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Background: Previous data of COVID-19 indicates the obstetric population to be at specified risk for critical COVID-19 disease. In this study patient records were analyzed to gain information about the connection between pregnancy and intensive care treatment due to COVID-19 infection. Material(s) and Method(s): A retrospective study of all COVID-19 positive obstetric patients in Helsinki University Hospital admitted to intensive care units (ICU) from the beginning of March 2020 until the end of January 2022. Primary outcome is to compare the number of COVID-19 positive obstetric ICU patients to all ICU patients. Secondary outcomes are maternal 30-day survival and immediate neonatal survival. The study also looks at number of variables related to pregnancy and ICU treatment including age, previous medical history, BMI and COVID-19 vaccination status, obstetric data (i.e., gestational weeks, obstetric complications and route of delivery), treatments received at the ICU and length of ICU and hospital stay. Result(s): In total 20 obstetric patients with COVID-19 were admitted to the intensive care unit during the observation period. This is 2,3% of all COVID-19 patients and 27,4% of all 18-45 years old female COVID-19 patients treated in the intensive care unit in Helsinki University Hospital. Maternal 30-day survival was 95% (n = 19). Immediate neonatal survival was 95% (n = 19). Conclusion(s): Pregnancy increased the risk of ICU admission for COVID-19 infection. These results align with previous studies reporting pregnancy as a risk for critical COVID-19 infection and ICU admission. The 30-day survival was high compared to all ICU patients.
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Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.Copyright © 2023. Thieme. All rights reserved.
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Objectives: To compare pregnancy loss rates, preterm birth rates and gestational age at delivery in women vaccinated against COVID-19 during pregnancy vs. those unvaccinated. Method(s): Data were captured from Dorsata Prenatal, an electronic medical record (EMR) system that captures obstetrical data for tens of thousands of pregnancies annually. Patients who delivered between February 11, 2021-June 2, 2022, were included. The vaccinated group included women who had at least one COVID-19 vaccination documented in their EMR between 30 days prior to pregnancy and delivery. The unvaccinated group included women without a COVID-19 vaccination documented. The primary outcome measure was gestational age (GA) at delivery. We analyzed the data using chi-square tests, with significance set at p<0.01. Result(s): A total of 51,994 pregnant women were identified-7,947 (15.3%) in the vaccinated group and 44,047 (84.7%) in the unvaccinated group. Vaccination rate varied by race (Asian: 19.7%;White: 17.3%;Black: 11.2%, P<0.001), ethnicity (Latino: 8.6%;Not-Latino: 18.7%;P<0.001), marital status (Married: 19.2%;Single: 8.8%;P<0.001), mother's age (>=35 years: 20.0%;<35 years 14.2%;P<0.001), and region (Northeast: 19.2%;South: 15.2%;West: 9.1%;P<0.001). The vaccinated group had significantly lower rate of preterm delivery (Gestational Age [GA]<37 weeks;vaccinated: 7.8% vs. unvaccinated: 9.6%;P<0.001), and significantly lower rates of pregnancy loss (GA<20 weeks;vaccinated: 1.1% vs. unvaccinated: 4.1%;P<0.001). Conclusion(s): This is one of the largest real-world studies to date in women who received the COVID-19 vaccination during pregnancy. Vaccination rates varied significantly across race/ethnicity. Vaccinated patients had lower preterm delivery and pregnancy loss rates compared with unvaccinated patients.Copyright © 2023
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Objective: The factors affecting the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies from mother to newborn and the duration of seropositivity rates in these infants have not yet been clearly demonstrated. The objectives of this study were (1) to assess the levels of SARS-CoV-2 spike-specific immunoglobulin G (IgG) in women infected in the pregnancy period and newborns born to these women and (2) to search the transplacental transfer ratio of spike-specific IgG. Method(s): Seventy pregnant women with symptomatic SARS-CoV-2 infection and their newborns were prospectively followed. Anti-SARS-CoV-2 immunoassay was used for the detection of the in vitro quantitative determination of total antibodies to the SARS-CoV-2 spike protein. Discussion(s): Spike-specific IgG was demonstrated in 89.1% (44 of 46) of pregnant women infected more than 14 days before delivery and in 92.6% (43 of 44) of their newborns. Median transfer ratio of spike-specific Ig was 0.87 (interquartile range [IQR], 0.34-0.90), 1.0 (IQR, 0.9-0.29), and 0.81 (IQR, 0.02-1.0) in first trimester (n = 4), second trimester (n = 14), and third trimester (n = 28) pregnant women, respectively. Antibody transfer ratio was correlated with time elapsed from infection (p < 0.001). Peak antibody transfer ratio above 1 was observed at a median 60 to 120 days after the infection from delivery. Antibody transfer ratio was high in pregnant women infected more than 60 days before delivery (p < 0.001). Transfer ratio was significantly higher in the severe-critically symptomatic women (n = 15) than the mild-moderately symptomatic women (n = 55) (p = 0.001). At 3 months, 18 of 25 infants (72%) had spike-specific IgG. Conclusion(s): Timing from infection to delivery and severity of maternal infection are critical in assessing the antibody generation and transport. Higher antibody transfer ratio can be detected in neonates when SARS-CoV-2 infection is present for more than 60 days before birth. Maternally derived antibody can persist for 3 months after birth.Copyright © 2023. The Author(s).
