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BACKGROUND: Persons with Coronavirus Disease 2019 (COVID-19) infection have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited. OBJECTIVE(S): To determine whether birthing individuals with COVID-19 have an increased risk of acute peripartum cardiovascular complications during their delivery admission. METHOD(S): This population-based retrospective cohort study used the National Inpatient Sample (2020) by utilizing ICD-10 codes to identify delivery admissions with a diagnosis of COVID-19. A multivariable logistic regression model was developed to report an adjusted odds ratio for the association between COVID-19 and acute peripartum cardiovascular complications. RESULT(S): A total of 3,458,691 weighted delivery admissions were identified, of which 1.3% were among persons with COVID-19 (n=46,375). Persons with COVID-19 were younger (median 28 vs. 29 years, p<0.01) and had a higher prevalence of gestational diabetes mellitus (GDM), preterm births and Cesarean delivery (p<0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, COVID-19 remained an independent predictor of peripartum cardiovascular complications including preeclampsia (aOR 1.33 [1.29-1.37]), peripartum cardiomyopathy (aOR 2.09 [1.54-2,84]), acute coronary syndrome (ACS) (aOR 12.94 [8.85-18.90]), and cardiac arrhythmias (aOR 1.55 [1.45-1.67]) compared with no COVID-19. Likewise, the risk of in-hospital mortality, AKI, stroke, pulmonary edema, and VTE was higher with COVID-19. For resource utilization, cost of hospitalization ($5,374 vs. $4,837, p<0.01) was higher for deliveries among persons with COVID-19. CONCLUSION(S): Persons with COVID-19 had a higher risk of preeclampsia, peripartum cardiomyopathy, ACS, arrhythmias, in-hospital mortality, pulmonary edema, AKI, stroke, and VTE during delivery hospitalizations. This was associated with an increased cost of hospitalization. Keywords: COVID-19, Pregnancy, GDM, PCOS, Preeclampsia, CVD, Cardiovascular Disease Abbreviations: COVID-19: Coronavirus disease-2019, GDM: Gestational Diabetes Mellitus, PCOS: Polycystic Ovary Syndrome, National Inpatient Sample: NIS, AHRQ: Agency for Healthcare Research and Quality, HCUP: the Healthcare Cost and Utilization Project Funding and Conflicts of Interest Dr. Michos reports Advisory Board participation for Amgen, AstraZeneca, Amarin, Bayer, Boehringer Ingelheim, Esperion, Novartis, Novo Nordisk, and Pfizer. The remaining authors have nothing to disclose.Copyright © 2023
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Background: Providing care for patients with Diabetes in Pregnancy (DiP) provides unique challenges beyond those faced in standard antenatal care, or diabetes outside of pregnancy. Teleclinics (use of telephone, email, or other technologies) as an alternative to in-person clinic appointments have become more widely used for care since the start of the COVID-19 pandemic. To understand how teleclinics might be improved for ongoing use, it is important to understand the experiences and perceptions of the clinicians involved in DiP care. Method(s): A qualitative study using semi-structured interviews of healthcare providers in a large DiP service. Twenty staff members (midwifery, obstetrics, physician, dietician, and administration) were approached to participate. Fifteen staff across 5 specialties consented to be interviewed. Template analysis of interview transcripts was performed, with a focus on 3 themes: collaboration and working together are important for providing DiP care;the need for flexibility in scheduling and the ability to individualise the way care is provided;challenges to adapting to new technology. Result(s): Potential benefits of teleclinics were acknowledged, but respondents also viewed teleclinics as not suitable for all DiP patients due to different needs and risks. Challenges to using teleclinics include establishing good rapport and the limited current infrastructure and patient resources. Conclusion(s): Healthcare providers viewed teleclinics as a way of supporting rather than replacing current care. Maintaining flexibility in clinic scheduling to allow incorporating teleclinics into patient's current schedule of visits ad hoc and providing extra technical and administrative support are important considerations for developing a teleclinic service.
