Caesarean section in critically unwell peri-partum patients with COVID-19: A tertiary centre's experience

Introduction: The COVID-19 pandemic has required clinical teams to function with an unprecedented amount of uncertainty, balancing complex risks and benefits in a highly fluid environment. This is especially the case when considering the delivery of a pregnant woman critically unwell with COVID-19. This is one maternal critical care team's reflections on establishing best practice and a shared mental model when undertaking a Caesarean section in critically unwell patients with COVID-19. Objective(s): We describe our experience of balancing the risks and streamlining the process of this high-risk intervention. Method(s): We used our standard clinical governance forums across four specialties (Obstetrics, Intensive care, Anaesthetics and Neonatology) to identify key challenges and learning points. We developed a working group to combine our learning and develop a shared mental model across the involved teams. Result(s): 1. The decision to deliver must be multidisciplinary involving Obstetrics, Intensive care, Anaesthetics, Neonatology and the patient according to their capacity to participate. The existing structure of twice daily ITU ward rounds could be leveraged as a 'pause' moment to consider the need for imminent delivery and review the risk-benefit balance of continued enhanced pharmacological thromboprophylaxis. 2. We identified a range of scenarios that our teams might be exposed to: 3. Perimortem Caesarean section 4. Critically unwell - unsafe to move to theatre 5. Critically unwell - safe to move to theatre 6. Recreating an obstetric theatre in the ICU Advantages Avoids moving a critically unstable patient, although our experience is increasing moving patients for ECMO. Some forms of maximal non-invasive therapy such as High Flow Nasal Oxygen may require interruption to move to theatre with resultant risk of harm or be difficult to continue in transport mode through a bulky ICU ventilator e.g. CPAP Disadvantages Significant logistics and coordination burden: multiple items of specialist equipment needing to be brought to the ICU. Human factors burden: performing a caesarean section in an unfamiliar environment is a significant increase in cognitive load for participating teams. Environmental factors: ICU side rooms may offer limited space vs the need to control the space if performed on an open unit. Delivering a Neonate into a COVID bubble. Conclusion(s): Developing a shared mental model across the key teams involved in delivering an emergency caesarean section in this cohort of critically unwell patients has enabled our group to own a common understanding of the key decisions and risks involved. We recommend a patient centred MDT decision making model, with a structure for regular reassessment by senior members of the teams involved. In most circumstances the human factors and logistical burden of recreating an operating theatre in the ICU outweighs the risk of transport to theatre. Pre-defined checklists and action cards mitigate the cognitive and logistical burden when multiple teams do perform an operative delivery in ICU. Action cards highlight key aspects of routine obstetric care to be replicated in the ICU environment.

Maternal outcome of pregnant and postpartum women admitted to intensive care unit due to COVID-19 infection: A retrospective study

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.

SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

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.

COVID-19 Vaccination during Pregnancy: A Structured Electronic Medical Record Data Study

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

Perioperative management in obstetric patients with suspected COVID-19 at Bali, Indonesia: Case series

The COVID-19 pandemic is a challenge for health practitioners, where there are many suspected and confirmed patients with COVID-19, including obstetric patients. Perioperative treatment of COVID-19 patients must be under applicable standards, for both patients and the medical personnel. Personal protective equipment is essential for health workers who treat patients with COVID-19 to prevent the transmission of the virus. The method of delivery ideally should be adapted to the clinical condition of the patient. At the same time, the management of anesthesia for patients with cesarean sections should also be adjusted to the patient's clinical condition by taking into consideration the availability of facilities and infrastructure that we have. Through this report, we want to show how we manage COVID-19 in obstetric cases using the available resources in a third-world country.Copyright © 2021 Bali Journal of Anesthesiology. All rights reserved.