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Background: Although over 100 million pregnant women worldwide are at risk of infection with SARS-CoV-2, little data exists on the impact of COVID-19 and related treatments on maternal/neonatal health. Objective(s): (1) To quantify the prevalence of medication use in pregnancy to treat COVID-19, and (2) To quantify and compare the risk of adverse pregnancy/neonatal outcomes in those with and without COVID-19. Method(s): In the Canadian Mother-Child population-based cohort (CAMCCO), two sub-cohorts were identified using prospective data collection of medical services, prescription drugs, hospitalization archives data, and COVID-19 surveillance testing program (02/28/2020- 2021). The first cohort included all pregnant women during the study period regardless of pregnancy status (delivery, induced/planned or spontaneous abortion);this cohort was further stratified on COVID-19 status. The second cohort included all nonpregnant women (aged 15-45) with a positive COVID-19 test. COVID-19 in pregnant or nonpregnant women was assessed using COVID-19 test results or ICD-10CM code U07.1 from hospital data. COVID-19 severity was categorized based on hospital admission. Women were considered exposed to COVID-19 medications if they filled at least one prescription for a medicine included in the WHO list in the 30 days pre- or 30 days post-COVID-19 positive test/diagnosis. Considering potential confounders, association between COVID-19 during pregnancy, treated vs not, and perinatal outcomes were quantified using log-binomial regression models. Result(s): 150,345 pregnant women (3,464 (2.3%) had COVID-19), and 112,073 nonpregnant women with COVID-19 diagnoses were included. Pregnant women with COVID-19 were more likely to have severe infections compared to nonpregnant women with COVID-19 (11.4% vs 1.6%, p<0.001). The most frequent medications used in pregnancy to treat COVID-19 were antibacterials (13.96%), psychoanaleptics (7.35%), and medicines for obstructive airway disease (3.20%). In pregnancy COVID-19 was associated with spontaneous abortions (adjRR 1.76, 95%CI 1.37, 2.25), gestational diabetes (adjRR 1.52, 95%CI 1.18, 1.97), prematurity (adjRR 1.30, 95%CI 1.01, 1.67), NICU admissions (adjRR 1.32, 95%CI 1.10, 1.59);COVID-19 severity was increasing these risks but exposures to COVID-19 medications reduced all risks. Conclusion(s): COVID-19 severity was higher in pregnancy. Antibacterials, psychoanaleptics, and medicines for obstructive airway disease were the most used overall. COVID-19 was associated with adverse outcomes for mothers and newborns.
