Restriction of follow-up of premature infants in the COVID-19 pandemic: a mixed approach / Restrição do acompanhamento de lactentes prematuros na pandemia da COVID-19: abordagem mista / Restricción del seguimiento de lactantes prematuros en la pandemia de COVID-19: enfoque mixto

Resumo Objetivo Analisar os fatores associados à restrição do acompanhamento de lactentes que nasceram prematuros e/ou baixo peso durante a pandemia da COVID-19 e a percepção de mães e profissionais de saúde quanto a essa realidade. Métodos Pesquisa de método misto com delineamento paralelo convergente, realizada com 14 mães de lactentes que nasceram prematuros e/ou baixo peso acompanhados no ambulatório de follow-up de uma maternidade em um município da Paraíba, e quatro profissionais de saúde desse serviço. A coleta de dados foi realizada no período de junho a julho de 2020, concomitantemente, em fonte de dados secundários, constituída de todos os 140 prontuários dos respectivos lactentes para abordagem quantitativa, por meio de entrevista semiestruturada, para abordagem qualitativa. A análise quantitativa ocorreu por estatística descritiva e inferencial, e a qualitativa, conforme análise temática indutiva. Resultados Houve associação significativa entre a idade dos lactentes e a restrição do seu acompanhamento no follow-up durante a pandemia, com priorização do atendimento presencial dos menores de seis meses, contatos pontuais com os familiares, via ligação telefônica ou aplicativo digital, e lacunas na atualização do calendário vacinal dos que tiveram o acompanhamento interrompido. Isso gerou insatisfação das mães e receio de prejuízos ao desenvolvimento dos lactentes. Também não houve continuidade do cuidado desses na unidade básica de saúde. Conclusão Houveram restrições no acompanhamento dos lactentes nascidos prematuros no serviço de follow-up durante a pandemia, gerando insatisfação materna e receio de prejuízos ao desenvolvimento de seus filhos.

Resumen Objetivo Analizar los factores asociados a la restricción del seguimiento de lactantes que nacieron prematuros o de bajo peso durante la pandemia de COVID-19 y la percepción de madres y profesionales de la salud respecto a esta realidad. Métodos Estudio de método mixto con diseño paralelo convergente, realizado con 14 madres de lactantes que nacieron prematuros o de bajo peso atendidos en consultorios externos de follow-up de una maternidad en un municipio del estado de Paraíba, y cuatro profesionales de la salud de este servicio. La recopilación de datos fue realizada en el período de junio a julio de 2020, simultáneamente en fuente de datos secundarios, compuesta por las 140 historias clínicas de los respectivos lactantes para el enfoque cuantitativo, por medio de entrevista semiestructurada, para el enfoque cualitativo. El análisis cuantitativo se llevó a cabo por estadística descriptiva e inferencial, y el cualitativo mediante análisis temático inductivo. Resultados Hubo relación significativa entre la edad de los lactantes y la restricción de su seguimiento en el follow-up durante la pandemia, con priorización de atención presencial a los menores de seis meses, contactos puntuales con los familiares, vía llamada telefónica o aplicación digital, y vacíos en la actualización del calendario de vacunación de los que tuvieron el seguimiento interrumpido. Esto generó insatisfacción de las madres y temor de perjudicar el desarrollo de los lactantes. Tampoco hubo continuidad del cuidado de estos en la unidad básica de salud. Conclusión Hubo restricciones en el seguimiento de los lactantes nacidos prematuros en el servicio de follow-up durante la pandemia, lo que generó insatisfacción materna y temor de perjudicar el desarrollo de sus hijos.

Abstract Objective To analyze the factors associated with restricting the follow-up of infants who were born premature and/or low birth weight during the COVID-19 pandemic and mothers' and health professionals' perception regarding this reality. Methods This is mixed methods research with a parallel convergent design, carried out with 14 mothers of infants who were born premature and/or low birth weight, followed up at a follow-up outpatient clinic of a maternity hospital in a municipality in Paraíba, and four health professionals from this service. Data collection was carried out from June to July 2020, concomitantly, in a secondary data source, consisting of all 140 medical records of the respective infants for a quantitative approach, through a semi-structured interview, for a qualitative approach. Quantitative analysis was performed using descriptive and inferential statistics, and qualitative analysis, according to inductive thematic analysis. Results There was a significant association between infant age and the restriction of their follow-up during the pandemic, with prioritization of one-to-one care for children under six months of age, occasional contacts with family members, via phone call or digital application, and gaps in updating the vaccination schedule of those whose follow-up was interrupted. This generated dissatisfaction on the part of mothers and fear of harm to the development of infants. There was also no continuity of care for these in the Basic Health Unit. Conclusion There were restrictions on follow-up of premature infants in the follow-up service during the pandemic, generating maternal dissatisfaction and fear of damage to the development of their children.

