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).

SARS-CoV-2 infection in pregnancy and adverse pregnancy outcomes: a systematic review and meta-analysis.

The coronavirus disease 2019 (COVID-19) outbreak which started in December 2019 rapidly developed into a global health concern. Pregnant women are particularly susceptible to respiratory infections and can experience adverse outcomes. This systematic review and meta-analysis compared pregnancy outcomes according to COVID-19 disease status. The MEDLINE, EMBASE, and Cochrane Library databases were searched for relevant articles published between December 1, 2019, and October 19, 2022. The main inclusion criterion was any population-based, cross-sectional, cohort, or case-control study that assessed pregnancy outcomes in women with or without laboratory-confirmed COVID-19. Sixty-nine studies including 1,606,543 pregnant women (39,716 [2.4%] diagnosed with COVID-19) were retrieved. COVID-19-infected pregnant women were susceptible to a higher risk of preterm birth (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.42-1.78), preeclampsia (OR, 1.41; 95% CI, 1.30-1.53), low birth weight (OR, 1.52; 95% CI, 1.30-1.79), cesarean delivery (OR, 1.20; 95% CI, 1.10-1.30), stillbirth (OR, 1.71; 95% CI, 1.39-2.10), fetal distress (OR, 2.49; 95% CI, 1.54-4.03), neonatal intensive care unit admission (OR, 2.33; 95% CI, 1.72-3.16), perinatal mortality (OR, 1.96; 95% CI, 1.15-3.34), and maternal mortality (OR, 6.15; 95% CI, 3.74-10.10). There were no significant differences in the rates of total miscarriage, preterm premature rupture of membranes, postpartum hemorrhage, cholestasis, or chorioamnionitis between the infected and non-infected pregnant women. This review demonstrates that COVID-19 infection during pregnancy can lead to adverse pregnancy outcomes. This information could aid researchers and clinicians in preparing for another pandemic caused by newly discovered respiratory viruses. The findings of this study may assist with evidence-based counseling and help clinicians manage pregnant women with COVID-19.

Mpox in pregnancy: Management, risks and challenges in Africa and lessons from the COVID-19 pandemic.

Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.

Comparison between the demographic shift clinical severity and outcome of the first two waves of COVID-19 in pregnancy in a tertiary hospital in India.

OBJECTIVE: To study and compare the maternal and neonatal outcomes of COVID-19 in pregnancy during the two waves of the pandemic in India. METHODS: This observational, retrospective cohort study on pregnant women with SARS-CoV-2 infection was conducted in a 2700-bed tertiary referral center in South India from March 1, 2020 to June 30 2021. The clinical presentation, severity, and maternal and neonatal outcomes of COVID-19 were compared between the two waves. RESULTS: A total of 623 pregnant women tested positive for SARS-CoV-2 infection in our institute; 379 (60.8%) were diagnosed during the first wave and 244 (39.2%) in the second wave. Most of the affected women (81.1%) were in their third trimester. Maternal mortality rate was 823 per 100 000 live births. Composite maternal outcome (increasing requirement for ventilation, pulmonary embolism, disease progression) were more pronounced during the second wave (2.1% vs 6.1%). Between the two waves, both maternal (1 vs 3; P = 0.162) and perinatal (3.2% vs 6.7%; P = 0.065) deaths were higher during the second wave. The cesarean section rate was high during the first wave (48% vs 32.4%; P < 0.001). Preterm births were comparable between the two waves (19.5% vs 22%; P < 0.500). CONCLUSION: The women presented with more severe illness during the second wave of COVID-19. There was higher perinatal mortality, but the maternal mortality was similar between the two waves.

COVID-19 mRNA vaccination status and concerns among pregnant women in Japan: a multicenter questionnaire survey.