Antenatal anaesthetic assessment of parturients with BMI > 40 kg/m2

Introduction: Frimley Park Hospital criteria for referral to High-Risk Obstetric Anaesthetic Clinic (HROAC) included all parturients with BMI > 40. The COVID-19 pandemic necessitated HROAC becoming virtual. It was still possible to discuss risk and assess patients' airways, but not to reliably assess the likely ease of neuraxial techniques or cannulation. Observationally, little useful clinical information was gained, and airway problems rarely noted. An audit was planned to assess how often clinically useful information about the women's airways was gained during appointments. Method(s): HROAC database search for women referred with BMI > 40 with estimated date of delivery 20/04/20-03/04/21 to see whether any airway difficulties were predicted (Mallampati 3 or 4;limited neck movement;jaw slide B or C;limited mouth opening). Result(s): 82 women had BMI > 40, of which 3 were assessed as having a potentially difficult airway: two had BMI > 50 and one had retrognathism causing difficult airway prediction unrelated to her BMI of 41.7. One woman, BMI 58.7, was assessed as having a straightforward airway but her notes revealed her airway had been challenging to intubate in the past. One was assessed in video consultation as straightforward but an airway assessment during admission at the end of her previous pregnancy was Mallampti 3. Five women declined a video consultation. Discussion(s): In view of the minimal gain of clinically useful information and the routine presence of difficult airway kit for the obstetric emergency theatre, it was deemed safe and more relevant to make airway and neuraxial assessments on admission to labour ward rather than in the antenatal clinic for women with BMI<50. The assessment would therefore be made by the duty trainee anaesthetist who would be responsible for managing the patient, thus facilitating appropriate planning and communication if a woman with a challenging airway was identified. It is therefore also made at the very end of pregnancy when weight gain and its impact on airway is likely to be at its maximum. This approach, in conjunction with an antenatal information leaflet, and the ability of any obstetrician to refer to the HROAC, complies with the need for timely assessment of women as required by GPAS [1]. By formalising the assessment of women with high BMI on the labour ward it is hoped that patient safety and planning can be maximised.Copyright © 2023 Elsevier Ltd

Detection of SARS-CoV-2 Antibodies in Matched Pregnant Women and Newborn Blood

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).

Towards gold standard care for peripartum women admitted to general intensive care units

Introduction: Critically-ill obstetric patients admitted to general intensive care units (ICU) are a rare and unique population for whom excellent care is essential to prevent devastating physical and psychological morbidity. Admissions are often unanticipated and can present challenges to obstetric and intensive care MDTs. 2018 Enhanced Maternal Care (EMC) Guidelines provide standards for caring for these women, and the 2022 Ockenden review exposed the association of peripartum ICU admission with undertreated psychological trauma and a desire for individualised debriefing [1,2]. We audited the care of obstetric admissions to general ICUs in our quaternary centre. We sought evidence of psychological morbidity to improve follow-up pathways in line with 2022 Ockenden actions. Method(s): Retrospective online case note review of maternity admissions to general ICUs between 1/1/2021-1/1/2022 compared to EMC audit standards. Exclusion criteria: <22/40 gestation, >6/52 postpartum and admissions to our level 2 labour ward high dependency unit. Result(s): 25 patients were admitted to general ICUs over 12 months. Median age was 35-39 years, mean parity was 1. The commonest indication was obstetric haemorrhage (n = 10). 15 of 25 patients required level 3 care, median length of stay was 1.5 days. Documentation of daily obstetric MDT ward round was variable, as was mother-baby contact. 0 of 25 women were seen in obstetric anaesthesia clinic after discharge, only 1 received outpatient ICU follow-up. 50% of postnatal admissions (n = 14) had documentation of significant psychological distress. In response a local checklist was developed with key colleagues to support collaborative working and standardise quality care. It includes automatic referral into obstetric anaesthesia clinic and access to a novel perinatal mental health service. Discussion(s): A peripartum admission to ICU is highly likely to be experienced as traumatic [2]. The incidence of obstetric ICU admissions may increase in the context of greater clinical complexity of the UK pregnant population and COVID-19, whilst the non-anaesthetic ICU workforce may have little obstetric training. Obstetric anaesthetists are therefore uniquely skilled to facilitate quality resuscitation and referral to ICU, but gold-standard holistic care extends beyond admission. We believe regular audit and dedicated local care pathways which incorporate proactive debriefing and psychological health can improve the care of this important group of women.Copyright © 2023 Elsevier Ltd

Comparison of Obstetric Outcomes in First and Second COVID-19 Waves: Analysis from a COVID-19-dedicated Tertiary Care Hospital

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.

COVID-19 Infection and Medicines in Pregnancy in Canada

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.