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Background: Diabetes in pregnancy (DIP) affects 6% of pregnancies annually in Aotearoa New Zealand, and 12% of pregnancies in our service at The Whatu Ora Counties Manukau, a multi-ethnic, socioeconomically diverse region. At the onset of the 2020 COVID-19 pandemic, telephone clinics (teleclinics) replaced face-to-face visits for those with DIP. However, there is limited information on the views of patients affected by DIP in Aotearoa about their maternity care, and their care since the COVID-19 pandemic. Aim(s): To explore the views of patients within Counties Manukau about their maternity care for DiP, including their perceptions of teleclinics. Method(s): Semi-structured interviews with women via telephone. Interviewers were matched by ethnicity with participants. Responses were analysed using a qualitative Framework Analysis. Result(s): We interviewed 20 women: New Zealand Maori ( n = 5), Pacific ( n = 4), Asian ( n = 5), and other ethnicity (European/New Zealand European) ( n = 4). Three key themes were identified, (1) 'shock, shame and adjustment', (2) 'learning to manage DIP' and (3) 'preparation for birth.' Participants primarily reported positive care experiences and appreciated both face-to-face and teleclinics. Women of Maori and Pacific ethnicity reported that the visible presence of healthcare professionals of a similar ethnicity within the DIP service would enhance their comfort and facilitate cultural understanding. Conclusion(s): This study adds important insights into the pregnancy care experience of a multi-ethnic and socioeconomically diverse group of women with DIP. Continuing teleclinics may be useful outside of a pandemic setting. More work is required to improve support and communication around diagnosis and management, particularly for gestational diabetes.
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Aim: The emergence of coronavirus disease 2019 (COVID-19) has not only create international concern, but also caused panic, fear, and an increase in mental health problems among individuals. Fear of COVID-19 Scale (FCV-19S), developed by Ahorsu, was previously reported as a valid psychometric instrument for the assessment of COVID-19 fear among individuals. Validation of the scale among other high-risk groups like pregnant women may help obstetricians develop better coping skills during the pandemic. Material(s) and Method(s): This cross-sectional methodological study included 277 pregnant women admitted for routine follow-up at the outpatient obstetrics clinic of Liv Ankara Hospital, Turkey. Participants were asked to complete the Turkish version of the Hospital Anxiety and Depression Scale (HADS) and FCV-19S. Statistical analysis was performed using SPSS 25 software. Result(s): The mean FCV-19S score was 19.2+/-5.7 (range: 7-35). Cronbach's alpha for internal consistency evaluating the reliability of FCV-19S, was 0.857, revealing a satisfactory internal consistency. According to the correlation matrix analysis, all items of FCV-19S showed positive and strong correlations with total FCV-19S scores (p<0.001), and positive and moderate correlations with HADS scores (p<0.001). Discussion(s): Turkish version of FCV-19S is a valid and reliable clinical tool to assess the anxiety of pregnant women during the COVID-19 pandemic in Turkey.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Background: Pregnant women experience physiological changes that make them more susceptible to respiratory infections, including COVID-19. Given the potential impact of COVID-19 on pregnancy, it is crucial to continue to investigate the effect of the pandemic on pregnant women and their infants. This information will be important for informing for all the stakeholders including clinical care, and public health policies. Method(s): This study is a retrospective observational analytical study conducted in the Department of Obstetrics and Gynecology at SMGS hospital, Jammu. The study included 180 pregnant females who reported to emergency Obstetrics and Gynecology from 1st April to 30 June 2020. The sample size of 180 patients was divided into two groups: Group 1 included 90 COVID-19 positive pregnant females and Group 2 included 90 COVID-19 negative pregnant females. Result(s): No significant differences were found in age, parity, gestational age, comorbidities, mode of delivery, maternal complications, neonatal Apgar scores, or birth weight. The prevalence of comorbidities and maternal complications was similar in both groups, and most neonates had normal Apgar scores and birth weights. Conclusion(s): Therefore, it is suggested that appropriate management and care should be provided to all pregnant women, regardless of their COVID-19 status, to minimize any potential adverse outcomes.Copyright © 2022, Anka Publishers. All rights reserved.