BACKGROUND: mRNA vaccination is an effective, safe, and widespread strategy for protecting pregnant women against infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, information on factors such as perinatal outcomes, safety, and coverage of mRNA vaccinations among pregnant women is limited in Japan. Therefore, this study aimed to investigate the perinatal outcomes, coverage, adverse effects, and short-term safety of mRNA vaccination as well as vaccine hesitancy among pregnant women. METHODS: We conducted a multicenter online survey of postpartum women who delivered their offspring at 15 institutions around Tokyo from October 2021 to March 2022. Postpartum women were divided into vaccinated and unvaccinated groups. Perinatal outcomes, COVID-19 prevalence, and disease severity were compared between the two groups. Adverse reactions in the vaccinated group and the reasons for being unvaccinated were also investigated retrospectively. RESULTS: A total of 1,051 eligible postpartum women were included. Of these, 834 (79.4%) had received an mRNA vaccine, while 217 (20.6%) had not, mainly due to concerns about the effect of vaccination on the fetus. Vaccination did not increase the incidence of adverse perinatal outcomes, including fetal morphological abnormalities. The vaccinated group demonstrated low COVID-19 morbidity and severity. In the vaccinated group, the preterm birth rate, cesarean section rate, and COVID-19 incidence were 7.2%, 33.2%, and 3.3%, respectively, compared with the 13.7%, 42.2%, and 7.8% in the unvaccinated group, respectively. Almost no serious adverse reactions were associated with vaccination. CONCLUSIONS: mRNA vaccines did not demonstrate any adverse effects pertaining to short-term perinatal outcomes and might have prevented SARS-CoV-2 infection or reduced COVID-19 severity. Concerns regarding the safety of the vaccine in relation to the fetus and the mother were the main reasons that prevented pregnant women from being vaccinated. To resolve concerns, it is necessary to conduct further research to confirm not only the short-term safety but also the long-term safety of mRNA vaccines.

SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic.

As the COVID-19 pandemic continues into its third year, there is accumulating evidence on the consequences of maternal infection. Emerging data indicate increased obstetrics risks, including maternal complications, preterm births, impaired intrauterine fetal growth, hypertensive disorders, stillbirth, gestational diabetes, and a risk of developmental defects in neonates. Overall, controversial concerns still exist regarding the potential for vertical transmission. Histopathological examination of the placenta can represent a useful instrument for investigation and can contribute significant information regarding the possible immunohistopathological mechanisms involved in developing unfavorable perinatal outcomes. Based on current evidence, SARS-CoV-2 infection can affect placental tissue by inducing several specific changes. The level of placental involvement is considered one of the determining factors for unfavorable outcomes during pregnancy due to inflammation and vascular injuries contributing to complex cascade immunological and biological events; however, available evidence does not indicate a strong and absolute correlation between maternal infection, placental lesions, and obstetric outcomes. As existing studies are still limited, we further explore the placenta at three different levels, using histology, immunohistochemistry, and molecular genetics to understand the epidemiological and virological changes observed in the ongoing pandemic.

Analysis of placental pathology after COVID-19 by timing and severity of infection.

