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Gallstone disease with advanced symptoms is one of the common abdominal emergencies during pregnancy and it is considered to be one of the most frequently reported non-obstetric surgical conditions in pregnant women. This study aimed to evaluate the outcomes of surgical cholecystectomy in pregnant women with symptoms of advanced gallstones. This is a retrospective analysis of 2814 pregnant women who attended various wards in government and private hospitals in the governorates of Diyala and Kirkuk in Iraq for more than 2 years, between February 2020 and June 2022. The hospital database was used to confirm the diagnosis of advanced gallstone symptoms in these pregnant women. The incidence of symptomatic gallstones in pregnant women, diagnosis and method of therapeutic management, cholecystectomy according to the pregnancy periods, and perinatal complications of patients according to therapeutic methods were determined. The results confirmed that out of 2814 pregnancies, only 126 (4%) had symptoms of gallstones. It was found that the majority of cases 67 (53%) were within the first trimester of pregnancy and the least 29 (23%) was observed in the second trimester. Acute cholecystitis was the generality 84 (67%) diagnosed in pregnant women with symptomatic gallbladder disease and only 9 (7%) of the patients had undergone prenatal cholecystectomy versus 117 (93%) who were managed conservatively. A total of 20 (16%) cases with undesirable complications were recorded, where 12 cases with low birth weight were noted, where 4 of them underwent surgery and 8 were treated conservatively. It was concluded that a large proportion of women suffer from symptoms of gallstones during pregnancy. Most cases can be managed conservatively, and intervention should be performed as often as needed.Copyright © 2023, Codon Publications. All rights reserved.
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Objectives: To provide an update overview on the current status of healthcare systems in the Maghreb region (Algeria, Morocco, and Tunisia) and to emphasize the progress made in the midst of the challenges facing these countries. Method(s): A descriptive comparative approach of healthcare systems in the three countries, based on data from sources with an established methodology, including descriptive healthcare data from the WHO database. Result(s): The population of the Maghreb will increase from 102 million to 132 million by 2050. The current population is mostly centered in Algeria and Morocco, accounting for 77%. Annual healthcare expenditure per capita is 447.9$, 776.8$ and 854.6$ in Morocco, Tunisia and Algeria, respectively. The average infant mortality rate per 1000 live improved to 10.9 in Tunisia, 16.8 in Morocco and 18.9 in Algeria. Maternal mortality rates have dropped to 43 and 48.5/100 000 births in Tunisia and Algeria, respectively while remaining relatively high in Morocco: 72.6. Number of hospital beds/1000 inhabitants is only 1.1 in Morocco, 1.9 and 2.9 in Algeria and Tunisia, respectively. The number of physicians/1000 people was 0.73 in Morocco, 1.3 in Tunisia and 1.72 in Algeria. This remains considerably low compared to the 3.9/1000 in Europe. The Maghreb countries are currently facing an exodus of physicians, mainly to France, which represents 7.1% and 10.7% of Tunisians and Moroccans, respectively, and more than 24% for Algerians. The Maghreb countries were very early mobilized (governments, ministries of health, civil society) to fight against COVID-19 and have successfully controlled the pandemic, according to pre-established control strategies and the strongly commitment of health professional. Conclusion(s): Despite the considerable progress made, the Maghreb countries still face major challenges. Physicians migration, rising cost of care and endemic infectious disease outbreaks constitute a huge hurdle on the already overburdened and resilient healthcare systems.Copyright © 2023
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Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Method(s): This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Result(s): Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion(s): MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.