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Background: Coronavirus disease 2019 (COVLD-19), the global pandemic that has spread throughout the world, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the limited scientific evidence on the manifestations and potential impact of this virus on pregnancy, we decided to report this case. Case presentation: The patient was a 38 year-old Iranian woman with a triplet pregnancy and a history of primary infertility, as well as hypothyroidism and gestational diabetes. She was hospitalized at 29 weeks and 2 days gestational age due to elevated liver enzymes, and finally, based on a probable diagnosis of gestational cholestasis, she was treated with ursodeoxycholic acid. On the first day of hospitalization, sonography was performed, which showed that biophysical scores and amniotic fluid were normal in all three fetuses, with normal Doppler findings in two fetuses and increased umbilical artery resistance (pulsatility index [PI] > 95%) in one fetus. On day 4 of hospitalization, she developed fever, cough and myalgia, and her COVID-19 test was positive. Despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses leading to the rapid development of absent umbilical artery end-diastolic flow. Finally, 6 days later, the patient underwent cesarean section due to rapid exacerbation of placental insufficiency and declining biophysical score in two of the fetuses. Nasopharyngeal swab COVID-19 tests were negative for the first and third babies and positive for the second baby. The first and third babies died 3 and 13 days after birth, respectively, due to collapsed white lung and sepsis. The second baby was discharged in good general condition. The mother was discharged 3 days after cesarean section. She had no fever at the time of discharge and was also in good general condition. Conclusion(s): This was a complicated triplet pregnancy, in which, after maternal infection with COVID-19, despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses, and the third fetus had a positive COVID-19 test after birth. Therefore, in cases of pregnancy with COVID-19 infection, in addition to managing the mother, it seems that physicians would be wise to also give special attention to the possibility of acute placental insufficiency and subsequent fetal hypoxia, and also the probability of vertical transmission.Copyright © 2022 Goldstein and Associates. All rights reserved.
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Objective. In the last two years COVID-19 infection has represented a true unknown in the management of pregnancies with maternal COVID-19 positivity. However, it has not represented a serious complication, indeed it has rarely caused premature rupture of the membrane, fetal thrombosis or postnatal complications. Materials and Methods. Our retrospective cohort study included placental samples from 350 patients from San Pietro Fatebenefratelli Hospital collected in a period of 4 months. Inclusion criteria were COVID-19 positivity during childbirth or in the previous two months but also a pregnancy without previous COVID-19 infection. Anamnestic data were carried out for the histological study on each placenta. 59% of patients were COVID-19 positive (15% of these had other associated disorders like gestational diabetes, hypertension, fetal death, preterm birth) 26.5% were preterm and the 14,5% were high-risk pregnancy with COVID-19 negativity. Results. The most frequently represented lesion in a COVID-19 placenta was a mild chronic deciduitis, usually absent in placentas with normal outcome. The same deciduitis was observed in gestational diabetes placentas, although less frequently. Other rare findings were patchy fibrinoid necrosis of capsular decidua, chronic villitis, umbilical cord thrombosis. Severe lesions were rare. Conclusions. COVID-19 does not seem to have a severe impact on the health of the placenta except in rare cases in which predisposing factors coexist and determine a more serious involvement of the fetus and its appendages. COVID-19 determines a constant but mild chronic placental inflammation, that is balanced by the maternal capacity to maintain homeostasis stemming the external injuries.
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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.