BACKGROUND: COVID-19 during pregnancy can have serious effects on pregnancy outcomes. The placenta acts as an infection barrier to the fetus and may mediate adverse outcomes. Increased frequency of maternal vascular malperfusion has been detected in the placentas of patients with COVID-19 compared with controls, but little is known about how the timing and severity of infection affect placental pathology. OBJECTIVE: This study aimed to examine the effects of SARS-CoV-2 infection on placental pathology, specifically whether the timing and severity of COVID-19 affect pathologic findings and associations with perinatal outcomes. STUDY DESIGN: This was a descriptive retrospective cohort study of pregnant people diagnosed with COVID-19 who delivered between April 2020 and September 2021 at 3 university hospitals. Demographic, placental, delivery, and neonatal outcomes were collected through medical record review. The timing of SARS-CoV-2 infection was noted, and the severity of COVID-19 was categorized on the basis of the National Institutes of Health guidelines. The placentas of all patients with positive nasopharyngeal reverse transcription-polymerase chain reaction COVID-19 testing were sent for gross and microscopic histopathologic examinations at the time of delivery. Nonblinded pathologists categorized histopathologic lesions according to the Amsterdam criteria. Univariate linear regression and chi-square analyses were used to assess how the timing and severity of SARS-CoV-2 infection affected placental pathologic findings. RESULTS: This study included 131 pregnant patients and 138 placentas, with most patients delivered at the University of California, Los Angeles (n=65), followed by the University of California, San Francisco (n=38) and Zuckerberg San Francisco General Hospital (n=28). Most patients were diagnosed with COVID-19 in the third trimester of pregnancy (69%), and most infections were mild (60%). There was no specific placental pathologic feature based on the timing or severity of COVID-19. There was a higher frequency of placental features associated with response to infection in the placentas from infections before 20 weeks of gestation than that from infections after 20 weeks of gestation (P=.001). There was no difference in maternal vascular malperfusion by the timing of infection; however, features of severe maternal vascular malperfusion were only found in the placentas of patients with SARS-CoV-2 infection in the second and third trimesters of pregnancy, not in the placentas of patients with COVID-19 in the first trimester of pregnancy. CONCLUSION: Placentas from patients with COVID-19 showed no specific pathologic feature, regardless of the timing or severity of the disease. There was a higher proportion of placentas from patients with COVID-19-positive tests in earlier gestations with evidence of placental infection-associated features. Future studies should focus on understanding how these placental features in SARS-CoV-2 infections go on to affect pregnancy outcomes.

Perinatal Outcome in Covid-19 Positive Patients at Obstetrics & Gynecological Unit

Aim: To determine the frequency of perinatal outcomes in COVID-19 positive patients at obstetric and gynecological unit. Material(s) and Method(s): An observational cross sectional study was conducted at Aziz Fatimah medical college, Obstetrics and Gynecology department from January 2021 to June 2021 on 100 pregnant COVID positive patients. Perinatal outcomes such as cesarean section, postpartum hemorrhage, preterm birth and NICU admissions were assessed. Data was presented as frequencies, percentages and Mean+/-SD. Result(s): Mean maternal age was 29.71+/-6.05 years. The mean gestational age was 36.47+/-3.83 weeks. Postpartum hemorrhage was seen in 11 (11%) patients, Preterm birth rate was 37 (37%), NICU admissions rate was 44 (44%) and 54 (54%) patients had cesarean section. Conclusion(s): Pregnant COVID 19 positive women are at great risk of having perinatal complication.Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Covid-19 and Pregnancy: Epidemiology, Clinical Features, Maternal and Perinatal Outcomes. A Systematic Review

Background and objectives: COVID-19 pandemic had quite a significant impact on a number of obstetric outcomes. This is often directly attributed to complications of COVID-19. This article is a systematically review literature on the epidemiology, clinical features, maternal and perinatal outcomes of COVID-19 in pregnancy. Materials and methods. A PRISMA methodology search was conducted on the databases of PubMed, Scopus, Medline, Google Scholar, Web of Science and Central BMJ using MeSH keywords or combinations of the words"COVID-19", "SARS-CoV-2", "pregnancy", "epidemiology", "comorbid disease", "pregnancy and childbirth outcome", "preeclampsia", "fetus". Only articles published between December 1, 2019 to February 28, 2022 were considered. After preliminary analysis of more than 600 publications, 21 articles were short-listed for final processing. The studies were selected using a Newcastle-Ottawa scale style questionnaire. The clinical features, risk factors, co-morbid conditions, maternal and neonatal outcomes were presented in two separate tables respectively. Results. COVID-19 incidence in pregnancy ranged from 4.9% to 10.0%. Such women were 5.4 times more likely to be hospitalized and 1.5 times more to need ICU care. Dyspnoea and hyperthermia were associated with a high risk of severe maternal (OR 2.56;95% CI 1.92-3.40) and neonatal complications (OR 4.97;95% CI 2.11-11.69). One in ten of neonates had a small weight for gestational age (9.27 +/- 3.18%) and one in three required intensive care unit observation. Conclusions. Despite the increasingly emerging evidence on the associations between pregnancy and COVID-19 infection, the data is sometimes contradictory necessitating further studies.Copyright © 2022 Trylyst. All rights reserved.