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Background. Every life aspect and group of the community have changed during the COVID-19 pandemic, including the group of pregnant, childbirth, and postpartum woman. COVID-19 Pandemic occurred in 2020-2021. Maternal mortality in East Java Province was the highest in Indonesia during the pandemic. Objective. This study analyzed the effect of spatial determinants that consist of antenatal, childbirth, and post-partum care on maternal mortality in East Java Province during the Pandemic. Methods. This study used a crossectional method with the unit of analysis in this study was all pregnant, childbirth and postpartum women in 38 districts of East Java Province from 2020 until 2021. Data were analyzed with spatial regression by using Geographically Weighted Regression Software. Results. Maternal mortality in East Java had a spreading pat-tern and negative value of the diff criterion, so we concluded that there was a spatial influence. The variables of antenatal care, accessibility of healthcare service, third postpartum visit, and complication service had significant effects on maternal mortality in all regions (P<0,05). There were four groups of districts that showed a similarity of significant factors. This result showed that each region's diversity of the accessibility of health services affects maternal mortality during the COVID-19 era. Antenatal services, access to health facilities and complication services affected maternal mortality in regions with high maternal mortality rate. Conclusion. Every region has its spatial determinants of maternal mortality. The top government should give authority to local government to have programs to reduce maternal mortality according to the condition in their region. r.Copyright © the Author(s), 2023.
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Introduction: The physiological changes in the respiratory and cardiovascular systems in the immunosuppressed state of pregnancy may exacerbate clinical features and deteriorate outcomes due to COVID-19 infection. We aimed to compare the maternal and neonatal adverse effects in the first and second COVID-19 waves. Methodology: This study was a prospective cohort study conducted in a tertiary care COVID-19-dedicated hospital. In total, 104 (group A) and 96 (group B) COVID-19-positive pregnant women admitted during the first and second waves, respectively, were included in the study. Data on baseline variables, associated comorbidities, clinical presentations, management strategies, and neonatal and maternal outcomes were collected and compared using parametric and nonparametric tests and analyzed. Result(s): Around 2.08% in group A and 6.72% in group B of COVID-19-infected pregnant women, respectively, had moderate-to-severe disease and required intensive care unit stay. Almost 1.04% in group A and 3.84% in group B had maternal mortality, 13.4% and 19.8% babies of groups A and B required admission in neonatal intensive care units, and 8.6% and 7.3% of newborns in groups A and B had COVID-19-positive reports by reverse transcriptase polymerase chain reaction (RT-PCR) at birth, respectively. Of them, 2.1% newborns in group B had RT-PCR positive on day 7 of life and beyond, whereas none had positive RT-PCR reports on 7 days and beyond in group A. Conclusion(s): Dreadful maternal outcomes like requirement of ICU and mechanical ventilator and persistence of neonatal infections were higher during the second wave.Copyright © The Author(s). 2023.
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Background. The Maternal Mortality Rate (MMR) in Indonesia is still a health problem that must be solved. In 2018 and 2019, the postpartum period still dominates maternal mortality in Surabaya. The postpartum visit method is one of the essential things that can affect postpartum services, so it is necessary to evaluate the implementation of the postpartum visit method and recommend visiting methods to improve maternal health. Objective.The study explores the implementation and recommendation of postpartum visit methods during the COVID-19 Pandemic. Materials and Methods. It used a qualitative research type by assessing the interview and observation dept. The instruments used are questionnaires and observation sheets. Researchers conducted interviews with 14 mothers who had completed the postpartum period, five midwives, a stakeholder in the health office and two experts in the field of maternal health. The data is processed using organizing, reduction, coding, description, linking between themes, and data interpretation. Results. Offline visits to health facilities still dominate the implementation of the postpartum visit method. The recommended postpartum visit method combines visits to health facilities, home visits, and telehealth. Besides that, it is necessary to consider maternal postpartum services up to 3 months after delivery, especially for postpartum mothers who have problems. Conclusion. The postpartum visit method during the COVID-19 pandemic, has not run optimally because there are restrictions on offline visits. However, it has not been supported by online monitoring or home visits.Copyright © the Author(s), 2023.