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With a share of 80%, gestational diabetes mellitus (GDM) is the most common form of hyperglycemia in pregnancy. Breastfeeding reduces the risk of type 2 diabetes;the longer the duration of breastfeeding, the greater the effect. Women who have had a premature birth or a stillbirth are at increased risk of dying prematurely themselves. The potential of pre-eclampsia prevention with low-dose acetylsalicylic acid in women with diabetes mellitus is far from being adequately used. Pregnant women reduce their risk of a severe course of the disease by being vaccinated against coronavirus disease 2019 (COVID-19). The still high rate of perinatal mortality in pregnancies with type 1 and type 2 diabetes may primarily be reduced by improving basic factors in periconceptional care. Two-stage screening for GDM reduces GDM prevalence and medicalization compared to one-stage screening without harm to mothers and their newborns. The approval of metformin for pregnant women since February 2022 does not mean that metformin is recommended as the primary pharmacotherapy for pregnant women.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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The coronavirus disease 2019 (Covid-19), that was later declared pandemic by World Health Organization, had led to panic and fear worldwide. Like many outbreaks caused by viruses, in cheif reason for fear was the infectious agent's potential to be transmitted from pregnant women to their fetuses and newborns. In our study, the hospital records of 117 pregnant women who delivered stillbirths in our clinic between 01.01.2015 and 31.12.2020 were examined. The pregnancy characteristics and perinatal outcomes were examined by making retrospective analysis of the records. Considering six year of the study data, it was observed that the stillbirth rates increased in the pandemic period. One hundred seventeen stillbirth cases that occurred in the last six years were analyzed. The mean age of the pregnant women was 29.64+6 (18-44) and parity was 2.54+1.58 (1-8). Body mass index was calculated as 21.36+3.40 (16-27) average and smoking consumption rate was 9.40% (11/117). Maternal diabetes was detected in 8.54% of the patients (10/117) and pregnancies were complicated by maternal hypertension in 5.12% of the patients (6/117). The average birth weight was 1597+1038 (500-4700) gram. Sixty percent of the deliveries (n=71) were performed by vaginally. Fetal sex was 52.1% male (n=61). The number of deliveries in the past six years was 11780. Almost 1% of the deliveries occurred as stillbirths (117/11780). The unusual stillbirth ratio during the pandemic was 3.1 times higher than the average of pre-pandemic period (2.5vs0.80). In our study, we investigated stillbirth rates before and during the pandemic. Although vertical transmission of Covid-19 has not been reported, the adverse pregnancy and neonatal outcomes have been provided in many studies. Undoubtedly, in obstetrical practice stillbirth is one of the most destructive consequences for pregnant women. Considering the increase in stillbirth rates, we think that pregnant women with adverse perinatal outcomes should be routinely tested for Covid-19, especially during the outbreak.Copyright © 2021 Necati Ozpinar. All rights reserved.
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Background Physical activity and dietary habit optimization in women with gestational diabetes mellitus (GDM) or such a history can improve both short-term [1,2] and long-term outcomes [3]. This requires strategies that are accessible, usable, and perceived as beneficial. Aim To examine uptake and engagement for the following interventions: (1) step and weight tracking through an online platform using a pedometer and weight scale, with delivery of weekly goals;(2) weekly telephone-based health coaching;and (3) a combination of these. We are assessing recruitment, completion of health coaching sessions and/or step count and weight data upload, and participant perspectives. Method Five-city pilot randomized controlled trial (Montreal, Halifax, Calgary, Winnipeg, Toronto;Canada). Women with GDM are recruited at 20-32 weeks' gestation. Data collection is through web-based questionnaire, electronic tracking of data upload, coaching session logs, chart review (gestational weight gain;blood pressure;A1C;glucose levels;offspring sex, weight, and gestational age), in-depth telephone interview (perspectives, breastfeeding status), and mailed in pedometers with concealed windows worn for 7 days (baseline and 37 weeks). Participants are randomized to one of the 3 interventions described or a control arm (resource website only). Results The trial started in August 2019 with COVID-related interruptions. By June 30, 2022, 192/225 mothers were recruited (recruitment ongoing): 27/192 (14%) withdrew, 13 are currently undergoing interventions, and 152 completed final questionnaires. An interim process analysis of the first 52 indicates that those randomized to step and weight tracking employ the pedometer and scale a mean 81.6% (SD 29.6%) and 69.0% (SD 32.0%) of the time, respectively. High proportions report step tracking (92.3%, n = 24/26) and health coach conversations (87.5% n = 21/24) as useful, with weight tracking endorsed by over half (61.5%, n = 16/26). Conclusion The findings will inform a larger scale clinical trial in terms of impacts on gestational weight gain and appropriate for size offspring status.Copyright © 2023 Elsevier B.V.