[Epidemiological characterization of COVID-2019 in Mexican pregnant women: a cohort study]

Background: COVID-19 in pregnancy can increase the risk of complications due to the cardiorespiratory and immunological changes typical of pregnancy. Objective: To report the epidemiological characterization of COVID-19 in Mexican pregnant women. Material and methods: Cohort study on pregnant women with a positive COVID-19 test, which were followed until delivery and one month later. Results: 758 pregnant women were included in the analysis. Mothers' mean age was 28.8 +/- 6.1 years;the majority were workers 497 (65.6%) and with an urban origin (482, 63.6%);the most common blood group was O with 458 (63.0%);478 (63.0%) were nulliparous women and more than 25% had some comorbidities;the average gestation weeks at infection were 34.4 +/- 5.1 weeks;only 170 pregnant women (22.4%) received vaccination;the most frequent vaccine was BioNTech Pfizer (96, 60%);there were no serious adverse events attributed to vaccination. The mean gestational age at delivery was 35.4 +/- 5.2 weeks;85% of pregnancies were cesarean section;the most frequent complication was prematurity (406, 53.5%), followed by preeclampsia (199, 26.2%);there were 5 cases of maternal death and 39 cases of perinatal death. Conclusions: COVID-19 in pregnancy increases the risk of preterm birth, preeclampsia, and maternal death. Vaccination against COVID-19 in this series showed no risk for pregnant women and their newborns. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

The coronavirus conundrum, the pregnant woman, her child. Part 2 / La incógnita del coronavirus, la gestante, su niño - Continuación

Resumen Cuando apareció la enfermedad por el coronavirus SARS-CoV-2, no esperábamos su rápida expansión en el mundo y las graves consecuencias que traería. Se ha ido conociendo al virus morfológicamente y su accionar en el ambiente y en el organismo del ser humano, su mayor predisposición de enfermar a poblaciones vulnerables, como el adulto mayor, poblaciones con comorbilidad como obesidad, diabetes, hipertensión e inmunodepresión, predilección por el sexo masculino, mayor prevalencia en países con mayor pobreza, promiscuidad, zonas deprimidas económicamente, entre otros. Se ha tenido que improvisar y descartar diversos tratamientos en aquellos pacientes con enfermedad COVID-19 moderada y severa. Eventualmente se está disminuyendo la frecuencia de muertes con medidas de protección personal, distanciamiento social, cuarentena de emergencia, y combinación de medicamentos y administración de oxígeno. Pero aún no hay cura, y se está a la expectativa en la aparición de la vacuna. Con relación a la mujer, ella es comprometida en menor proporción y severidad por la enfermedad COVID-19, pero debe cumplir las medidas de prevención, especialmente si es frágil y tiene comorbilidades. Se ha postergado temporalmente su evaluación preventiva y las intervenciones quirúrgicas si no son de emergencia. En la gestante se está encontrando aumento de prematuridad, gestaciones frustras, lesiones placentarias y presencia del virus en anexos placentarios, con casos de morbilidad severa y muerte maternas. En este artículo se hace una puesta al día resumida sobre la situación de la enfermedad COVID-19 en el mundo y el Perú, enfatizando el cuidado de la mujer y de la gestante.