COVID-19 and obstetric outcomes: a single-center retrospective experience in a predominantly Black population.

Objective: This retrospective, single-center case series was designed to characterize the effects of perinatal COVID-19 diagnosis on obstetric and neonatal outcomes in a predominantly high-risk, urban Black population.Study Design: Data were collected via retrospective chart review on all COVID-19-positive obstetric patients and their neonates who presented to the University of Chicago Medical Center between March 2020 and November 2020, before the availability of the COVID-19 vaccine. Patient demographics, delivery outcomes, COVID-19 symptoms, treatment, and outcomes were analyzed.Results: A total of 56 COVID-19-positive obstetric patients were included in the study, of which four were lost to follow-up before delivery. The median age of patients was 27 years (IQR 23, 32), with 73.2% publicly insured and 66.1% Black. Patients had a median body mass index (BMI) of 31.6 kg/m2 (IQR 25.9, 35.5). 3.6% of patients had chronic hypertension, 12.5% had diabetes, and 16.1% had asthma. Perinatal complications were common. Twenty-six patients (50.0%) had a diagnosis of a hypertensive disorder of pregnancy (HDP). 28.8% had gestational hypertension, and 21.2% had preeclampsia (with and without severe features). The rate of maternal ICU admission was 3.6%. Furthermore, 23.5% of patients delivered preterm (<37 weeks gestation), and 50.9% of infants were admitted to the Neonatal Intensive Care Unit (NICU).Conclusion: In our study of a predominantly Black, publicly-insured, unvaccinated group of COVID-19-positive pregnant patients, we found high rates of hypertensive disorders of pregnancy, preterm delivery, and NICU admission compared to rates reported in existing literature before widespread vaccine availability. Our findings suggest that SARS-CoV-2 infection during pregnancy, irrespective of maternal disease severity, may exacerbate existing obstetric health disparities by disproportionately impacting Black, publicly insured patients. Larger comparative studies are needed to better characterize possible racial and socioeconomic disparities in obstetric outcomes in the setting of SARS-CoV-2 infection during pregnancy. These studies should examine the pathophysiology of SARS-CoV-2 infection during pregnancy, as well as potential associations between adverse perinatal outcomes and disparities in access to care, COVID-19 vaccination, and other social determinants of health amongst more vulnerable populations infected with SARS-CoV-2 during pregnancy.

Coronavirus Disease-2019 in Pregnancy.

Coronavirus disease-2019 (COVID-19) infection during pregnancy is associated with severe complications and adverse effects for the mother, the fetus, and the neonate. The frequency of these outcomes varies according to the region, the gestational age, and the presence of comorbidities. Many COVID-19 interventions, including oxygen therapy, high-flow nasal cannula, and invasive mechanical ventilation, are challenging and require understanding physiologic adaptations of pregnancy. Vaccination is safe during pregnancy and lactation and constitutes the most important intervention to reduce severe disease and complications.

Impact of the First and Second Lockdown for COVID-19 Pandemic on Preterm Birth, Low Birth Weight, Stillbirth, Mode of Labor, and of Delivery in Lombardy, Italy.

We investigated the effect of lockdown measures implemented in Lombardy on selected obstetric and perinatal outcomes. Births that occurred during the two lockdowns imposed (i.e., the first from 16 March to 2 June 2020 and the second from 3 November 2020 to 5 April 2021) and the comparison periods (i.e., the first from 16 March to 2 June 2018 and the second from 3 November 2018 to 5 April 2019) were identified using regional healthcare databases. The distribution of births according to the selected outcomes was computed and the Chi-square test was used for testing differences in the periods compared. During the two lockdowns, we observed a lower proportion of low birth weight, from 6.8% in the comparison period to 6.1% in the first lockdown (p = 0.019), and from 6.5% to 6.1% in the second one (p = 0.109). The proportion of preterm births decreased from 6.8% to 6.3% in the first lockdown (p = 0.097), and from 6.2% to 6.0% in the second one (p = 0.172). No differences in stillbirth rate emerged for both lockdowns. Induction of labor was more frequent during both lockdowns, from 28.6% to 32.7% in the first (p < 0.0001), and from 29.9% to 33.2% in the second one (p < 0.0001). Cesarean section was less frequent during the second lockdown.