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This study aims to examine the clinical characteristics and mortality-related factors of obstetric patients, who were taken to the intensive care unit due to Coronavirus Disease 2019 (COVID-19). This study included 31 patients in the peripartum period with COVID-19 pneumonia, followed up in the intensive care unit (ICU) from March 2020 to December 2020. Symptoms, laboratory values, intensive care unit duration of stay, complications, the requirement of non-invasive and invasive mechanical ventilation, and mortality were recorded. The mean age was 30.7 ± 6.2 years and the mean gestational age was 31.1 ± 6.4 weeks. Among the patients, 25.8% had a fever, 87.1% had a cough, 96.8% had dyspnoea and 77.4% had tachypnoea. Seventeen patients (54.8%) had mild, 6 (19.4%) had moderate and 8 (25.8%) had severe pulmonary involvement on computed tomography. Sixteen (51.6%) patients required high-frequency oscillatory ventilation, 6 (19.3%) patients required continuous positive airway pressure, and 5 (16.1%) patients required invasive mechanical ventilation. Sepsis complicated by septic shock and multiorgan failure occurred in 4 patients and all of them died. The ICU duration of stay was 4.9 ± 4.3 days. We have found that older maternal age, obesity, high LDH, AST, ALT, ferritin, leukocyte, CRP, and procalcitonin values, and severe lung involvement were mortality-related factors.Impact statementWhat is already known on this subject? Pregnant women are in the high-risk group for Covid-19 disease and its complications. Although most pregnant women are asymptomatic, severe infection-related hypoxia can cause serious foetal and maternal problems.What do the results of this study add? When we examined the literature, we found that the number of studies on pregnant women with severe Covid-19 infection was limited. For this reason, with our study results, we aim to contribute to the literature by determining the biochemical parameters and patient-related factors associated with severe infection and mortality in pregnant patients with severe Covid-19 infection.What are the implications of these findings for clinical practice and/or further research? With our study results, predisposing factors for the development of severe Covid-19 infection in the pregnant patient population and biochemical parameters that are early indicators of severe infection were determined. In this way, pregnant women in the high-risk group can be followed closely and the necessary treatments can be started quickly so disease-related complications and mortality can be reduced.
Subject(s)
COVID-19 , Humans , Female , Pregnancy , Young Adult , Adult , Infant , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , SARS-CoV-2 , Intensive Care Units , Hospitalization , FeverABSTRACT
Background: Maternal mortality is one of the health statuses that is considered global. Central Java Province has the highest maternal mortality rate in Indonesia, and one of the regencies with a high MMR (Maternal Mortality Rate) is Grobogan. Purpose: This research wants to describe maternal mortality in Grobogan in 2020-2021. In further research, we can determine the relationship between risk factors that cause maternal death and use them to develop program decisions to reduce maternal mortality in Grobogan. Methods: This study used a descriptive-quantitative study using Maternal and Infant Mortality data from the Health Office of Grobogan in 2020-2021 and analyzed averages and proportions. Results: This study showed that 103 mothers died, 69% mothers at the age of 20-35 years, 46.60% mothers had Junior High School, 8% were in the Purwodadi 2 area, 73% with gestational age >28 weeks, 52% had 2-3 parity, 87.38% of mothers never abortion, 57% of mothers died during the puerperium, and 39% caused by being infected of COVID-19. Conclusion: Maternal mortality in Grobogan Regency during the 2020-2021 COVID-19 pandemic, most of the causes of death were due to COVID-19 infection, which mainly occurred in mothers aged 20-35 years, last educated at junior high school, at gestational age >28 weeks, parity 2-3, more common in mothers who have never had a history of abortion, and is currently experiencing the puerperium. This maternal death occurred in 28 of the 30 Puskesmas in Grobogan.
