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Objective: The current study aimed to describe the clinical characteristics of mild SARS-CoV-2 infected pregnant women with abnormal liver function (ALF), explore the association between ALF with maternal and fetal outcomes. Method(s): This retrospective analysis included 87 pregnant patients with mild SARS-CoV-2 infection admitted and treated from December 1, 2022, to 31, 2022 in the department of Obestircs at Beijing Obstetrics and Gynecology Hospital. We evaluated patients for demographic and clinical features, laboratory parameters and pregnancy complications. Result(s): 27 Patients in this cohort had clinical presentations of ALF. Compared with the control group, the peripheral blood platelet (PLT), D-dimer quantitative determination (D-Dimer), lactate dehydrogenase (LDH), total protein (TP), albumin (ALB), indirect bilirubin (DBIL), gamma- glutamyltranspeptidase (GGT) and total bile acid (TBA) showed significantly differences (p<0.05). 12 cases (44.44%) complicated with pregnancy induced hypertension (PIH), 14 cases (51.85%) complicated with intrahepatic cholestasis of pregnancy (ICP), 2 cases (7.4%) complicated with acute fatty liver during pregnancy (AFLP) and 5 cases (14.81%) complicated with postpartum hemorrhage in patients with abnormal LFT were significantly higher than those in the control group (p<0.05). Compared with the control group, the incidence of premature delivery (22.22%) and fetal distress (37.04%) in the experiment group were significantly higher (p<0.05), and the incidence of neonatal asphyxia was not significantly different (p>0.05). Conclusion(s): Pregnant women are generally susceptible to mild SARS-CoV-2 and may induce ALF. ALF is associated with increased risk of mother and infant. The maternal and infant outcomes of those who terminated pregnancy in time are acceptable. Therefore, pregnant women with COVID-19 who received antiviral treatment should be closely monitored for evaluating liver function and relevant indicators. The long-term outcomes in the future are worth to further study.Copyright © 2023
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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.
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Objective. The pandemic forced the re-organization of birth hospitals in the province of Reggio Emilia. In 2018 there were four difference birth centres, in 2021 only two out of four were still working. The OBJECTIVE of the study was to evaluate if the centralization of birth centres had worsened the stillbirth rate and perinatal asphyxia (PA) outcome during the SARSCoV- 2 pandemic period (years 2020-21) compared to the pre-pandemic period (years 2018-19). Materials and Methods. Retrospective review of birth rate, recovery for PA rate and stillbirth rate in the province of Reggio Emilia. Results. Statistical data showed a decrease of overall births from 2018 to 2021 (7516 newborns in 2018-19 to 6363 in 2020- 21), in accordance with the national trend. The percentage of newborns in the NICU in Reggio Emilia increased from the pre-pandemic period (59.66%) to the pandemic period (83.66%). Regarding the stillbirth rate, we observed a decrease from the pre-pandemic period (3.20%) to the pandemic period (2.36%). As far as concerned the PA rate, the percentage showed a reduction from the pre-pandemic (0.44%) to the pandemic period (0.36%). We also observed a decrease of the hypoxic-ischemic encephalopathy (HIE) rate from 0.16% to 0.12%. Finally, three different outcomes were evaluated in patients admitted for perinatal asphyxia: mortality, brain imaging lesions and seizures. During the pandemic we observed a significant decrease in all of these (Table 1). Conclusions. Centralization of birth centres did not worsen perinatal diseases as far as concerns stillbirth, PA and HIE rate. On the contrary, we observed an enhancing of patients' outcomes.
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Objective: Chonburi province is ranked fourth in Thailand in terms of COVID-19 cases. The objective was to compare neonatal and maternal outcomes among pregnant women with and without COVID-19 infection delivered in Chonburi hospital. Materials and Methods: The present study was a retrospective matched cohort study that included all pregnant women who delivered between January 1 and August 31, 2021, at Chonburi Hospital, Thailand. The exposure group comprised women with a current or previous positive COVID-19 PCR test, while the comparators were the PCR negative group. The matching ratio was 1:4, based on gestational and maternal age, parity, and the closest delivery date. Clinical data were obtained from medical records. Results: Forty-six pregnant women had a positive COVID-19 PCR, 24 (52.17%) were Thai and 22 (47.83%) were of other ethnicities. Most (60.87%) were asymptomatic or required no medical assistance. Three (6.52%) had severe pneumonia and required respiratory support. Neither maternal death nor vertical transmission was detected. Compared with 184 COVID-19-negative pregnant women, no significant differences in low APGAR score of less than 7, and preeclampsia in the 46 COVID-19-positive pregnant women were observed. However, COVID-19-positive pregnant women showed an increased rate of neonatal respiratory distress (RD) (relative risk [RR] 2.55;95% confidence interval [CI] 1.04 to 6.21] and clinical early-onset neonatal sepsis (RR 3.60;1.55 to 8.36). Additionally, a higher cesarean section rate was observed in the COVID-19 positive group (RR 1.45, 1.11 to 1.85). Conclusion: There were no significant differences in neonates with APGAR of less than 7 between the cohort of 46 pregnant women who tested positive for COVID-19 and those who tested negative. However, a higher rate of cesarean delivery, presumed early-onset neonatal septicemia, and RD in the COVID-19 positive group were noted and should be monitored.