The utility of systemic immune-inflammation index and systemic immune-response index in the prediction of adverse outcomes in pregnant women with coronavirus disease 2019: Analysis of 2649 cases.

AIM: To investigate the association of systemic immune-inflammation index (SII) and systemic immune-response index (SIRI) with adverse perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19). METHODS: The cases were divided into (1) the Mild-moderate COVID-19 group (n = 2437) and (2) the Severe-critical COVID-19 group (n = 212). Clinical characteristics, perinatal outcomes, SII (neutrophilXplatelet/lymphocyte), and SIRI (neutrophilXmonocyte/lymphocyte) were compared between the groups. Afterward, SII and SIRI values were compared between subgroups based on pregnancy complications, neonatal intensive care unit (NICU) admission, and maternal mortality. A receiver operator characteristic analysis was performed for the determination of optimal cutoff values for SII and SIRI in the prediction of COVID-19 severity, pregnancy complications, NICU admission, and maternal mortality. RESULTS: Both SII and SIRI were significantly higher in complicated cases (p < 0.05). Cutoff values in the prediction of severe-critical COVID-19 were 1309.8 for SII, and 2.3 for SIRI. For pregnancy complications, optimal cutoff values were 973.2 and 1.6. Cutoff values of 1045.4 and 1.8 were calculated for the prediction of NICU admission. Finally, cut-off values of 1224.2 and 2.4 were found in the prediction of maternal mortality. CONCLUSION: SII and SIRI might be used in combination with other clinical findings in the prediction of poor perinatal outcomes.

Maternal and Neonatal Outcomes Before and During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic brought about many social, psychological, and economic changes. We sought to compare pregnancy and birth outcomes immediately preceding the COVID-19 lockdown to those 12 months later. STUDY DESIGN: This was a retrospective cohort study of people giving birth at a large-volume tertiary medical center in Rhode Island. We compared those who gave birth in February 2020 to those in February 2021.  Results: Fewer people delivered in 2021 than 2020 (562 vs. 655). There was a non-significant decrease in the number of primary cesarean deliveries from 2020 to 2021. Insurance status modified this effect as there was a significant decrease in the number of patients with private insurance undergoing primary cesarean (63.6 vs 36.4%, p=0.004). Neonatal complications significantly decreased (55.4% vs 47.4%, p=0.006). CONCLUSION: There were differences in sociodemographic characteristics and outcomes of birthing people between 2020 and 2021. The socioeconomic and healthcare landscape caused by COVID-19 altered statewide birthing patterns.

Safety of COVID-19 vaccination in pregnant women: A study of the adverse perinatal outcomes.

OBJECTIVE: To compare adverse perinatal outcome among COVID-19 vaccinated and unvaccinated pregnant women. METHOD: Retrospective equivalence cohort study comparing 930 women who received at least one BNT162b2 (Pfizer/BioNTech) COVID-19 vaccine during the second or third trimester of pregnancy and 964 unvaccinated women. The primary outcome was a composite adverse perinatal outcome including at least one of the following: preterm delivery<35 weeks gestation; intrauterine fetal death>23 weeks gestation; intrauterine growth restriction defined as birthweight<10th percentile; 5-minute Apgar score<7; neonatal care unit admission. RESULTS: We found no effect of the COVID-19 vaccine on the rate of the individual adverse perinatal outcomes. At least one adverse perinatal outcome was found in 108 (11.25%) of unvaccinated women versus 82 (8.82%) of vaccinated pregnant women (p=0.080). Observed proportion difference (unvaccinated minus vaccinated) was 0.024; In the equivalence analysis with margin of 0.05, the 90% CI (0.01 to 0.05) lies entirely within the equivalence zone (-0.05 to 0.05) with p=0.032. CONCLUSION: Our study demonstrated an equivalent rate of adverse perinatal outcomes among vaccinated and unvaccinated women, thus supporting vaccine safety during the second and third trimesters of pregnancy. We believe this information is useful in counseling and convincing pregnant women regarding COVID-19 vaccination during pregnancy.