Digital follow-up in obstetric anaesthesia

Introduction: Throughout the COVID-19 pandemic and in order to maintain essential operations in a socially distanced environment, many services in healthcare have undergone significant change, moving towards telemedicine solutions. This has ranged from virtual GP consultations to virtual examinations for post-graduate students. Telemedicine solutions are unlikely to provide a wholesale replacement for face-to-face patient interaction without significant deficiencies, however, they do herald new hybrid ways of working, allowing service providers to reach clients where they are. Anaesthetic followup for Obstetric clients who have undergone an anaesthetic intervention is a national recommendation by RCOA [1] and AAGBI/OAA [2]. The aim of this QI project was to launch a digital follow-up survey for Obstetric clients who underwent an anaesthetic intervention which could be utilised in a busy unit where staff shortage or high clinical workload often preclude daily face-to-face follow up. Method(s): We created a digital clients survey which is accessed by scanning a QR code. With the support of senior midwifery coordinators, large posters advertising the survey and QR code were put up in each client bay on the post-natal ward and flyers with QR codes were given to clients. Midwives reminded post-natal clients to complete the survey. We included a flyer with the QR code in discharge paperwork. The survey included an option to request a face-to face anaesthetic review. Result(s): During the trial period of three weeks, 87 inpatient and discharged post-natal clients responded via the digital follow-up tool. Discussion(s): Digital follow-up can provide an invaluable supplemental source of follow-up, supporting conventional follow-up methods and facilitating safe fast-track discharge. [Figure presented]Copyright © 2023 Elsevier Ltd

Frequency of Prenatal Care Visits: Protocol to Develop a Core Outcome Set for Prenatal Care Schedules.

BACKGROUND: Prenatal care, one of the most common preventive care services in the United States, endeavors to improve pregnancy outcomes through evidence-based screenings and interventions. Despite the prevalence of prenatal care and its importance to maternal and infant health, there are several debates about the best methods of prenatal care delivery, including the most appropriate schedule frequency and content of prenatal visits. Current US national guidelines recommend that low-risk individuals receive a standard schedule of 12 to 14 in-office visits, a care delivery model that has remained unchanged for almost a century. OBJECTIVE: In early 2020, to mitigate individuals' exposure to the SARS-CoV-2 virus, prenatal care providers implemented new paradigms that altered the schedule frequency, interval, and modality (eg, telemedicine) of how prenatal care services were offered. In this paper, we describe the development of a core outcome set (COS) that can be used to evaluate the effect of the frequency of prenatal care schedules on maternal and infant outcomes. METHODS: We will systematically review the literature to identify previously reported outcomes important to individuals who receive prenatal care and the people who care for them. Stakeholders with expertise in prenatal care delivery (ie, patients or family members, health care providers, and public health professionals and policy makers) will rate the importance of identified outcomes in a web-based survey using a 3-round Delphi process. A digital consensus meeting will be held for a group of stakeholder representatives to discuss and vote on the outcomes to include in the final COS. RESULTS: The Delphi survey was initiated in July 2022 with invited 71 stakeholders. A digital consensus conference was conducted on October 11, 2022. Data are currently under analysis with plans to submit them in a subsequent manuscript. CONCLUSIONS: More research about the optimal schedule frequency and modality for prenatal care delivery is needed. Standardizing outcomes that are measured and reported in evaluations of the recommended prenatal care schedules will assist evidence synthesis and results reported in systematic reviews and meta-analyses. Overall, this COS will expand the consistency and patient-centeredness of reported outcomes for various prenatal care delivery schedules and modalities, hopefully improving the overall efficacy of recommended care delivery for pregnant people and their families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43962.

Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995.

OBJECTIVE: To report results of the 2021 French National Perinatal Survey (ENP) in metropolitan France and assess trends in the main indicators of perinatal health, medical practices, and risk factors in France since 1995. POPULATION AND METHOD: All the samples included all women giving birth at a gestational age of at least 22 weeks of gestation and/or to an infant weighing at least 500 grams in all maternity units in metropolitan France during one week in 1995 (N=13 048), 2003 (N=14 324), 2010 (N=14 546), 2016 (N=12 553), and 2021 (N=12 088). The data came from postpartum interviews of the women at the hospital and their medical records. Comparisons between surveys showed trends over time. RESULTS: Between 1995 and 2021, maternal characteristics changed. Maternal age and the frequency of women with obesity rose: in 2021, 24.6% of women were 35 years or older (21.1% in 2016, 19.2% in 2010, 15.9% in 2003 and 12.4% in 1995) and 14.4% were obese (11.8% in 2016, 9.9% in 2010 and 7.4% in 2003). Some antenatal prevention behaviors that improved in 2021 were not smoking during the third trimester, acid folic administration before pregnancy, and vaccination against influenza. The percentage of women with an early prenatal appointment ("4th month appointment"), implemented to facilitate screening of maternal vulnerability during pregnancy, has continued to rise. The percentage of women receiving prenatal care by midwives has risen markedly (39.0% in 2021 versus 11.7% in 2016). Serum screening for Down syndrome continues to increase (91.8% of women in 2021). The rate of induction of labor has risen significantly (20.2% in 1995 and 25.8% in 2021). The mode of delivery has not varied significantly since 2003; in 2021, the cesarean rate was 21.4% and the instrumental vaginal delivery rate 12.4%. Episiotomy was increasingly rare, among both primiparous and multiparous women (16.5% and 2.9% in 2021, respectively). The prevalence of coronavirus (SARS-CoV2) infection during pregnancy was 5.7%. Preterm live births increased regularly, slightly but significantly over the 1995-2016 period and then remained stable between 2016 and 2021 (7.0%). In 2021, 56.3% of women exclusively breastfed during their hospital stay, a modest increase in comparison with 2016 (54.6%). CONCLUSION: Routine national perinatal surveys highlight positive trends over time in some preventive practices, decreases in some medical interventions consistent with national guidelines, and the increasing role of midwives in prenatal care. Nonetheless, some indicators remain less than optimal and require more detailed analyses.

Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia.

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.

COVID-19 and pregnancy

The current COVID-19 pandemic has resulted in an unprecedented worldwide health crisis. The increased vulnerability of pregnant women as well as past experience from previous coronavirus epidemics are cause for concern of maternal and fetal complications. The rapid outbreak of the disease combined with the uncertainty, as a direct result of the lack of strong scientific data, has forced obstetricians to adapt their current practices pragmatically. This article reviews obstetrical management of pregnant patients infected by SARS-CoV-2 based on the current knowledge.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Frequency and outcomes of extremely early preterm birth in pregnant women with new coronavirus infection COVID-19

The frequency of extremely early preterm birth (ERPR), their obstetric and perinatal outcomes, morphological features of the placenta in pregnant women in the city of Chelyabinsk and the Chelyabinsk region (CO) with a new coronavirus infection (NCI) in periods 1-2 and 3-4 waves of the COVID pandemic were studied. -19. The results obtained indicate that there is no increase in the frequency of ERPR in pregnant women with NCI. Delivery by caesarean section is associated mainly with the increase in acute respiratory distress syndrome (ARDS) of the mother. In the period of waves 3-4 of the COVID-19 pandemic, an increase in the perinatal mortality rate was noted compared to the period of waves 1-2 without statistical significance of these indicators. At the same time, antenatal fetal death during the 3rd-4th wave of the NCI pandemic was observed statistically significantly more often (p=0.033). The features of placental damage to the placentas in patients with NCI with ERPR and antenatal fetal death during the 3rd-4th wave of the pandemic are severe maternal and fetal vascular malperfusion and severe acute inflammatory lesions of the placenta (2,3 stages and 2,3 degrees).

Analysis of Prolonged Caesarean Section Response Time in True Emergency Obstetric Care during Covid-19 Pandemic Era: Study at Kariadi Tertiary Hospital Indonesia

Intro: COVID-19 pandemic era makes quality of obstetric triage care including caesarean section in obstetric true emergency cases delayed. Maternal fetal triage index (MFTI) score is an instrument used to define true emergency in obstetric cases. Decision to delivery interval (DDI) is time interval from caesarean section decision to delivery within <30 minutes standard in emergency cases.This study was designed to evaluate the decision to delivery time interval and its effect on perinatal outcomes and the associated factors during category-1 emergency caesarean section deliveries. Method(s): A prospective observational descriptive study was conducted from 2020-2022 at Kariadi tertiary Hospital. A total of 40 clients who were undergone category-1 emergency caesarean section were included in this study. This is a indepht analysis pregnant women confirmed with COVID-19 infection and had true emergency cases based on MFTI score (stat-priority 1). Finding(s): Among 346 pregnant women with COVID-19, total 160 C-section cases with 40 eligible data were included in this study. Gestational age mostly in their second and third trimester. Maternal comorbidities were diabetes in pregnancy, HIV, pre eclampsia, SLE and thyroid disease. This study showed that DDI <30 minutes were found in 34 cases (85%), DDI 30-60 minutes as many as 6 (15%), and no (0%) DDI >60 minutes. Emergency cases with the shortest DDI were umbilical cord prolapse 3 (100%), fetal distress 14 (93%), placental abruption 5 (83%), impending uterine rupture 5 (83%), and antepartum hemorrhage 7 (70%). Perinatal outcome were Apgar score lower than 7 at 1 minutes (25%) and stillbirth (5%). Conclusion(s): Most of DDI in this study met the recommendation of <30 minutes, but some cases did not meet the standard. This can be caused by multifactorial factors such as advice from the doctor in charge, patient transfer distance, operating room preparation, and anesthetic preparation due to COVID-19.Copyright © 2023