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Introduction: The clinical therapy of COVID-19 infection during pregnancy is still insufficient and limited. The current literature on COVID-19 infection during pregnancy and childbirth is summarized in this article, with a focus on maternal and neonatal outcomes. Material and methods: From June 1 to September 7, 2020, a systematic search of pertinent medical subject heading (MeSH) terms, covered by the electronic databases Web of Science and Scopus, PubMed, Google Scholar, and SID key phrases including coronavirus or COVID-19 and pregnancy was undertaken. The search and selection criteria were restricted to English and Farsi literature. COVID-19 in pregnancy articles of all types were considered in the study. The references of relevant studies were also searched. After deleting duplicate and ineligible items, a total of 21 articles were collected. Result: We found 21 studies with a total of 6,569 pregnant women who had COVID-19 infection: only one publication provided disease severity: 368 (95.6%) mild cases, 14 (3.6%) severe cases, and three (0.8%) serious cases. A total of 6,569 women gave birth more often by caesarean than by vaginal delivery. With multiple organ dysfunction syndromes (MODS), some women developed symptoms that necessitated ICU admission. The most commonly administered treatments for pregnant women with COVID-19 were hydroxychloroquine, Beclomethasone, Calamine, diclofenac sodium, Methylprednisolone, Azithromycin, Ganciclovir, Chinese herbal medicine, and Oseltamivir. The most commonly reported symptoms were fever and cough, followed by rhinorrhea, chest tightness, dyspnea, nasal congestion, and myalgias. Maternal outcomes included premature rupture of membranes, maternal death (21), gestational diabetes, preeclampsia, placental abruption, fetal distress, anemia, preterm birth (< 37 weeks), and fetal growth restriction, miscarriage, hypertension, and influenza. Neonatal intensive care unit (NICU) admission, prematurity, birth weight 2,500 g, preterm delivery (37 weeks), fetal discomfort, neonatal asphyxia, stillbirth (5), and neonatal death (9) were among the outcomes for babies. All of the infants had good Apgar scores. Conclusion: Prenatal and neonatal outcomes appear to be favorable in the majority of cases. Pregnant women and babies should be considered particularly vulnerable populations in terms of COVID-19 preventive and management strategies.
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Background: The incidence of mother-to-newborn Covid 19 transmission is low. However, data are limited on the factors associated with neonatal clinical or viral testing outcomes. This study aims at evaluation of clinical profile of neonates born to COVID positive mothers. Objective: To determine the number of neonates from 01 April 2020 to 30 August 2021 with lab confirmed COVID-19 infection born to Covid 19 positive mothers. To assess the clinical features of neonates born to Covid 19 positive mothers. Methods & Materials: Study design: Retrospective cohort study Study period: 01 April 2020 to 30 August 2021 Study Place: Gulbarga institute of medical science kalaburagi, Karnataka India. Conclusions: Perinatal covid 19 infection may have adverse effects on newborns causing problems such as fetal distress, premature labour, Hyperbilirubinemia, respiratory distress, oxygen requirement, sepsis, birth asphyxia and even death. However vertical transmission of Covid 19 is yet to be confirmed Aims and objectives: To determine the number of neonates from 01 April 2020 to 30 August 2021with RTPCR confirmed COVID-19 infection born to Covid 19 positive mothers. To assess the clinical features of newborns born to Covid 19 positive mothers. Inclusion criteria: All neonates born to Covid 19 positive mothers METHODS: Manual medical records of mother and baby were reviewed. Data on maternal demographic factors (age, residence, socioeconomic status), co morbidities, symptoms of COVID 19, Data on newborn demographic factors (gestational age, sex, birth weight, mode of delivery, Apgar score) were collected . All neonates born to covid 19 positive mother were reviewed for clinical and lab data till time of discharge. Clinical data such as respiratory distress, oxygen desaturation, poor feeding, apnea, seizures, tachycardia, fever, hypothermia, jaundice in those neonates was reviewed. Associated morbid factors such as Birth asphyxia, prematurity, relative sepsis were analysed. Lab data such as TLC, CRP, Sr Ferritin, Sr LDH, D-Dimer, Procalcitonin, RTPCR analysis of nasopharyngeal and throat swab of neonates born to covid positive mothers were reviewed. Chest x ray was reviewed. Those having clinical symptoms/ signs were admitted in NICU. Asymptomatic hemodynamically stable Covid19 negative neonates were isolated on mother side. Sample size: 200 neonates born to covid19 positive mothers. Sample size was determined based on the incidence of covid19 positive rates of neonates born to covid positive mothers, using formula 4PQ/L2. Results: Among these 200 pregnant women with confirmed Covid 19 infection, fever and cough were the common symptoms noted. Of the newborns born to these mothers, 92 were male neonates and 108 were female neonates, 153 were full-term neonates and 32 were born premature;15 were small-for-gestational-age (SGA) neonates. Clinically, the initial presentations in the neonates were respiratory distress(n=5) and failure to breathe at birth(n=4), but other presentations such as fever(n=1), poor feeding(n=3),rapid heart rate(n=4), hyperbilirubinaemia (n=5) abnormal Xray(n=3) and oxygen requirement(n=4) were also observed. All neonates were improved and discharged. Nasopharyngeal and throat swab specimens were collected from these neonates 2to3days after birth for Covid 19 RT-PCR tests, out of which 02 neonates showed positive results. One COVID-19 positive baby presented with failure to breathe at birth was treated with antiviral and antibiotics. The other baby also had similar presentation was treated with antiviral and oxygen. Both neonates improved and discharged.