Abstract When COVID-19 appeared, we did not expect its rapid expansion throughout the world nor the serious consequences it would bring. We currently understand more about the virus' morphology and its activity in the environment and within the human body, as well as its greater predisposition to affect vulnerable populations, such as the elderly and persons with comorbidities like obesity, diabetes, hypertension and immunosuppression. This virus shows a predilection for men, and a higher prevalence in countries with greater poverty, promiscuity and economically depressed areas, among others. Various treatments have been tested and discarded in patients with moderate and severe disease. The frequency of deaths is decreasing due to personal protection measures, social distancing, emergency quarantine, and combination of medications and supplemental oxygen. However, there is still no cure, and we are waiting for the appearance of the vaccine. Women are less frequently and less severely affected; however, they should follow preventive measures, especially if frail with comorbidities. Preventive medical consultations and non-emergency surgical procedures have been temporarily postponed. Pregnant women are experiencing an increase in prematurity, fetal deaths, placental lesions and presence of the virus in placental adnexa, with cases of severe morbidity and maternal death. This article is an update on the situation of COVID-19 in the world and in Peru, emphasizing the care of women and pregnant women.

Reductions in stillbirths and preterm birth in COVID-19 vaccinated women: a multi-center cohort study of vaccination uptake and perinatal outcomes.

BACKGROUND: COVID-19 infection in pregnancy is associated with a higher risk of progression to severe disease, but vaccine uptake by pregnant women is hindered by persistent safety concerns. COVID-19 vaccination in pregnancy has been shown to reduce stillbirth, but its relationship with preterm birth is uncertain. OBJECTIVE: The aim of this study was to measure the rate of COVID-19 vaccine uptake among women giving birth in Melbourne, Australia, and to compare perinatal outcomes by vaccination status. STUDY DESIGN: Retrospective multicenter cohort study occurring after the June 2021 government recommendations for mRNA COVID-19 vaccination during pregnancy. Routinely collected data from all 12 public maternity hospitals in Melbourne were extracted on births > 20 weeks' gestation from 1st July 2021 to 31 March 2022. Maternal sociodemographic characteristics were analyzed from the total birth cohort. Perinatal outcomes were compared between vaccinated and unvaccinated women for whom weeks 20-43 of gestation fell entirely within the 9-month data collection period. The primary outcomes were the rates of stillbirth and preterm birth (spontaneous and iatrogenic) in singleton pregnancies of at least 24 weeks gestation, after exclusion of congenital anomalies. Secondary perinatal outcomes included the rate of congenital anomalies among infants born > 20 weeks gestation; and birthweight < 3rd centile and newborn intensive care unit (NICU) admissions among infants born without congenital anomalies at > 24 weeks gestation. We calculated the adjusted odds ratio of perinatal outcomes among vaccinated versus unvaccinated women using inverse propensity score weighting regression adjustment with multiple covariates; p< 0.05 was considered statistically significant. RESULTS: Births from 32,536 women were analyzed: 17,365 (53.4%) were vaccinated and 15,171 (47.6%) were unvaccinated. Vaccinated women were significantly more likely to be older, nulliparous, non-smoking, not requiring an interpreter, of higher socioeconomic status, and vaccinated against pertussis and influenza. Vaccination status also varied by region of birth.Vaccinated women had a significantly lower rate of stillbirth compared with unvaccinated women (0.2% vs 0.8%, aOR 0.18, 95%CI 0.09-0.37, P < 0.001. Vaccination was associated with a significant reduction in total preterm births < 37 weeks (5.1% vs 9.2%, aOR 0.60, 95% CI 0.51-0.71, p< 0.001), spontaneous preterm birth (2.4% vs 4.0%, aOR 0.73 95% CI 0.56-0.96, p=0.02) and iatrogenic preterm birth (2.7% vs 5.2%, aOR 0.52, 95%CI 0.41-0.65, p< 0.001). Babies born to vaccinated mothers also had lower NICU admission rates.There was no significant increase in the rate of congenital anomalies or birth weight < 3rd centile in vaccinated women. Vaccinated women were significantly less like to have an infant with a major congenital anomaly compared with the unvaccinated group (2.4% vs 3.0%, aOR 0.72, 95%CI 0.56-0.94, p=0.02). This finding remained significant even when the analysis was restricted to women vaccinated before 20 weeks' gestation. CONCLUSIONS: COVID-19 vaccination during pregnancy was associated with a reduction in stillbirth and preterm birth, and not associated with any adverse impacts on fetal growth or development. Vaccine coverage was significantly influenced by known social determinants of health.