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Background: We evaluated SARS-CoV-2 antibody binding and neutralization responses at delivery among pregnant persons with prior SARS-CoV-2 infection by vaccine status. Method(s): We enrolled participants with evidence of prior SARS-CoV-2 infection detected in pregnancy (anti-nucleocapsid [anti-N] IgG+ on enrollment or prior RT-PCR+ or antigen+) and followed them through delivery. Maternal delivery and cord blood samples were tested for SARS-CoV-2 binding antibodies to spike (anti-S) (from vaccination and/or infection) and anti-N (from infection only) IgG by Abbott Architect followed by neutralizing antibodies (classified as neutralizing if serum dilution inhibited infection by 50% [ND50 heat] >=20 and R2 >=0.9) if sample volume allowed. Positive IgG thresholds were Abbott index >=1.4 for anti-N and >=50 AU/mL for anti-S. Chi-squared test was used to compare differences in proportions between groups. Wilcoxon rank sum test was used to compare medians. Result(s): Among 71 participants with delivery and cord samples, median age was 33 years (interquartile range [IQR] 30-35) and median gestational age was 31.7 weeks (IQR 18.0-37.9) at enrollment in pregnancy. By delivery, 17 (24%) participants were unvaccinated, 21 (30%) were partially vaccinated or had completed a primary series, and 33 (46%) were boosted. Median time from infection (RT-PCR+ or antigen+ result) to delivery was 16.7 weeks (IQR 9.7- 24.3). At delivery, 33 (46%) of maternal (median 3.2 index) and 37 (52%) of cord samples (median 3.1 index) were anti-N IgG+. Participants with >=1 vaccine were more likely to be anti-S IgG+ than those unvaccinated (100% vs. 82%, p< 0.01), have higher median anti-S IgG+ (25,000 vs 1,019 AU/ml, p< 0.01), and have neutralizing antibodies (100% vs. 81%, p< 0.01) with higher median log10 neutralization (1:4.00 vs 1:2.41, p< 0.01) at delivery. Similarly, cord blood from participants with >=1 vaccine was more likely to be anti-S IgG+ than those unvaccinated (100% vs. 82%, p< 0.01), have higher median anti-S IgG+ (25,000 vs 1,188 AU/ml, p< 0.01), and have neutralizing antibodies (100% vs. 75%, p< 0.01) with higher median log10 neutralization (1:4.00 vs 1:2.41, p< 0.01) at delivery. Conclusion(s): Among pregnant people with prior SARS-CoV-2 infection detected during pregnancy, maternal and cord blood antibody binding and neutralization responses were higher among those receiving SARS-CoV-2 vaccination prior to delivery. (Table Presented).
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Purpose of Study: COVID-19 caused by the SARS-CoV-2 virus has led to a worldwide pandemic with cytokine storm as the leading cause of morbidity and mortality. It is known that pregnant women are at higher risk of viral infections given an alteration in immune response. Mothers who smoke cigarettes during pregnancy are even at higher risk. The infection varies from asymptomatic to severe disease in pregnant women depending upon the degree of inflammation and cytokine storm. At present, limited data are available to show the effects of simultaneous maternal smoking and SARS-CoV-2 infection on the biologic efficacy of human umbilical cord derived mesenchymal stem cells (MSCs). We hypothesized that SARS-CoV-2 infection in combination with smoking of the pregnant mother at the time of delivery will lead to an alteration in the growth and differential potential of cord-derived MSCs. Our aims included collection, isolation and growth of human umbilical cord derived MSCs followed by assessment of their differentiation potential. Methods Used: The study was approved by the Institutional IRB. The umbilical cords were collected from the following groups of pregnant mothers at the time of delivery: Normal (non-smoking and negative SARS-CoV-2 infection), Smoker (smoking with negative SARS-CoV-2), Covid Smoker (smoking with positive SARS-CoV-2 infection) and Covid non-smoker (non-smoking with positive SARS-CoV-2 infection). Plastic adherent cells were harvested from 3 pooled human umbilical cords from each group. These cells were cultured and underwent immunodepletion per International Society for cellular therapy guidelines to isolate MSCs. MSCs were cultured in MSC-culture media to assess the duplication time. Similarly, MSCs were cultured in differentiation media (adipocytes and osteocytes) to assess differentiation time. Summary of Results: Picture shows the duplication and differentiation time from each group. Smoker group showed the longest duplication and differentiation time. Covid non-smoker group showed the shortest duplication and differentiation time. Covid Smoker group showed similar duplication and differentiation time as normal controls. All these results were statistically significant (T-test). Conclusion(s): Maternal smoking and active SARS-CoV-2 infection at the time of delivery alters the growth and differentiation potential of cord-derived MSCs. Further in vitro and in vivo studies are currently in progress to determine how this change effects the biological potential of these cells.