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BACKGROUND // The multiple effects of the COVID-19 pandemic are beginning to be seen from the alteration of vital statistics figures. This is summarized in changes in the usual causes of death and excess attributable mortality, which can finally be seen in structural changes in the populations of the countries. For this reason, this research was created with the objective of determining the impact of the COVID-19 pandemic on maternal, perinatal and neonatal mortality in four locations in Bogota D.C. (Colombia).METHODS // A retrospective longitudinal investigation was carried out in which 217,419 mortality data were analyzed in the towns of Kennedy, Fontibon, Bosa and Puente Aranda in the city of Bogota -Colombia that occurred between the years 2018 to 2021, of which maternal (54), perinatal (1,370) and neonatal (483) deaths in order to identify a history of SARS-CoV-2 infection that could be related to the excess mortality associated with COVID-19. The data were collected from the open records of vital statistics of the National Statistics Department (DANE), where they were analyzed from frequency measures or central tendency and dispersion according to the types of variables. The specific mortality indicators related to maternal, perinatal and neonatal death events were calculated.RESULTS // A decrease in perinatal and neonatal mortality was evidenced since 2020, which was associated with the progressive de-crease in pregnancies in those same years;Additionally, a considerable increase in maternal deaths was observed for 2021 compared to the other years analyzed. The proportion of maternal deaths in 2020 and 2021 by 10% and 17%, respectively, were attributed to COVID-19.CONCLUSIONS // It is observed that the trend of maternal mortality is related to the increase in mortality from COVID-19, maternal deaths associated with COVID-19 occurred specifically in the zonal planning units that registered more than 160 cases of COVID-19 for the year 2021.
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The COVID-19 pandemic is unprecedented in our lifetime, especially in perinatology. The gold standard is to strongly recommend COVID-19 vaccinations to those trying to get pregnant, to those who are pregnant, and to those who are postpartum. When the benefits of vaccines far outweigh the risks, it is unethical to disseminate wrong information and discourage patients from becoming vaccinated. COVID-19 vaccinations and boosters prevent severe diseases and adverse pregnancy and neonatal outcomes. A pregnant patient's vaccination also protects the newborn infant because maternal antibodies protect the fetus and newborn. COVID-19 vaccinations and boosters in pregnancy are safe for the pregnant patient and her fetus. The three root causes of physician hesitancy-misapplication of therapeutic nihilism, misapplication of shared decision-making, and misapplication of respect for autonomy should not be ignored and need to be addressed. It is important that we heed Brent 's insightful recommendations. Doing nothing with respect to vaccination is not an option, whether it applies to COVID-19 vaccines or to future pandemics. Physician hesitation is not an option. When there is sufficient evidence of vaccine safety and effectiveness without documented risks, vaccine recommendations before, during, and after pregnancy should be explicitly made to prevent maternal, fetal, and neonatal morbidity and mortality.Copyright © The Author(s). 2023.
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The United States of America (USA) has the highest maternal mortality rate of all high-income countries, with over 80% found to be preventable. After leveling off around 2015, maternal mortality rates in the USA further increased due to coronavirus disease 2019 (COVID-19) related deaths starting in 2020 by about 20% from about 17-18/100,000 live births to about 24/100,000 live births with about one in seven maternal deaths due to COVID-19 infections. The vast majority of COVID-19-related maternal deaths were among unvaccinated pregnant patients. A total of 11% of postpartum maternal deaths were found to be associated with mental health issues, with the remainder usually due to medical issues such as hemorrhage and hypertension. As physicians, we have the ethical obligation to address perinatal and maternal mortality, especially preventable maternal mortalities, reduce the discrepancy between different races and ethnicities, recommend COVID-19 vaccinations, and develop approaches to address the causes.Copyright © The Author(s). 2023.
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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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RESUMEN Objetivo . Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en estos primeros 4 meses de 2020y el embarazo. Metodología . Revisión sistemática en las bases de datos PubMed y Google Scholar, hasta el 25 de abril de 2020. Se buscó artículos publicados relacionados con mujeres embarazadas infectadas con SARS-CoV-2. No hubo restricción de idioma. La búsqueda se extendió a las referencias de los artículos encontrados. Resultados . La enfermedad COVID-19 en mujeres embarazadas se caracteriza porque más del 90% de las pacientes evoluciona en forma leve, 2% requiere ingresar a las unidades de cuidados intensivos. Una muerte materna ha sido reportada. La prematuridad es alrededor de 25%, con predominio de recién nacidos prematuros tardíos; aproximadamente el 9% se complica con rotura prematura de membranas; la mortalidad perinatal es baja o similar a la de la población general y no se ha demostrado la transmisión vertical. Conclusiones . Los ginecólogos obstetras deben prepararse para atender cada vez más casos con COVID-19 y, por lo tanto, es necesario tener su conocimiento. La enfermedad evoluciona de la misma manera que en las no embarazadas, genera mayor prematuridad, no se ha demostrado la transmisión vertical, pero hay altas posibilidades de transmisión horizontal durante el parto vaginal.