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Purpose of Study Birth asphyxia is a major cause of neonatal mortality in low- and middle-income countries (LMIC). A Blended Learning Program was set up by Georgetown University (GU) faculty for quality improvement (QI) activities in several district hospitals in Ghana (funded by GU Global Health Initiative). Birth asphyxia was selected as the top priority by the Ghana staff, specially focusing on resuscitation at birth. The in- country workshop was cancelled due to the COVID pandemic. However, facilitation of QI activities was carried out using digital technology. We share the impact of this program in one Ghana regional hospital. Methods Used Hospital staff had received in-country training in AAP-Helping Babies Breathe (HBB) course earlier. Using Zoom and WhatsApp, the GU faculty worked with health care providers to facilitate QI activities to improve resuscitation at birth. This included setting up a QI team, correct documentation of Apgar scores, refresher courses, practices on a manikin, promoting having at least two persons at each birth and ensuring appropriate equipment being kept in readiness. Monthly changes in proportion of babies ≥ 34 wks. gestational age whose Apgar score rose from £ 6 at 1 min. to ≥ 7 at 5 min of age were monitored. Pre-and post-intervention periods were Oct-Dec 2019 and Jan 2020 to Mar 2021. The program was considered exempt from review by the GU IRB. Summary of Results Figure 1 indicates the proportion of babies in whom the Apgar score rose from £ 3 at 1 min to > 4 at 5 min and those in whom the score rose from 4-6 at 1 min to ≥ 7 at 5 min. No significant difference was noted between the pre and post intervention periods. Table 1 shows that among 112 newborns with a 1minute Apgar score of £ 3, the scores remained at £ 3 at 5 minutes in about 50% of babies despite resuscitation attempts until the 4th quarter;17 (37%) of these infants died. Table 2 shows that in 639 infants with Apgar scores of 4-6, the scores did not improve to > 7 in 75 babies (11.7%);there were 5 deaths (0.8%) attributed to birth asphyxia in this group. Conclusions The improvement in Apgar scores showed that HBB had a positive effect. However, to have the full desired impact on outcome in newborns with birth asphyxia, it is essential to go beyond 'HBB' to a more comprehensive 'Mother-Baby Approach' where management addresses prevention and treatment. This includes (a) Counseling in the antenatal period promoting mothers to reach the facility at the appropriate time in labor (b) 'Helping Mothers Deliver' through capacity building of the maternal health staff for competency in optimal management of labor and delivery (c) 'HBB' to improve competence related to neonatal resuscitation (d) Better communication and coordination between maternal and newborn health staff and (e) Post resuscitation care of the baby. (Table Presented).
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Objective. To evaluate pregnancy and childbirth outcomes after the combined use of VIFERON® (interferon α-2b with antioxidants) rectal suppositories (3,000,000 IU) and VIFERON® gel for external and local use (36,000 IU/g) in the treatment of new coronavirus infection (COVID-19) in pregnant women against the background of standard complex therapy. Patients and methods. A total of 140 pregnant women diagnosed with COVID-19 were examined and divided into two groups: group 1 consisted of 70 patients who received VIFERON® and standard complex therapy;group 2 – 70 patients who received only standard therapy. Results. Patients from group 1 had a significantly decreased incidence of preterm birth, perinatal loss, and severe birth asphyxia. Most of these pregnant women gave birth at 38-40 weeks of gestation, and no antenatal fetal death was recorded. Conclusion. Inclusion of VIFERON® (rectal suppositories and gel for external and local use) in the complex treatment of COVID-19 in pregnant women contributed to more prompt relief of symptoms and improved pregnancy and childbirth outcomes.