The Predictive Role of Maternal Biological Markers and Inflammatory Scores NLR, PLR, MLR, SII, and SIRI for the Risk of Preterm Delivery.

In many countries, preterm birth, defined as birth before 37 completed weeks of gestation, is the primary cause of infant death and morbidity. An increasing body of research suggests that inflammation (both clinical and subclinical) plays a significant role in inducing preterm labor or developing pregnancy problems that lead to premature birth. Consequently, the purpose of this research was to determine the predictive value of the Neutrophil-Lymphocyte Ratio (NLR), derived Neutrophil-Lymphocyte Ratio (dNLR), Monocytes-to-Lymphocyte Ratio (MLR), Platelets-to-Lymphocyte Ratio (PLR), Systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), for premature delivery. A retrospective study analyzed a total of 243 eligible pregnancies that resulted in a preterm birth during 2020 and 2021. A control group without a history of preterm birth was matched by age and trimester of laboratory analysis at a 1:1 ratio. Although the number of comorbidities was similar among study groups, the body-mass index estimated for the week of gestation was significantly higher among the patients from the prematurity group, as well as the prevalence of urinary tract infections and smoking. Laboratory data showed that patients with a preterm birth had significantly higher white blood cell count and monocytes, but significantly lower lymphocytes, platelets, and hemoglobin. The NLR, dNLR, PLR, and MLR scores showed to be significantly higher among patients from the prematurity group, but SII and SIRI were not significantly different between the study groups. It was observed that the AUC values of NLR, dNLR, PLR, and MLR were higher than 0.600, respectively NLR had the highest value among the tested scores (AUC = 0.694) and the highest sensitivity in this study (71%). The highest sensibility was achieved by dNLR, with 70%, and an AUC value of 0.655 (p-value = 0.022). PLR had the second-highest AUC value (0.682) and the best score in terms of sensitivity (70%) and sensibility (69%) (p-value = 0.015). Lastly, MLR had the lowest significant AUC score (0.607) and lowest sensitivity/sensibility. The significant cut-off values for the inflammatory scores were 9.0 for NLR, 9.8 for dNLR, 250 for PLR, and 4.07 for MLR. After evaluating the importance of these inflammatory scores, further clinical applications should be conducted to confirm the results and improve therapy and care to reduce the burden of premature deliveries.

Exposure to the early COVID-19 pandemic and early, moderate and overall preterm births in the United States: A conception cohort approach.

BACKGROUND: The United States (US) data suggest fewer-than-expected preterm births in 2020, but no study has examined the impact of exposure to the early COVID-19 pandemic at different points in gestation on preterm birth. OBJECTIVE: Our objective was to determine-among cohorts exposed to the early COVID-19 pandemic-whether observed counts of overall, early and moderately preterm birth fell outside the expected range. METHODS: We used de-identified, cross-sectional, national birth certificate data from 2014 to 2020. We used month and year of birth and gestational age to estimate month of conception for birth. We calculated the count of overall (<37 weeks gestation), early (<33 weeks gestation) and moderately (33 to <37 weeks gestation) preterm birth by month of conception. We employed time series methods to estimate expected counts of preterm birth for exposed conception cohorts and identified cohorts for whom the observed counts of preterm birth fell outside the 95% detection interval of the expected value. RESULTS: Among the 23,731,146 births in our study, the mean prevalence of preterm birth among monthly conception cohorts was 9.7 per 100 live births. Gestations conceived in July, August or December of 2019-that is exposed to the early COVID-19 pandemic in the first or third trimester-yielded approximately 3245 fewer moderately preterm and 3627 fewer overall preterm births than the expected values for moderate and overall preterm. Gestations conceived in August and October of 2019-that is exposed to the early COVID-19 pandemic in the late second to third trimester-produced approximately 498 fewer early preterm births than the expected count for early preterm. CONCLUSIONS: Exposure to the early COVID-19 pandemic may have promoted longer gestation among close-to-term pregnancies, reduced risk of later preterm delivery among gestations exposed in the first trimester or induced selective loss of gestations.

