiratory distress of the new-born in a mother with active AIHA, 3 cases of foetal growth restriction, a preterm birth, an infant reporting neurologic sequelae, a case of AIHA of the new-born requiring intravenous immunoglobulins, blood transfusions and plasma exchange, and 2 perinatal deaths. The latter both occurred in women on active AIHA therapy and were secondary to a massive placental detachment and a symptomatic SARS-CoV-2 infection. (Figure Presented ) Summary/Conclusion: AIHA developing/reactivating during pregnancy or postpartum is rare (about 5%) but mainly severe requiring steroid therapy and transfusions. Importantly, severe maternal and foetal complications may occur in up to 26% of cases mostly associated with active disease, pinpointing the importance of maintaining a high level of awareness. Passive maternal autoantibodies transfer to the foetus seems a rare event.
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Background: The new coronavirus disease 2019 (COVID-19) is a worldwide pandemic. Concerns have been raised about the influence of SARS-CoV-2 infections on pregnant mothers and their fetuses, and patient care in the setting of COVID-19 is difficult. As a result, the current study was conducted to determine the outcomes of pregnant females with COVID-19 infection and their obstetric care of COVID-19. Materials and methods: The study enrolled 8622 pregnant women from April 1st, 2020 to September 30th, 2020 at Lokmanya Tilak Medical College and Sion Hospital, a tertiary care hospital. There were 455 women who tested positive for COVID, whereas the remaining 8167 patients tested negative for COVID. The results obtained were compared in both groups. Results: The percentage of pregnant women who tested positive for COVID was determined to be 5.27%. Most patients were delivered by LSCS in the COVID-positive group (49.45%) than in the COVID-negative group (43.95%) (p >0.05). Among 455 COVID-positive women, 401 were asymptomatic, whereas 54 patients showed COVID-19 symptoms like fever and cough (12%). All patients with mild symptoms were adequately handled with a multivitamin supplement, high-protein diet, fluid-electrolyte balance, regular vitals monitoring, and prophylactic antibiotic therapy. In total, 23 women were admitted to the intensive care unit after developing severe COVID-19 pneumonia with ARDS. The risk of maternal mortality in COVID-positive patients was somewhat higher 16 (3.51%) than in COVID-negative pregnant women 39 (0.47%) (p <0.05). In the majority of neonates in both the COVID-positive and-negative women, Apgar score was normal 7–10, and birth weight between 2.6 and 3 kg. Low Apgar scores (0–3) were seen in 6 (1.43%) of COVID-positive mothers’ neonates and 197 (2.60%) of COVID-negative mothers’ neonates. Overall, the majority of the newborns were healthy. Swabs from seven neonates were first determined to be positive, but were retested on day five and proved to be negative. Conclusions: In times of global pandemic, quick and judicious management of COVID-19 positive pregnant women is a critical notion for safe motherhood and healthy children. However, our findings reveal that COVID infection has no substantial influence on maternal and fetal outcomes in pregnancy, and there is no indication of vertical transmission of the COVID-19 infection, but long-term monitoring of these newborns is suggested.
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Introduction: Coronary artery disease complicates 0.01% of pregnancies. In this case study, we illustrate the successful management strategy of a pregnancy with a cardiometabolic disorder who conceived after a ST-elevation myocardial infarction (STEMI). Case Description: A 41-year-old woman in her third pregnancy was referred to our maternal-fetal-medicine unit at 8 weeks of gestation. She had a history of an acute inferior myocardial infarction (MI) Killip 1 with 70% occlusion of the left anterior descending artery and ectatic vessels, which was successfully thrombolysed 1 year prior. On presentation, she had uncontrolled type 2 diabetes, chronic hypertension on treatment, and was morbidly obese with a BMI of 44 kg/m2. She had 2 previous lower segment caesarean sections and an umbilical hernia repair. A systematic effort involving a multidisciplinary team, both at tertiary and community level, was coordinated from the start, which successfully prevented any cardiac events during pregnancy. She recovered from Covid-19 category 4a at 28 weeks with no cardio-respiratory implications. She went on to have a lower segment caesarean section near term with tubal ligation. Post-operative recovery was uneventful, and she continued to see cardiologists and endocrinologists. Discussion: Specific risks such as MI recurrence, pre-eclampsia and low birth weight baby can be minimised through comprehensive antenatal and perinatal plans supported by patient compliance. Our case showed that pregnancy after MI results in good maternal-fetal outcome provided the pre-pregnancy cardiac performance status is good, early multidisciplinary management, patient-centred approach, close antenatal monitoring, adequate delivery preparation and patient compliance.
