Characteristics of cardiotocography in pregnant women with mild COVID-19 in the third trimester.

Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Characteristics of cardiotocography in pregnant women with mild COVID-19 in the third trimester.

Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Ethical Lessons Learned from the COVID-19 Pandemic in Perinatal Medicine

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.

Impact of Sars-Cov2 Infecion during Pregnancy on Maternal and Neonatal Outcomes

Purpose of Study: Pregnant women are at considerable risk for SARS-CoV-2 infection with adverse maternal and neonatal outcomes. Mother-to-child-transmission can occur, in-utero, perinatally or postnatally with significant complications in the newborn. Little is known on impact of SARS-CoV-2 on newborn infants. Our objectives were to describe maternal and neonatal outcomes among those with SARS-CoV-2 infection since beginning of the pandemic. Methods Used: This was a retrospective review of data from a single center with level III NICU from April 2020 through March 2022 in Los Angeles, CA. The study included pregnant women who were screened at delivery and/or during pregnancy and tested positive with PCR test. Data of these women and their infants were reviewed from medical records. Institutional IRB approval was obtained to review the data. Summary of Results: During the study period 152 mothers were SARs-CoV-2 positive in pregnancy or at delivery. Maternal risk factors included obesity (13.2%), pre-eclampsia (15.1%) and diabetes (19.7%). Fourteen (9.2%) were symptomatic for 0-7 days prior to delivery predominantly with cough, fever and myalgia. Majority (58.7%) delivered vaginally. SARS-CoV-2 exposed infants had a median gestational age of 38.3 weeks;35 (23%) were preterm. Median birthweight was 3120 grams and 32 infants 31 (20.5%) were low birthweight. Thirty-one (20.4%) infants needed resuscitation at delivery. Common symptoms for infants included respiratory symptoms (22.4%), hyperbilirubinemia (15.1%) and hypoglycemia (7.2%). Sixty-eight infants (44.7%) required admission to NICU. Majority of the infants (130) had PCR tests at 24 hours and 48 hours if still hospitalized. Five (3.8%) were PCR+: 4 at 24 hours and 1 at 48 hours. Another 5 infants had positive PCR for SARS-CoV-2 in infancy. Conclusion(s): SARS-CoV-2 infection was present at delivery in a significant number of pregnant women with 3.8 % of their infants. Although a majority of women were asymptomatic at the time of delivery, there was significant morbidity among women with pre-eclampsia and diabetes. Newborn morbidity included prematurity, low birth weight and respiratory distress even in PCR- newborns. These data emphasize the need for screening all pregnant women for SARS-CoV-2 at delivery, and close monitoring of mother-infant dyad if infected. Vaccination of pregnant women should be encouraged.

Maternal and neonatal morbidity for SARS-CoV-2 infection

Objective: to carry out an updated bibliographic review focused on maternal and neonatal morbidity due to SARSCoV-2 infection with the purpose of evaluating the severity that could occur in these risk groups. Methodology: this study consisted of a systematic review between December 2019 and September 2020 using platforms such as: PubMed, Scopus, Digital Library of the Complutense University of Madrid, Google Scholar and Scielo. The data were tabulated according to the recommendations of the PRISMA guide. Result(s): Of 116 pregnant women with a positive diagnosis for COVID 19, 91.3% had a favorable evolution without requiring intensive care;8.62% presented severe pneumonia and mechanical respiratory assistance and none of them died. On the other hand, of 117 neonates, 93.2% had negative results for COVID-19 while 6.8% had positive results and there were three neonatal deaths not related to COVID-19. Conclusion(s): This indicates that SARS-CoV-2 does not generate greater susceptibility in obstetric patients or neonates and usually only manifests with mild to moderate symptoms. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

Assessment of newborn health dynamics after the Russian Federation transition to international criteria for live births and stillbirths

To assess the state of children’s health in obstetric care organizations after Russia transition to international statistics on live births and stillbirths, we studied the main indicators of newborn health in the dynamics from 2013 to 2020. It was found that between 2013 and 2020 the morbidity of newborns decreased by 6.3% (from 337.2‰ to 316.3‰;p<0.05), neonatal mortality by 45.7% (from 3.5‰ to 1.9‰;p<0.05), stillbirth rate by 45.6% (from 10.9‰ to 5.5‰;p<0.05), and hospital mortality of newborns born sick and ill by 40.0% (from 1.0% to 0.6%;p<0.05). Assessment of the distribution of live-born infants by birth weight showed that changes in this parameter of physical development during the period under study had no statistically significant differences (p>0.05). The assessment of the impact of the COVID-19 pandemic on newborn health revealed slight shifts in the distribution of children born alive by birth weight and a 6.8% increase in the stillbirth rate compared to the pre-pandemic level. Thus, in the period from 2013 to 2020 the share of children discharged from obstetric hospitals who were healthy has increased due to the reduction in morbidity and mortality of newborns. The analysis showed that there was an improvement in the health indicators of newborns in the Russian Federation.