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Background: Maternally derived antibodies are crucial for neonatal immunity. Understanding the binding and -cross neutralization capacity of maternal/ cord antibody responses to COVID-19 vaccination during pregnancy can inform neonatal immunity. Method(s): Here we characterized binding and neutralizing antibody profile at delivery in 24 pregnant individuals following two doses of Moderna mRNA-1273 or Pfizer BNT162b2 vaccination. We evaluated the transplacental antibody transfer by profiling maternal and umbilical cord blood. We analyzed for SARS-CoV-2 multivariant cross-neutralizing antibody levels for wildtype Wuhan, Delta, Omicron BA1, BA2, and BA4/BA5 variants by enzyme-linked immunosorbent assay Results: Our results reveal that current vaccination induced significantly higher (p=0.003) RBD-specific binding IgG titers in cord blood compared to maternal blood for both Wuhan and Omicron BA1 strain. Interestingly, binding IgG antibody levels for the Omicron BA1 strain were significantly lower (P< 0.0001) when compared to the Wuhan strain in both maternal and cord blood. In contrast to the binding, the Omicron BA1, BA2, BA4/5 specific neutralizing antibody levels were significantly lower (P< 0.0001) compared to the Wuhan and Delta variants. It is interesting to note that the BA4/5 neutralizing capacity was not at all detected in both maternal and cord blood. Conclusion(s): Our data suggest that the initial series of COVID-19 mRNA vaccines were immunogenic in pregnant women, and vaccine-elicited binding antibodies were detectable in cord blood at significantly higher levels for Wuhan and Delta variants but not for Omicron variants. Interestingly, the vaccination did not induce neutralizing antibodies for Omicron variants. These results provide novel insight into the impact of vaccination on maternal humoral immune response and transplacental antibody transfer for SARS-CoV-2 variants and support the need for boosters as new variants emerge.
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Introduction: This study included pregnant patients with severe COVID to test the hypothesis that the impact of delivery on maternal outcome depends upon illness severity at the time of delivery;we hypothesized that patients not yet requiring IPPV would improve following delivery (due to improvement in respiratory mechanics), while patients already on IPPV, or close to requiring ventilation, would deteriorate (due to maternal cardiovascular intolerance to autotransfusion). Method(s): This multicenter, prospective/retrospective cohort study evaluated Israeli ICU admissions of pregnant women with COVID-19 pneumonitis from 1-Feb-2020 to 31-Jan-2022. We assessed maternal, neonatal outcomes and longitudinal maternal clinical data. The primary outcome was maternal outcome (no-IPPV, IPPV, ECMO, death). The primary longitudinal outcome was SOFA score, the secondary longitudinal outcome was the novel PORCH score (PEEP, Oxygenation, Respiratory-support, Chest-X-ray, Haemodynamic-support). Patients were classified into: no-delivery, postpartum admission, deliverycritical and delivery-not-critical groups. Result(s): 84 patients in 13 ICUs were analysed;there were 34 nodelivery, 4 postpartum, 32 delivery-critical, 14 delivery-not-critical patients. Delivery-critical and postpartum had worse outcomes with, 26/32(81%) and 4/4(100%) requiring IPPV;12/32(38%) and 3/4(75%) requiring ECMO;1/32(3%) and 2/4(50%) dying. Deliverynot- critical and no-delivery had far better outcomes with, respectively, 6/34(18%) and 2/14(14%) requiring mechanical ventilation;no patients required ECMO or died. SpO2, S/F ratio, P/F ratio in Deliverycritical deteriorated on the day of delivery, continued to deteriorate, and took longer to recover;delivery-not-critical improved rapidly following delivery. The day of delivery was a highly significant covariate for PORCH (p < 0.0001), not SOFA (p = 0.09). Conclusion(s): Interventional delivery should be considered for maternal indications before patients deteriorate and require IPPV.
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Background: Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria and, in Uganda, its control relies heavily in the administration of intermittent preventive treatment with sulfadoxinepyrimethamine (SP-IPTp) during antenatal care visits (ANC). COVID-19 pandemic severely impacted health systems globally. This study aims to assess trends in delivering malaria in pregnancy related healthcare services before and during Covid-19 in thirty health facilities in Northern Uganda. Method(s): Interrupted time series study comparing two periods: I) pre- Covid-19 (January 2018 to February 2020) and II) Covid-19 (from March 2020 to December 2021) period. Data were sourced from the District Health Information Management System II (DHIMS2) routinely collected indicators. Comparisons between the two periods were computed with a jointpoint regression model and Annual Average Percentage Changes (AAPC) were calculated. Result(s): The study involved data collected by 30 health facilities, 30 health facilities in Northern Uganda - including one hospital - with a catchment area of 506,276 inhabitants and an estimated number of pregnancies ranging from 21,440 to 23,315. Covid cumulative cases and deaths for Oyam districs are reported in Figure 1. As shown in Figure 2, during COVID period we found a significant reduction in the number of women accessing to at least 4 antenatal care (ANC) visits and taking at least three doses of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine. The total number of pregnant women receiving Artemether-Lumefantrine for nonsevere malaria or being hospitalized for severe malaria, along with the total number of institutional deliveries and stillbirths followed kept following the trend recorded prior to the pandemic. Conclusion(s): The present study shows that, despite the international call for prioritization of maternal and reproductive health service delivery during COVID-19 pandemic, in Uganda, the essential care for malaria in pregnancy have been disrupted. This is concerning, as the failure to increase the delivery of SP-IPTp may impact malaria-related mortality.