Prevalence of Preterm Births and Complications of Prematurity: A Comparison Between First Year of COVID-19 Pandemic and the Previous Year

Background: COVID-19 pandemic imposed significant challenges on the health systems. COVID-19 management policies such as lockdown have made access to the health centers difficult. Pregnant women are a high-risk group whose pregnancy outcomes may be affected by COVID-19 pandemic. So, it is necessary to determine changes in the prevalence of preterm births and complications of prematurity during the pandemic. Objectives: This study aimed to determine the prevalence of preterm births and complications of prematurity during the first year of COVID-19 pandemic compared with the previous year. Methods: In this cross-sectional study, we included all live births born between March 2019 to March 2021 in Mahdiyeh hospital, Tehran, Iran. We reviewed medical records to extract the prevalence of preterm births and prematurity complications. Then, the prevalence of preterm births and prematurity complications during COVID-19 pandemic compared with the previous year. We used Results: A total of 10,830 live births were included in this study. During COVID-19 pandemic, the prevalence of moderate or late prematurity had a 4.64% reduction (P < 0.001), and the prevalence of term birth increased by 5.37% (P < 0.001) compared with the previous year. The prevalence of respiratory distress syndrome (RDS) decreased significantly during COVID-19 pandemic compared with the previous year (23.64% vs. 26.56%, P < 0.001). The prevalence of retinopathy of prematurity (ROP) significantly increased during COVID-19 pandemic compared with the previous year (3.97% vs. 2.28%, P < 0.001). Additionally, sepsis was significantly more prevalent during COVID-19 pandemic compared with the previous year (6.84% vs. 1.23%, P < 0.001). Moreover, intraventricular hemorrhage (IVH) significantly increased during COVID-19 pandemic in comparison to the previous year (1.10% vs. 0.08%, P < 0.001). Conclusions: The prevalence of preterm birth decreased during COVID-19 lockdown. Also, major complications of prematurity such as RDS, ROP, sepsis, and IVH may be affected by COVID-19 lockdown.

Exploring Clinical and Biological Features of Premature Births among Pregnant Women with SARS-CoV-2 Infection during the Pregnancy Period.

Studies observed that women infected with SARS-CoV-2 during pregnancy had a higher risk of preterm birth. Although it is likely that COVID-19 during the late trimester of pregnancy can trigger premature birth, prematurity remains a concern, and it is vital to study additional clinical and biological patient factors that are highly associated with this negative pregnancy outcome and allow for better management based on the existing predictors. In order to achieve this goal, the current study retrospectively recruited 428 pregnant patients that were separated into three study groups using a 1:2:4 matching ratio and a nearest-neighbor matching method. Sixty-one pregnant patients had a history of COVID-19 during pregnancy and gave birth prematurely; 124 pregnant patient controls had COVID-19 and gave birth full-term, while the second control group of 243 pregnant patients had a premature birth but no history of COVID-19. It was observed that a symptomatic SARS-CoV-2 infection during the third trimester was significantly more likely to be associated with premature birth. Even though the rate of ICU admission was higher in these cases, the mortality rate did not change significantly in the COVID-19 groups. However, SARS-CoV-2 infection alone did not show statistical significance in determining a premature birth (ß = 1.09, CI = 0.94−1.15, p-value = 0.067). Maternal anemia was the strongest predictor for prematurity in association with SARS-CoV-2 infection (ß = 3.65, CI = 1.46−5.39, p-value < 0.001), followed by elevated CRP (ß = 2.11, CI = 1.20−3.06, p-value < 0.001), and respectively IL-6 (ß = 1.92, CI = 1.20−2.47, p-value = 0.001. SARS-CoV-2 infection is associated with an increased risk of preterm birth, as shown by our data. If SARS-CoV-2 infection arises during the third trimester, it is recommended that these patients be hospitalized for surveillance of clinical evolution and biological parameters, such as anemia and high inflammatory markers, which have a multiplicative influence on the pregnancy result.