INFANT DEVELOPMENTAL SCREENING AT 16 TO 18 MONTHS OF AGE AFTER IN-UTERO EXPOSURE TO MATERNAL SARS-COV-2 INFECTION

Purpose of Study Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in pregnant women is associated with increased maternal and neonatal morbidities. The impact of in-utero exposure to maternal SARS-CoV-2 infection on long-term infant neurodevelopment is currently unknown. Objective: The objective of the study was to undertake developmental screening in infants aged 16-18 months born to mothers with confirmed SARS-CoV-2 during pregnancy. Methods Used This was a descriptive prospective cohort study of full-term infants who had in-utero exposure to maternal SARS-CoV-2 infection as assessed by the Ages and Stages Questionnaire- 3rd edition® (ASQ-3®) at 16 to 18 months of life. Subjects were identified via electronic medical record search of full-term infants delivered to mothers with SARSCoV- 2 positive test during hospitalization between 3/1/2020 to 12/31/2020. The families of eligible subjects were contacted via telephone and if they agreed to participate an informed consent was obtained. Infants with prematurity (<37 weeks gestational age), major congenital anomalies or genetic diagnoses were excluded. Data on maternal and neonatal characteristics were extracted from the charts. Summary of Results A total of 31 children were enrolled in the study till date. Seven (23%) were below cutoff in at least one domain of development. Two subjects (6.5%) were below cutoff in more than one domain. Fine motor was identified as delayed among 3 children (10%). While communication, gross motor and problem solving was identified below cutoff in 2 children (6.5%). One child (3%) had delay in personal social domain. Conclusions About one-quarter of children with history of inutero exposure to maternal SARS-CoV-2 infection were below cutoff in at least one domain of development on (ASQ-3®) at 16-18 months. In this currently ongoing study, we intend to enroll larger group of children with in-utero exposure with maternal SARS-CoV-2.

Neonatal morbidity after the start of the pandemic: Disparate outcomes across two sites

Objective: During the early months of the pandemic, policies were implemented that sought to reduce in-person office visits. We sought to evaluate the neonatal outcomes associated with those policy changes across two disparate clinical sites. Study Design: We performed a cohort study of patients obtaining prenatal care at two clinics that were disparate in patient population and resources during two different 6 month intervals (Time I: July 1, 2019 - December 31, 2019 and Time II: March 23, 2020 - September 23, 2020). Both sites shared identical policies and leadership. Patients with known SARS-CoV-2 infection were excluded from the analysis. Medical records were reviewed for clinical and demographic characteristics. Neonatal morbidity was defined as any of the following: stillbirth, neonatal death, preterm birth, NICU admission, low birthweight. Data was analyzed using chi square and Cochran Q test where appropriate. P< 0.05 was significant. Results: Site A’s prenatal visits decreased (Time I= 9,782 and Time II= 8,694) while Site B’s prenatal visits increased (Time I= 4,144 and Time II= 6,644). At baseline, Site A compared to Site B was more likely to have patients with commercial insurance (88.7 vs 12.9%, p< 0.001) and who self-identified as White race (66.6 vs 29.9%, p< 0.001). Patients from Site A were less likely to be Hispanic (18 vs 39.1%, p< 0.001) and had a lower neonatal morbidity rate (19 vs 26%, p< 0.001). In Time I, neither site was using telehealth. In Time II, Site A conducted 21.5% of prenatal visits by telehealth. Site B conducted 1.8% of visits by telehealth but experienced net transfer of patients whose physician offices were closed. In Time II, the neonatal morbidity disparity between the two sites persisted (18.7 vs 28%, p< 0.001), with Site B experiencing a slight increase in neonatal morbidity. Cochran's Q test indicates a statistically significant difference in the proportion of perinatal morbidity over time, χ2 (2) = 740.7, p< 0.001. Conclusion: Policies to reduce in-person visits are associated with an increased neonatal morbidity in lower resourced settings and higher risk populations.