ABSTRACT Objective : To search for all the information and available evidence on infection with SARS-CoV-2, a virus that appeared during the first 4 months of 2020, and pregnancy. Methods : Systematic review in PubMed and Google Scholar databases until April 25, 2020. We searched for published articles related to pregnant women infected with SARS-CoV-2. There was no language restriction. The search was extended to the references of the articles found. Results : In pregnant women with COVID-19, more than 90% of patients evolve mildly, 2% require intensive care. One maternal death has been reported. Prematurity occurs in approximately 25% of the cases, with predominance of late preterm infants; premature rupture of membranes presents in about 9%. Perinatal mortality is lower or similar to that of the general population, and vertical transmission has not been shown. Conclusions : Obstetrician-gynecologists must prepare to attend more cases with COVID-19 and therefore they need to know this disease. COVID-19 progresses similarly in pregnant and non-pregnant women, although it is associated to prematurity. While vertical transmission has not been demonstrated, horizontal transmission during vaginal birth is very likely.
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This study investigated maternal mortality solutions mentioned on Twitter by maternal health advocacy organizations in the United States. Using qualitative content analysis, we examined tweets from 20 advocacy organizations and found that the majority of the tweets focused on policy, healthcare, community, and individual solutions. The most tweeted policy solutions include tweets advocating signing birth equity, paid family leave, Medicaid expansion, and reproductive justice bills, whereas the most tweeted community solutions were funding community organizations, hiring community doulas, and building community health centers. The most tweeted individual solutions were storytelling, self-advocacy, and self-care. These findings provide insights into the perspectives and priorities of advocacy organizations working to address maternal mortality in the United States and can inform future efforts to combat this critical public health issue.
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Social Media , Humans , United States , Maternal Mortality , Communication , Health Knowledge, Attitudes, Practice , Social JusticeABSTRACT
OBJECTIVES: This study aimed to present perinatal outcomes, clinical challenges, and basic ICU management in pregnant women with severe-critical COVID-19 at our tertiary referral center. METHODS: In this prospective cohort study, patients were divided into two groups, whether they survived or not. Clinical characteristics, obstetric and neonatal outcomes, initial laboratory test results and radiologic imaging findings, arterial blood gas parameters at ICU admission, and ICU complications and interventions were compared between groups. RESULTS: 157 of the patients survived, and 34 of the patients died. Asthma was the leading health problem among the non-survivors. Fifty-eight patients were intubated, and 24 of them were weaned off and discharged healthfully. Of the 10 patients who underwent ECMO, only 1 survived (p<0.001). Preterm labor was the most common pregnancy complication. Maternal deterioration was the most common indication for a cesarean section. Higher neutrophil-to-lymphocyte-ratio (NLR) values, the need for prone positioning, and the occurrence of an ICU complication were important parameters that influenced maternal mortality (p<0.05). CONCLUSIONS: Overweight pregnant women and pregnant women with comorbidities, especially asthma, may have a higher risk of mortality related to COVID-19. A worsening maternal health condition can lead to increased rates of cesarean delivery and iatrogenic prematurity.