A Study on Neonatal Outcome Due to Placental Infection during Severe COVID-19

Introduction: COVID-19 pandemic has severe consequences for the whole world. Each age group has been affected. Both the pediatric and geriatric populations have been worst affected by COVID-19. Even pregnant females were affected much and especially the neonates of pregnant women with COVID-19. The vulnerability increases in neonates of mothers with COVID-19. There is less literature and guidelines available which discussed the outcomes of neonates of mothers who had COVID-19 during gestation. Aims and Objectives: To find out the effect on the fetus of mothers, who were infected with COVID-19 during gestation. Method(s): This is a retrospective study which considered 120 pregnant women, comprising 60 pregnant females with COVID-19 (study group) and another 60 pregnant females without COVID-19 (control group). The baseline characteristics were obtained from the hospital in both groups and the outcomes were evaluated and analyzed. Result(s): The study found that there are significant differences between the two groups in gestational age at the time of delivery, premature delivery occurred and neonatal death (p<0.05). Conclusion(s): The study has concluded that the presence of COVID-19 in pregnant females caused placental infection affecting the fetus significantly, as evidenced by premature birth and neonatal deaths among the COVID-19 group. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

What complications have arisen after early medical abortion -’both pills by post’’ policy in the uk during Covid? Do these increase the risk of subsequent premature birth?

BackgroundDuring 2019 NICE and the RCOG introduced UK guidelines normalising the early medical abortion (EMA) protocol for pregnancies prior to 10 weeks gestation. Mifepristone is taken at the abortion clinic, and the second pill, Misoprostol may be taken unsupervised at home 36–48 hours later. In March 2020, UK EMA policy changed, and telemedicine with ‘both pills by post’(BPBP) was authorised by DHSC, during Covid-19.MethodsA worldwide systematic review and meta-analyses were conducted to compare risk of PTB after one or more abortions compared to none, and PB after medical versus surgical abortion. Systematic evidence on outcomes after medical abortion are recorded through the Finnish Abortion registry. Mannisto (2013) published a paper showing that when surgical abortion, or evacuation of retained products of conception (ERPC) is required after a medical abortion, it increases the risk of subsequent PB by 241%. Very little data has been collected on this subject in England. We examine data from FOI requests to CQC in Dec 2020 and to NHS Acute hospital trust A&E departments in England and Wales (E&W) to investigate the incidence of complications (haemorrhage and sepsis) and ERPC after EMA and BPBP since April 2020.ResultsOur meta-analysis showed adj OR of 1.52, 95% CI (1.43–1.62), for increased risk of PTB after Abortion, compared to none. Surgical abortion carried more risk (RR 1.23) than Medical Abortion. FOI (response rate 67%) showed a 5.9% EMA failure rate in E&W from data from NHS A&E depts between April 2020 and 2021. This is similar to EMA failure rate (5.48%) published in Marie Stopes Australia 2020 report. It means that more than 7,400 women per annum across England have had complications from EMA since the Covid approval for telemedicine and BPBP. 2.4% needed a subsequent ERPC, which increases further the risk of a PTB in a later pregnancy. Incidence of complications or ERPC after EMA is 0.75%, 5x higher than reported by DHSC (0.15%).ConclusionThese results suggest that this policy of BPBP during Covid-19, should revert to in-person consultation for EMA for the safety of women. The BPBP was a departure from Evidence Based Medicine. Abortion should be appropriately governanced, and outcomes fully evaluated with evidence collected using longitudinal data via the NHS number on HSA4 forms. This would inform a safer policy for the wellbeing of women and help to reduce the increasing rates of PTB for the future.

Neonatal complications of SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance

1206 Figure 1Weekly number of neonates admitted who have confirmed SARS-CoV-2 by date of diagnosis, UK, 1st March 2020 to 7th November 2021[Figure omitted. See PDF] 1206 Table 1Maternal and neonatal mortality in association with SARS-CoV-2 infection, UK 01/03/2020-31/10/2021ConclusionUsing population level surveillance data we describe neonatal complications directly and indirectly attributable to SARS-CoV-2 infection during the first three pandemic waves. This study demonstrates the low risk to neonates despite the emergence of new variants. Continued surveillance will allow the impacts of new variants on the neonatal population to be characterised.ReferencesGale C, Quigley MA, Placzek A, et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. Lancet Child Adolesc Heal 2021;5:113–21.Vousden N, Ramakrishnan R, Bunch K, et al. Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort. Medrvix 2021. doi:10.1101/2021.07.22.21261000.Knight M, Kurinczuk JJ, Tuffnell D, Brocklehurst P. The UK Obstetric Surveillance System for raredisorders of pregnancy. BJOG An Int J Obstet Gynaecol 2005;112:263–5.