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Objectives: Dengue is a vector borne infectious disease, endemic in the tropical regions, that may be associated with significant maternal and fetal morbidity and mortality. However, literature is sparse on the rate and factors associated with stillbirths in women suffering from dengue. In this study, we aimed to explore the frequency of stillbirths in dengue infection in pregnancy during the COVID pandemic. We also studied the effect of severity of the disease on fetal morbidity and mortality. Design: Retrospective review of registers and case records Method: We reviewed the data of pregnant women admitted for dengue in the Obstetrics & Gynecology department in a tertiary care hospital of Northern India between September and December, 2021. Data collected included the age, parity, gestation at admission, severity of the maternal disease, other comorbities, maternal outcome, obstetrical outcome during the dengue disease and fetal outcome. Results: Twenty three pregnant women were admitted to the department between September and December 2021. The average age of the women was 26+/-5 years. Half of these women were primigravidas (12 out of 25). Most women were in the third trimester, while one woman each presented in second trimester and the postpartum period. Eleven mothers presented with severe dengue, 11 had dengue with warning signs and only one woman had dengue without warning signs. There were 7 maternal deaths. Three mothers died undelivered. There were 10 stillbirths of 20 deliveries and 22 babies. Majority of the woman delivered preterm. There were 2 twin deliveries. Of the babies who delivered at term, most were liveborn(6 of 7). The stillbirth rate was higher in the severe dengue group, dengue with warning signs and dengue without warning signs were 60%, 36% and nil respectively. Conclusions: The stillbirth rate is high in women with dengue in pregnancy, especially in the third trimester. The chances of stillbirth escalate with the severity of dengue. Maternal mortality is high in women admitted with dengue in pregnancy. Public health strategies to prevent dengue should be strengthened to avoid high stillbirth rates and maternal mortality. The data is limited by the retrospective design and skewed as women with only severe form of dengue would have been admitted.
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Objective: Pregnancy is known to worsen the clinical course of coronavirus disease-2019 (COVID-19) compared to non-pregnant women of the same age. The aim of this study is to evaluate maternofetal and neonatal clinical features and outcomes of pregnant women with COVID-19. Material and Methods: For this prospective single-center study, data of 124 pregnant women who were hospitalized and treated for COVID-19 between April 20, 2020 and March 20, 2021 were collected. Clinical, laboratory and obstetric characteristics of pregnant women during hospitalization were recorded. Results: Of the pregnant women, 61% were symptomatic while hospitalized. Nine of the pregnant women were admitted to the intensive care unit, 4 required invasive mechanical ventilation, and two died during the hospitalization associated with COVID-19. Abortion occurred in 3 pregnant women. As maternofetal outcomes, 18% of pregnant women had preterm labor and 10% had fetal distress. The polymerase chain reaction (PCR) test of 46 pregnant women was positive during delivery, and the PCR test of 37 pregnant women was negative. Neonatal intensive care unit was required in 19% of newborns. COVID-19 PCR was positive in 2 newborns. Non-COVID-19 related death was observed in 1 premature newborn. Conclusion: Pregnancies complicated by COVID-19 infection should be followed closely due to the risk of adverse maternal and fetal outcomes.