Analyzing pregnancy course and outcomes in women with varying degrees of severity of novel coronavirus infection COVID-19 in Saint Petersburg: the lessons from pandemic.

Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women. Aim(s): to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy. Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020-2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1-57 patients with asymptomatic and mild form of verified COVID-19;Group 2-50 patients with COVID-19 of moderate and severe course;Group 3-52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19. Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries - 54 (94.7 %) and 38 (76.0 %) (chi2 = 7.76) respectively, as well as a significantly lower number of premature births - 3 (5.3 %) and 12 (24.0 %) (chi2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births - 33 (57.8 %) and 42 (80.8 %) (chi2 = 6.63) respectively, but a greater rate of caesarean section - 24 (42.0 %) and 10 (19.2 %) (chi2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) - 16 (28.1 %) and 2 (6.3 %) (chi2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia - 5 (8.8%) and 42 (84.0%) (chi2 = 61.2;p < 0.001) respectively, increased aspartate aminotransferase - 4 (7.0 %) and 38 (76.0 %) (chi2 = 53.15;p < 0.001), lactate dehydrogenase (LDH) - 0 (0.0 %) and 12 (24.0 %) (chi2 = 15.41;p < 0.001), C-reactive protein (CRP) - 6 (10.5 %) and 49 (98.0 %) (chi2 = 81.58;p < 0.001), creatinine reduction - 0 (0.0 %) and 11 (22.0 %) (chi2 = 13.98;p < 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase;a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level. Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity. Copyright © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.

PREGNANCY AND COVID-19. PERINATAL OUTCOMES

Introduction. The coronavirus infection COVID-19 has become a major medical problem around the world. Despite the fact that the infection is new and research on COVID-19 is ongoing, the main risk factors for severe consequences for pregnant women have already been identified. Aim. The aim of our study – analyze the impact of coronavirus infection and its consequences on the course of pregnancy and perinatal outcomes. Material and methods. The medical records of 4422 pregnant women were studied on the basis of the Kazan city obstetric hospital. The study included two groups: an experimental group – 67 patients who underwent COVID-19 at various times during pregnancy and a control group – 65 patients with a normal pregnancy. The analysis of the collected data was performed in the GraphPad Prism 9 software (GraphPad Software, San Diego, CA, USA). Results and discussion. Most often, pregnant women had infection COVID-19 during the third trimester, n=51 (76%). The main complications during pregnancy in the experimental group were moderate preeclampsia – 6;9% (in the control group – 2;3%) and the threatened preterm labor – 14;17% (in the control group – 2;3%). The main complications in newborns: respiratory distress syndrome (9;13%) and intrauterine pneumonia (3;5%). The calculated odds ratios showed that the chance of getting 7 or more points on the Apgar scale in the control group was 7,2 times higher compared to the experimental group at 1 minute, and 10,1 times higher at the fifth minute. A significant difference (p-value=0,0027) was also shown between the average values of body weight of newborns in the experimental group [(3047±186) g] and control [(3403±243) g]. Conclusion. The number of cases of complicated pregnancy was significantly higher in experimental the group compared to the control group. Children in the control group are more likely to have higher Apgar score and have higher body weight than children born to mothers included in the experimental group. Also, the number of newborns with complications (mainly pathology of the respiratory system) in the early neonatal period was higher in the experimental group compared to the control group. © 2022, LLC "IMC" Modern Clinical Medicine. All rights reserved.