Comparative study on neonatal outcomes during pre-COVID and COVID period- a single centre study

AimsWith the declaration of the pandemic in March 2020, concerns on its impact on neonatal outcomes were raised. This study was conducted to compare neonatal diagnoses and outcomes during pre-COVID and COVID periods in a local neonatal unit (LNU) in the United Kingdom.MethodsA retrospective study was conducted between 1st January 2019 – 31st May 2021. Admissions into the neonatal/post-natal wards were screened via electronic record system. Data was categorised as pre-COVID (January 2019- March 2020, 15months) and COVID periods (April 2020- May 2021, 14 months). Preterm births, congenital anomalies, hypoxic ischemic encephalopathy (HIE), deaths were included. P-value was calculated using Chi-square test, <0.05 was considered significant.Results8825 were the total births recorded. 1809 (20%) neonatal admissions were identified. 638 (7%) neonates were included in the analysis (based on inclusion criteria). Live births between pre-COVID and COVID periods were similar (median – 4412, p 0.99). Neonatal admissions during the COVID period were higher in comparison to pre-COVID (943 vs 866, p <0.01). No ethnical differences were observed between two periods (p 0.65). One preterm neonate at day 13 was COVID positive. On comparison of gestational ages (pre-COVID and COVID periods)- <27 weeks (0.2% vs 0.16%, p 0.56), 27-32 weeks (0.5% vs 1.3% p <0.01), 32-37 weeks (3.2% vs 5.4%, p<0.01). Congenital anomalies during pre-COVID and COVID periods (15% vs 10%, p 0.21) were the same. HIE in COVID period was higher in comparison to pre-COVID (0.06% vs 0.23%, p 0.03). Neonatal deaths were the same (0.09% vs 0.02%, p 0.2).ConclusionThis observational study captures a large number of neonatal births and outcomes during pre-COVID and two COVID peaks in the region. We report very low COVID test positivity rate in neonates in this cohort. We conclude that neonatal admissions during COVID increased due to preterm and complex term admissions. Interestingly, HIE incidence was high during COVID period, this needs further validation.

Status of Perceived Stress and Associated Factors among Pregnant Women during Coronavirus Pandemic in Antenatal Care at Gondar Town, Northwest, Ethiopia: A Cross-Sectional Study

[...]this problem doesn't get adequate attention during antenatal care in Ethiopia. [...]this study is aimed to assess the status of perceived stress and associated factors among pregnant women during antenatal care at Gondar town governmental health institutions, northeast, Ethiopia. Conclusions: The prevalence of perceived stress during pregnancy was high in the study area. [...]it is crucial for the ministry of health to incorporate screening the status of pregnancy perceived stress into basic antenatal care in assessment tools. The results of this study also provide further evidence for the management of pregnant women's perceived stress and prevention of adverse maternal and neonatal outcomes. [...]our study is aimed at exploring the prevalence of perceived stress and associated factors among pregnant women during antenatal care in Gondar town, Ethiopia. The PSS used in this study was customized to an 11-item version (PSS-11) from the original 14-item version (PSS-14) 14 measure for all general populations. Since 11-item version (PSS-11) was more appropriate and easy-to-administer self-assessment tools for measuring perceived stress in pregnant women [2].

The best response to US criminalisation of abortion is decriminalisation elsewhere

[...]with the US Supreme Court overturning Roe v Wade, sexual and reproductive rights are under threat globally.23 The US is polarised on abortion, but criminalising abortion, as many states in the US are now doing,4 is harmful and costs lives.5 It disproportionately affects the poorest, most marginalised, and most vulnerable. Despite many US states following the Supreme Court ruling, the Republican state of Kansas recently voted to allow abortion.7 In the UK, although the public and politicians are supportive of abortion, it remains a criminal act under certain circumstances.8 Only Northern Ireland in the UK has decriminalised abortion, but that sea change in law is not yet matched by provision of services. Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study.