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Problem: The placenta performs various functions of the lung/GI/GU tract for the developing fetus, while also moderating host defenses of the fetus against infections in utero, and likely educates the developing fetal immune system. It thus has long-term impacts on the health of both the woman and the child. Knowledge is limited about the underlying mechanisms that enable the placenta to serve as a protective barrier for the fetus against infection. The long-term goals of my research program are to, 1) elucidate the normal barriers to infection in the placenta and show how dysfunction in barrier function can lead to adverse maternal-fetal outcomes, 2) define how viral infections impact placental biology, and 3) characterize possible functional roles for the newly described microbiota at the maternal-fetal interface. Method of Study: To address the above questions, our research includes the use human placentas, primary human trophoblasts and immune cells derived from term placentas, cultured placental cells, trophoblast organoids, and mousemodels. Results: We found that placentas from women who gave birth prematurely exhibit reduced autophagy activity. Prematurity and reduced autophagy levels were also strongly associated with maternal infection. In a mouse model of pregnancy, we showed that placentas from mice deficient for Atg16L1 were significantly less able to withstand infection, and the deficient mice gave birth prematurely upon an inflammatory stimulus. We have also shown that the autophagy pathway plays a key role in ZIKV vertical transmission from mother to fetus. We demonstrated that hydroxychloroquine (HCQ), an autophagy inhibitor approved for use in pregnant women, can attenuate placental and fetal ZIKV infection and ameliorate adverse placental and fetal outcomes. More recently, we have identified a small molecule inhibitor that targets the NS2B-NS3 protease of ZIKV and inhibits viral replication. It has recently become evident that SARS-CoV-2 infection is also associated with adverse outcomes for pregnant women, including preterm birth, preeclampsia, and fetal growth restriction. We localized SARS-CoV-2 to the placenta and showed that infection alters the Renin Angiotensin System (RAS) that regulates blood pressure, thereby increasing risk for preeclampsia. In new work, we are showing that SARS-CoV-2 non-structural proteins affect autophagy in different ways than in Zika virus. Finally, we have discovered that the maternal fetal interface of the placenta harbors intracellular resident microbes, and functionally demonstrated that they do not induce any inflammatory response or cell death but may promote immune tolerance and support normal pregnancy outcomes. Conclusions: For the past 10 years of my career, I have been working on host microbial interactions at the maternal fetal interface. Our work has led to new insights into viral infections, showing how they co-opt host defenses, and that tolerance may have microbial drivers. We have shown how cellular pathways in the placenta such as autophagy and RAS mechanistically regulate host defenses against pathogens, including ZIKV and SARS-CoV-2. Additionally, our studies provide a foundation for understanding possible 'commensal' microbial- placental interactions and hint at the functional importance of microbes at the fetal maternal interface in maintaining placental health and supporting fetal development.
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Aim: We have witnessed diverse presentations of coronavirus disease-2019 (COVID-19) in pregnant females during first and second waves. The aim of this study was to evaluate the usefulness of chest X-ray and its correlation of severity scoring with clinical, laboratory parameters and maternal-fetal outcome during management of COVID-19 pregnant women in low resource settings. Methodology: This was a retrospective observational study conducted at the Government Institute of Medical Sciences, Greater Noida, from May 2020 to May 2021. The study included 185 pregnant women in second and third trimesters with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 disease. The chest radiographs of all patients were analyzed and severity scoring was done using modified radiographic assessment of lung edema (RALE) criteria. The correlation of severity index with clinical and biochemical profile of patients with normal and abnormal X-ray findings was compared. Two-tailed p-value of <0.05 was considered significant in our study. Results: Out of 185 patients, 38 had abnormal X-ray findings, whereas 147 had normal X-ray. A significant difference was observed in mean values of lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), D-dimer, total leukocyte count (TLC), and interleukin 6 (IL-6) levels across both X-ray groups. The proportion of pregnant mothers with live birth, high-risk pregnancy, steroid treatment, oxygen supplementation, invasive ventilation, and number of presenting symptoms varied statistically across both the X-ray groups (p-value <0.05). Receiver-operating characteristic (ROC) analysis revealed that an X-ray score of “5.5” has the best prognostic significance of maternal death with sensitivity of 87.5 and 96.6% specificity. Conclusion: Chest radiography for the assessment of disease status in COVID-19 pregnancies is an effective and affordable alternative to CT scan in low resource settings.