Analyzing pregnancy course and outcomes in women with varying degrees of severity of novel coronavirus infection COVID-19 in Saint Petersburg: the lessons from pandemic

Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women. Aim(s): to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy. Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020-2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1-57 patients with asymptomatic and mild form of verified COVID-19;Group 2-50 patients with COVID-19 of moderate and severe course;Group 3-52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19. Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries - 54 (94.7 %) and 38 (76.0 %) (chi2 = 7.76) respectively, as well as a significantly lower number of premature births - 3 (5.3 %) and 12 (24.0 %) (chi2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births - 33 (57.8 %) and 42 (80.8 %) (chi2 = 6.63) respectively, but a greater rate of caesarean section - 24 (42.0 %) and 10 (19.2 %) (chi2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) - 16 (28.1 %) and 2 (6.3 %) (chi2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia - 5 (8.8%) and 42 (84.0%) (chi2 = 61.2;p < 0.001) respectively, increased aspartate aminotransferase - 4 (7.0 %) and 38 (76.0 %) (chi2 = 53.15;p < 0.001), lactate dehydrogenase (LDH) - 0 (0.0 %) and 12 (24.0 %) (chi2 = 15.41;p < 0.001), C-reactive protein (CRP) - 6 (10.5 %) and 49 (98.0 %) (chi2 = 81.58;p < 0.001), creatinine reduction - 0 (0.0 %) and 11 (22.0 %) (chi2 = 13.98;p < 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase;a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level. Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity. Copyright © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.

Maternal and Perinatal Outcomes During the COVID-19 Epidemic in Pregnancies Complicated by Gestational Diabetes.

Introduction: Gestational diabetes (GDM) is one of the most common complications in pregnancy, with a prevalence that continues to rise. At the time of the COVID-19 epidemic, immediate reorganisation and adjustment of the system was needed. Telemedicine support was offered in order to provide high-quality treatment to pregnant women. However, the success of the treatment is unknown. We therefore aimed to evaluate COVID-19 epidemic effects on pregnancy outcomes in GDM. Methods: The maternal outcomes (insulin treatment, gestational weight gain, caesarean section, hypertensive disorders) and perinatal outcomes (rates of large and small for gestational age, preterm birth and a composite child outcome) of women visiting a university hospital diabetes clinic from March to December 2020 were compared with those treated in the same period in 2019. Results: Women diagnosed with GDM during the COVID-19 epidemic (n=417), were diagnosed earlier (23.9 [11.7-26.0] vs. 25.1 [21.8-26.7] gestational week), had higher fasting glucose (5.2 [5.0-5.4] vs. 5.1 [4.8-5.3] mmol/l) and earlier pharmacological therapy initiation, and had achieved lower HbA1c by the end of followup (5.1% (32.2 mmol/mol) [4.9% (30.1 mmol/mol)-5.4% (35.0 mmol/mol)] vs. 5.2% (33.3 mmol/mol) [5.0% (31.1 mmol/mol) - 5.4%·(35.5 mmol/mol)], p<0.001) compared to a year before (n=430). No significant differences in perinatal outcomes were found. Conclusions: Although GDM was diagnosed at an earlier gestational age and higher fasting glucose concentration was present at the time of diagnosis, the COVID-19 epidemic did not result in worse glucose control during pregnancy or worse pregnancy outcomes in Slovenia.

Pregnancy outcomes with confirmed SARS-CoV-2 infection during first wave: A review.

Maternal and foetal care has become an important concern in the wake of enormous global spread of coronavirus disease-2019 (COVID-19), but there is scarcity of information about maternal and perinatal outcomes. The current review was conducted from March to July 2020. Appropriate and related databases were searched electronically by using terms, like "COVID-19 and pregnancy", "pregnancy outcomes of COVID-19". Pooled analysis of the reviewed studies showed that of the 164 newborns, vertical transmission was noted in 7(2.95%). The most common element 140(84.98%) was caesarean section deliveries. COVID-19 pneumonia developed in almost 54(30.90%) of 175 women. The most common symptom of COVID-19 among women was fever 88(50.77%). Adverse maternal and foetal outcomes were found to be associated with COVID-19 in the form of severe illness, increased rates of caesarean section deliveries and worse birth outcomes. Yet, vertical transmission of COVID-19 infection remains debatable.