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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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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.
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Resumen Se presenta un caso de atención de parto eutócico sin complicaciones en una paciente COVID-19 positivo. La mujer de 33 años, tercigesta de 39 semanas, controlada en una clínica privada, acudió en trabajo de parto presentando tos no asociada a otra sintomatología. Fue diagnosticada con COVID-19 por prueba rápida IgM (+) IgG (-). Se realizó el aislamiento y se proveyó de equipo de protección personal según protocolo de la clínica. El trabajo de parto fue manejado según condiciones obstétricas, con analgesia epidural en fase activa, y teniendo como resultado un recién nacido sin complicaciones. No se realizó contacto piel a piel ni clampaje tardío. Ambos fueron dados de alta sin complicaciones previo período de aislamiento del recién nacido con estudios negativos para COVID-19. Se les realizó seguimiento telefónico en casa. En el caso presentado, se cumplió con el protocolo recomendado para la atención del parto durante la pandemia de COVID-19.
Abstract We present the case of a eutocic, uncomplicated delivery in a patient positive for COVID-19. The patient, a 33-year-old woman, 39 weeks pregnant, who had received prenatal care in a private clinic, presented in labor, coughing, without any other symptoms. She was diagnosed with COVID-19 by rapid test, IgM (+) and IgG (-). We isolated the patient and provided personal protective equipment following our clinic's protocol. Delivery was managed according to obstetric conditions, applying epidural anesthesia in the active phase; the baby was born without complications. Nor skin-to-skin contact nor delayed umbilical cord clamping were performed. Mother and child were discharged without complications after the newborn completed the required isolation period, testing negative for COVID-19. Telephone follow-up was performed. The healthcare team followed the recommended protocol to manage delivery during the COVID-19 pandemic.
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Background: In new pandemic, the probable effects of COVID-19 pneumonia on pregnant woman and their infant is one of new critical challenge for health care. Here we presented clinical symptoms, laboratory findings and outcome of COVID-19 pneumonia in pregnant woman. Method(s): In a case series study, from 15 Feb to 15 June 2020, all women with RT-PCR COVID-19 who referred to two hospitals (Taleghani and Qods Hospital) affiliated to Arak University of Medical Sciences were selected. The epidemiological and demographic variables, laboratory test and outcomes obtained from patient's medical records. Result(s): In this case series, we presented thirteen confirmed COVID-19 pregnant women. Their mean age was 34.6 (S.D.: 5.9) years and the mean gestational age was 32.4 (S.D.: 7.3) weeks. Most of patient didn't show any maternal complication and intrauterine vertical transmission. The large number of pregnant women had normal HRCT and also in terms of laboratory most of the patients had normal laboratory tests. Amniotic fluids, cord blood, the throat swab of neonate in our pregnant woman with delivery were tested for COVID-19 and all of them were negative. Conclusion(s): The COVID-19 mothers and their infant didn't have higher risk for morbidity and mortality and this virus didn't associate with intrauterine vertical transmission.Copyright © 2020 Ubiquity Press. All rights reserved.
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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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Background & Purpose: Hypertension Canada's 2020 clinical practice guidelines emphasize the importance of education and cardiovascular risk reduction for patients after the hypertensive disorders of pregnancy (HDP). While 18 specialized clinics across Canada were developed to address this clinical need, they are limited by low rates of patient follow-up. Understanding the experiences and preferences of patients attending these clinics may help improve attendance and ultimately health outcomes. As such, this study's objective was to examine the experiences of patients attending Calgary's PreVASC clinic (which offers an initial consultation 3-6 months after delivery and annual follow-up for CVD risk factor screening and management) to inform CVD preventive care tailored for people after HDP. Method(s): This multi-method study was conducted in two stages: 1) quantitative electronic survey of patient experiences;and 2) individual semi-structured interviews conducted by phone. Eligible participants included patients who attended at least one clinic visit and consented to participate. Quantitative survey results were summarized with descriptive statistics and qualitative interviews were grouped thematically by two independent reviewers. Results were triangulated between the survey and interviews. Result(s): 74 of 115 (64%) eligible patients consented and 57% (n=42) completed the electronicsurvey. Overall, 79% (n=33) of patients reported being very satisfied with the PreVASC clinic;95% (n=40) reported making at least one health behavior change (e.g., heart-healthy diet or increasing physical activity);and 31% (n=23) reported a medication change. 11 participants completed interviews to achieve theme saturation which found improvements in health literacy and reductions in anxiety levels. Patients reported preferences for a specialty care provider and face-to-face visits despite the COVID-19 pandemic. Conclusion(s): While patients reported high-satisfaction with an in-person model of CVD preventive care, additional research should examine the long-term impacts of clinical programs specifically tailored for people after HDP on patient-important health outcomes.