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Objective. Whilst most cases of COVID-19 in pregnancy evolve uneventfully, some others have a poor outcome, such as preterm birth and HDP. The effect of COVID-19 on fetal growth still has to be addressed and appears controversial. Our study aims to focus on fetal growth velocity across the trimesters in pregnancy affected with COVID-19. Materials and Methods. This is a multicentric prospective observational study on data from COVID-19 pregnancies referred to the centers of Careggi University Hospital and S. Stefano Hospital in Prato from 2020 to 2022, included in the local branch of ItOSS surveillance. Fetal growth was evaluated across the three trimesters of pregnancy by abdominal circumference (AC) and expected fetal weight (EFW). Both AC, and EFW plus birthweight were used to calculate growth velocity (Vannuccini et al., 2017). Results. Data from a cohort of 211 cases was collected. The majority (80%) of COVID-19 cases occurred in the third trimester. Of note, the percentage of gestational diabetes (12.3%) and preterm births (7.1%) was comparable to the general population. Mean birthweight was 3259 +/- 509 g. The percentage of cesarean sections was acceptable (13.7%). Concerning the velocity of growth, AC decreased from the second to third trimester to reach values < 10th centile in 24% of cases and < 5th percentile in 17% of cases, even in presence of 2% of hypertensive disorders (HDP). Fetal growth restriction according to Gordjin et al. (2015) was antenatally identified in 4.7% of cases. Fetal growth > 95th centile occurred in 5.7% of cases. At birth, the cumulative percentage of small for gestational age newborns defined as birth weight < 2500 g resulted 5.2%. A significant percentage of newborns required NICU assistance (7.8%). Conclusions. Regardless of the association and prevalence of preterm birth, SGA and HDP in pregnant women, fetal growth appears to be affected by COVID-19 with a higher incidence of impaired growth velocity compared to the general population.
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SESSION TITLE: Pathologies of the Post-COVID-19 World SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Cavitary lung lesions are a relatively common finding on imaging with a vast differential diagnosis. CASE PRESENTATION: A 36-year-old female with history of gestational diabetes, preeclampsia and obesity presented to an outside hospital for evaluation of acute onset shortness of breath and chest pain. The patient tested positive for COVID19 two weeks prior. She initially developed some mild symptoms including headache, nasal congestion, generalized body aches, cough with mild sputum production and shortness of breath. Despite improvement in these symptoms, she suddenly developed chest discomfort that radiated to the back and was worse with inspiration and cough. The patient had been fully vaccinated against COVID-19 and had received a booster dose as well. Upon evaluation in the emergency room, she was afebrile, respiratory rate was 20, blood pressure was 144/90 mmHg, heart rate was 88 and her oxygen saturation was 99% on room air. Her physical exam was unremarkable. Basic laboratory work up including CBC and chemistry was normal. EKG and troponins were normal as well. A chest x-ay was performed which showed bilateral nodular densities with possible cavitation. A CT chest was later performed and showed multiple bilateral subsolid pulmonary nodules, some with apparent central cavitation. The patient was admitted for further work up at our institution. The patient's subsequent evaluation was largely unrevealing. An autoimmune panel testing for SLE, rheumatoid arthritis, ANCA vasculitis, and Goodpasture's syndrome revealed only a weakly positive ANA with negative anti-DNA and anti-Smith antibody. HIV and QuantiFERON tests were negative. Blood cultures were negative as well. Unfortunately, the patient was not able to expectorate and therefore no sputum cultures were obtained. Due to the patient's clinical improvement and absence of hypoxemia, diagnostic bronchoscopy was deferred, and the patient was subsequently recommended to undergo short interval chest imaging. Repeat chest computed tomography scan one month later showed complete resolution of the previously seen cavitary pulmonary nodules. At the time of outpatient clinical follow up, the patient remained asymptomatic from a respiratory perspective. DISCUSSION: Cavitary pulmonary nodules on chest imaging is an atypical presentation of COVID19 pneumonia that has been rarely described in the literature. In our patient, the temporal correlation between her pulmonary nodules and COVID19 infection as well as her negative work up for other common infectious and inflammatory causes known to cause cavitary lung lesions, makes COVID19 the most plausible cause for her findings. The pathophysiology of these findings remains unclear but may be explained by endothelialitis and small vessel vasculitis may be implicated in the formation of these lesions. [1] CONCLUSIONS: We presented a rare case of cavitary pulmonary nodules due to COVID19 pneumonia. Reference #1: Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020 Jul 9;383(2):120-128. DISCLOSURES: No relevant relationships by Karim Anis No relevant relationships by Carolyn Garcia
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The period of conception, pregnancy and the first 1000 days of life are crucial for a person's lifelong health. The recent rises in obesity before conception, through pregnancy and during childhood are increasing the risk of a non-communicable disease epidemic in the near future. Preventive measures targeted at the community level and implemented by local authorities may be the most effective way of creating healthy environments that improve lifelong health.