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Ultrasound is the hallmark imaging modality traditionally used by obstetricians for fetal diagnosis and surveillance. The COVID-19 pandemic highlighted the role of point of care ultrasound (POCUS) for expeditious assessment of maternal cardiopulmonary status. The familiarity of obstetricians with ultrasound coupled with the availability of ultrasound equipment without the need to transport the patient make POCUS particularly valuable on labor and delivery. The rising contribution of cardiopulmonary disorders to maternal morbidity and mortality carves out many potential applications for POCUS on labor and delivery. Obstetricians have access to the technology and skills to obtain the basic views required to assess for the presence of pulmonary edema, ventricular dysfunction, or intraabdominal free fluid. POCUS can routinely be used for the evaluation of pulmonary complaints or in the assessment of hypotension and may play an essential role in the diagnosis and management of life-threatening emergencies such as shock, amniotic fluid embolism, or cardiac arrest. We review the currently established POCUS protocols for the evaluation of cardiopulmonary complaints through the lens of the obstetrician. We call upon educators and academic leaders to incorporate maternal POCUS into existing curricula. POCUS is of enormous value for providers with limited access to diagnostic imaging or subspecialty providers. With the growing complexity of the obstetric population, acquiring clinical skills to meet these evolving needs is a requisite step in the ongoing efforts to reduce maternal morbidity and mortality.
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The aim of this study was to demonstrate the poor prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in unvaccinated pregnant women. In this retrospective study, the clinical and laboratory parameters of 26 pregnant or immediately postpartum patients, who were hospitalised and needed intensive care unit (ICU) follow-up due to coronavirus disease 2019 (COVID-19) infection were reported. All pregnant patients who followed up in the ICU were unvaccinated. The mortality rate was calculated as 34.62% in the patients included in the study who were admitted to the ICU. Among patients hospitalised in the ICU, the maternal mortality and stillbirth rates associated with COVID-19 infection were found to be 156.28/100,000 and 11.54%, respectively. Preterm birth occurred in 58.33% of the patients who delivered. 79.17% of the patients were delivered by caesarean section. Lymphopenia, high ferritin, interleukin-6, lactate dehydrogenase, D-dimer and C-reactive protein values were found to be associated with mortality. The course of pregnant patients with COVID-19 infection is not always predictable. Clinical and laboratory data should be evaluated in combination for disease prognosis. Adequate information should be given about the importance of vaccination.Impact StatementWhat is already known on this subject? The SARS-CoV-2 infection has caused a public health crisis worldwide. As a result of studies on coronavirus disease 2019 (COVID-19) infected pregnant women, it was observed that there was an increase in maternal and perinatal mortality. There has been an increase in intensive care unit (ICU) admissions, especially after patients infected with the Delta variant. The pandemic continues with an unpredictable course of the new variants.What do the results of this study add? Compared to the pre-pandemic period, COVID-19 infection caused a more than 10-fold increase in maternal mortality, particularly after the Delta variant. In intensive care follow-up, low lymphocyte count, high lactate dehydrogenase, D-dimer, C-reactive protein, ferritin and interleukin-6 values are indicators of poor prognosis.What are the implications of these findings for clinical practice and/or further research? COVID-19 infection causes increased maternal mortality. Considering that all of the patients admitted to the ICU in our study were unvaccinated, pregnant women should be encouraged to get vaccinated.
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Background: Pregnant women experience physiological changes that make them more susceptible to respiratory infections, including COVID-19. Given the potential impact of COVID-19 on pregnancy, it is crucial to continue to investigate the effect of the pandemic on pregnant women and their infants. This information will be important for informing for all the stakeholders including clinical care, and public health policies. Method(s): This study is a retrospective observational analytical study conducted in the Department of Obstetrics and Gynecology at SMGS hospital, Jammu. The study included 180 pregnant females who reported to emergency Obstetrics and Gynecology from 1st April to 30 June 2020. The sample size of 180 patients was divided into two groups: Group 1 included 90 COVID-19 positive pregnant females and Group 2 included 90 COVID-19 negative pregnant females. Result(s): No significant differences were found in age, parity, gestational age, comorbidities, mode of delivery, maternal complications, neonatal Apgar scores, or birth weight. The prevalence of comorbidities and maternal complications was similar in both groups, and most neonates had normal Apgar scores and birth weights. Conclusion(s): Therefore, it is suggested that appropriate management and care should be provided to all pregnant women, regardless of their COVID-19 status, to minimize any potential adverse outcomes.Copyright © 2022, Anka Publishers. All rights reserved.