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Background: Maternal mortality prevention and delivering optimal outcomes for both mother and fetus is the utmost concern of health systems in any country. Objective(s): This study aimed to examine maternal mortality in pregnant women since the beginning of the COVID-19 pandemic in Hamadan province, western Iran. Examining the causes of maternal mortality can be valuable in identifying mortality factors in line with prospective strategic plans. Method(s): This case series study introduces the data of seven deceased pregnant women, the deaths of whom occurred since the beginning of the COVID-19 pandemic (December 2019 - March 2021) in the hospitals of cities within Hamadan province. All data were reported at the time of death or at least 14 days after hospital admission. In this study, epidemiological features and pregnancy history, background dis-eases, clinical symptoms, initial vital signs, medications in use, clinical laboratory values, delivery type, and neonatal outcome were assessed, respectively. Result(s): In the seven maternal mortality cases reported in this study, three women succumbed to pregnan-cy-related causes (two cases of preeclampsia and one case of antiphospholipid syndrome), and four women to severe coronavirus disease. All deceased mothers had been admitted to the intensive care unit as a result of severe illness. Four cases concerned a background condition as well, which included thrombo-embolic disorders, epilepsy, and lupus. In mortality cases, two women displayed a BMI score over 30. One maternal death had occurred 42 days postpartum, while five deaths had occurred prior to 37 weeks of gestation, and one past 37 weeks of gestation. Conclusion(s): This report provided valuable information on maternal mortality factors. Maternal mortality necessitates a careful acquisition of monitoring data, but in the prevailing pandemic circumstances, cau-tion necessitates raising awareness of the maternal mortality potential in women with COVID-19 diagnosis in the second or third trimester. Pregnancy care programs must focus on recognizing high-risk groups of mothers-to-be with background conditions and risk factors for pregnancy, given that early diagnosis and prompt referral are invaluable in the immediate treatment and relief of pregnant mothers-to-be.Copyright © 2022 Bentham Science Publishers.
ABSTRACT
Prevention is better than cure This covid-19 pandemic has made many changes in everyone's life, in this pandemic WHO focuses on the safety of healthcare workers and Safety ofpatients, WHO set COVID-19 protocols. Aim(s): Assessment of educational intervention on knowledge regarding World Health Organization covid-19 protocols during delivery among staff nurses. Methodology: The present study is evaluative study with methodological research design. A total of 60 samples were selected for the study by using the non -probability purposive sampling technique based on the selection criteria. The reliability was done by using the test re-test method for structured questionnaire. Data were analysed by using descriptive and inferential statistics. Result(s): In pre-test, 43.3% of the staff nurses had average knowledge (Score 4 to 6), 55% of them had good knowledge (Score 7 to 9) and 1.7% of them had excellent knowledge (Score 10) regarding WHO covid 19 protocols.In post-test, 18.3% of them had good knowledge (Score 7 to 9) and 81.7% of them had excellent knowledge (Score 10) regarding WHO covid 19 protocols. This indicates that the knowledge among the staff nurses regarding WHO covid 19 protocols had improved remarkably after the health teaching. Researcher had applied paired t-test for the effect of health teaching on knowledge regarding WHO covid 19 protocols. Average knowledge scorein pre-test was 6.8;which increased to 9.8 in post-test. T-value for this test was 14.08 with 59degrees of freedom. Corresponding p-value was small (less than 0.05), the null hypothesis is rejected. It is evident that the knowledge among the staff nurses regarding WHO covid 19protocols had improved significantly after health teaching. Conclusion(s): there is a significant gap in the knowledge score WHO COVID-19 Protocol among labour room nurses, and hence there is need for a WHO COVID-19 Protocol for the improvement of knowledge.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.