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Introduction: In the obstetric population, ARDS due to COVID- 19 has been found to have worse outcome. Treatment of severe COVID-19 has been a real challenge world over. This case report is aimed at giving an insight to the management of COVID-19 in a pregnant patient. Case report: A 36-year-old primi with 33 weeks and 2 days of gestation was admitted with fever, cough, and shortness of breath for 4 days. The patient was found to be positive for COVID. The patient was initially admitted in the wards. In view of worsening oxygenation patient was shifted to the ICU. The patient was initiated on high flow nasal cannula with FiO2 100%, but maintained saturation of 82-84% with that. Hence, patient was intubated and initiated on mechanical ventilation. Post intubation patient maintained a saturation of 86-88% with 100% FiO2. Within half an hour of intubation, fetal bradycardia was noted. The patient was taken up for an emergency Caesarian section. At birth, the child did not cry and received two cycles of CPR and positive pressure ventilation and was shifted to the NICU. The baby was extubated after days. Postpartum the mother required 70% FiO2 to maintain 90% saturation which further improved upon proning. The Pplat and inturn the driving pressure improved upon Cesarian section. Patient required one more round of proning on D5 of ICU stay. During the course of hospitalization, the patient had one episode of septic shock and 2 episodes of urosepsis. This was treated appropriately with antibiotics. Bedside sonography revealed right-sided Hydro Uretero Nephrosis which was tackled with DJ stenting. On day 11 of ICU stay, patient was tracheostomised. By the end of 1 month, the mother was decannulated and discharged. Discussion: Pregnancy especially in the final trimester causes changes like reduced functional residual capacity and compliance. Airway edema in pregnancy complicates intubation making it difficult. Proning though not contraindicated may be difficult to achieve in pregnant patients. In our patient, we could prone the patient postpartum with ease. Though Caesarian section was done in view of fetal distress. But postpartum it was easier to ventilate the patient and oxygenation showed steady improvement. AJOG also suggests that a Caesarian section may be considered after 34 weeks in a critically ill COVID-19 patient. We also had the luxury of a neonatal ICU and the neonate could be saved though the mother's well-being was our priority. Pregnancy and gestational diabetes mellitus and receiving steroids made the patient susceptible to multiple infections which we handled by source control and antibiotics. Conclusion: Though the pandemic is on the decline this case report is an attempt to throw light on the management of the critically ill pregnant patient with ARDS. Cesarean section may aid in the management of the pregnant patient with severe ARDS.
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Aim: To study the efficacy and clinical safety of Prishniparni ghanavati in Gestational Diabetes Mellitus (Prameha in Garbhini). Methodology: The study was conducted on 20 patients, Prishniparni ghanavati 500 mg twice daily, with warm water. This study was conducted at Bharati Ayurveda hospital during 2020-2022. It was a randomized, open-control trial study. Patients with raised DIPSI (Diabetes in pregnancy societies of India), i.e., above 140 mg/dl and below 200 mg/dl, were included in this study. Results: A total of 31 patients were evaluated in this study. Out of which, 30 were recruited and 20 patients completed. A total of two patients dropped out due to factors like the covid-19 pandemic, irregular follow-up, etc. The herbal medicine was tolerated well in trial group patients. Conclusions: In this study, it is proved that prishniparni could be the choice of the herb in these cases. Prishniparni proved effective in managing GDM if the BSL is less than 200. All patients well tolerated the herb. The side effects are not observed in this study.
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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: Gestational Diabetes is considered to be a serious health problem among pregnant women in Egypt. The seriousness, dramatically increasing and incidence of this disease make its management more essential and need more attention. Applying Tele-nursing in healthcare is increasingly prioritized to reduce maternal mortality, morbidity and improve newborns’ survival. Aim of the study: was to evaluate the effect of Tele-nursing guidelines on health lifestyle and self-efficacy among women with gestational diabetes during COVID-19 pandemic. Research design: Quazi experimental design was adopted to carry out this study. Setting: The study was conducted at family planning and antenatal care unit in outpatient clinic, at Zagazig University Hospital. Subjects: Purposive sample of 5o pregnant women with gestational diabetes. Tools of data collection: Four tools were used for data collection. Tool I: A structured interviewing questionnaire, Tool II: Health Promotion Lifestyle Profile scale (HPLP), Tool III: Self-efficacy scale in gestational diabetes and Tool IV: An educational nursing guidelines booklet for pregnant women with gestational diabetes. Results: There was a statically significant difference regarding mean score of all domains of the health promotion lifestyle profile throughout the intervention phase (p<0.001).Also;a statistically significant relation (p<0.05) was found between post self-efficacy score and post-knowledge score through post-intervention phase, Conclusion: it was concluded that;there was a highly statistical significant improvement among the studied women regarding total knowledge, health promotion life style and self-efficacy about GDM at pre and post intervention. In addition;there was a positive correlation coefficient (r =0.336), with statistically significant p (0.017) between self-efficacy and health promotion lifestyle throughout study phases Recommendations: Tele-nursing should be programmed, implemented and applied as a part of health plan with the routine nursing care in antenatal unites.
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Objective: To study the impact of national recommendations on the method of screening used for GDM during the COVID-19 pandemic, and evaluate differences in maternal and fetal outcomes among women with first-time GDM (ftGDM). Design: A retrospective observational study in a single Tertiary London Hospital. During the pandemic, the RCOG recommended an amended GDM screening protocol to reduce hospital attendance and risk of virus transmission (fasting blood glucose level ≥5.3 and/or HbA1c ≥39 at 28 weeks of gestation). Our Trust did not adopt this due to concerns regarding its sensitivity. We adopt a 2-step approach to universal GDM screening using a 50g glucose challenge test, and refer those screening positive for a full oral glucose tolerance test. Method: Outcomes were reviewed for women with ftGDM delivering a singleton at ≥24 weeks gestation between 01/04/20 -28/ 5/21. Our primary aim was to determine the impact of the change in COVID-19 GDM screening policy, had it been implemented. Our secondary outcomes included GDM management method, maternal and perinatal complications. We excluded women with a booking HbA1c ≥42 (indicative of pre-diabetes) and those who had bariatric surgery. Demographic and outcome data were obtained from electronic databases. Results: 247 women were diagnosed with ftGDM using local screening methods. Only 23 of these women had a HbA1c ≥39 at time of diagnosis and a further 12 had FBG ≥5.3. There was no significant difference in age or ethnicity between the two groups. The locally diagnosed group had a statistically significantly lower booking BMI (P<0.001) and were less likely to require pharmacological management of GDM (P<0.001). There were no significant differences in rates of induction of labour, gestation at delivery, birth weight or any perinatal adverse outcome. However, the women in the Covid-19 GDM screening group were significantly more likely to be delivered by Emergency Caesarean Section (p = 0.03) and have gestational hypertensive disease (p = 0.025). Conclusions: If we had implemented RCOG HbA1c screening, we would have not diagnosed 207 women with GDM, 41% of whom required pharmacological treatment. It is not surprising that women with higher HbA1c values had higher rates of maternal complications, due to the well-established association between maternal hyperglycaemia and adverse obstetric outcomes. As such, it is imperative that more sensitive screening protocols such as the 50g screen are considered in any future pandemics, such that women with GDM can be identified and maternal hyperglycaemia treated to benefit in-utero fetal programming.