Preterm birth: the impact of risk factors on pregnancy outcomes

BACKGROUND: Despite the achievements of modern obstetrics and neonatology, the problem of preterm birth remains one of the most pressing. AIM: The aim of this study was to evaluate the influence of risk factors on the outcome of threatened preterm birth. MATERIALS AND METHODS: This prospective cohort study included the analysis of clinical and anamnestic data of 130 patients delivered at various gestational ages. The main group comprised 68 women with preterm delivery, with the control group consisting of 62 women with timely delivery. RESULTS: The outcome of preterm birth is adversely affected by overweight in the group of modifiable risk factors, by history of premature birth in the immediate family in the group of non-modifiable risk factors, and by a previous COVID-19, anemia and autonomic nervous system disorders in the group of potentially modifiable risk factors. The most reliable prognostic marker for the development of preterm labor was the shortening of the cervical length of less than 2.5 cm according to ultrasound. CONCLUSIONS: The formation of risk groups based on the analysis of clinical, anamnestic, medical, and social data, as well as somatic and gynecological diseases can help avoid the development of adverse outcomes of preterm birth. © 2022 Eco-Vector LLC. All rights reserved.

Severe SARS-CoV-2 infection in a 32-week pregnant woman treated with Remdesivir-Dexamethasone combination therapy: A case report.

This study shows that remdesivir and dexamethasone combination therapy can be considered as a suitable treatment choice for pregnant women infected with COVID-19. It is worth mentioning that more studies are required to evaluate the efficacy and side effects of remdesivir monotherapy and its combination with dexamethasone during pregnancy.

Clinical Characteristics and Pregnancy-Related Outcomes of Pregnant Women Hospitalized with COVID-19 During the Delta Wave: A Single-Center Observational Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) during pregnancy is associated with increased disease severity and an increased risk of perinatal complications. However, few studies of pregnant women with COVID-19 have been conducted in Korea. The purpose of this study was to describe the clinical course and pregnancy outcomes of pregnant women admitted to our hospital with COVID-19 according to the severity. MATERIALS AND METHODS: This retrospective cohort study included women aged 18 years of age or older who were hospitalized in the Gachon University Gil Medical Center with COVID-19 during pregnancy between July 1, 2021 and January 31, 2022. COVID-19 severity was classified according to the "Criteria for severity classification by symptoms of COVID-19" presented by the Korea Disease Control and Prevention Agency. Severe cases were defined as those who required oxygen treatment administered via a high-flow nasal cannula or invasive mechanical ventilation or should be applied extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy. RESULTS: A total of 103 pregnant women were hospitalized with COVID-19 during the study period. Their mean age was 33 (± 4.14) years, and 4 (3.9%) had been vaccinated against COVID-19. At the time of diagnosis of COVID-19, 3 (2.9%), 33 (32.0%), and 67 (65.1%) patients were in the first, second, and third trimester, respectively. The most common symptoms were cough (99 patients, 96.1%) and fever (85 patients, 82.5%). There was 1 (1.0%) asymptomatic patient. Forty patients (38.8%) required supplemental oxygen and 19 patients (18.4%) had severe disease. Of the 19 severe cases, 7 were in the 2nd trimester and 12 were in the 3rd trimester. Forty-one (39.8%) patients delivered, including two twin deliveries. Of the 41 cases of delivery, 14 were premature, 4 out of 21 (19.0%) in mild, 4 out of 12 (25.0%) in moderate, and 6 out of 8 (75.0%) in severe. Severe disease was associated with an increased rate of preterm birth (P = 0.012). Four of the 43 neonates (9.1%) received oxygen treatment. CONCLUSION: Pregnant women with COVID-19 had a high rate of severe disease and a high preterm delivery rate, especially among those with severe disease.

Clinical decision analysis of elective delivery vs expectant management for pregnant individuals with COVID-19-related acute respiratory distress syndrome.

BACKGROUND: Pregnant individuals are vulnerable to COVID-19-related acute respiratory distress syndrome. There is a lack of high-quality evidence on whether elective delivery or expectant management leads to better maternal and neonatal outcomes. OBJECTIVE: This study aimed to determine whether elective delivery or expectant management are associated with higher quality-adjusted life expectancy for pregnant individuals with COVID-19-related acute respiratory distress syndrome and their neonates. STUDY DESIGN: We performed a clinical decision analysis using a patient-level model in which we simulatedpregnant individuals and their unborn children. We used a patient-level model with parallel open-cohort structure, daily cycle length, continuous discounting, lifetime horizon, sensitivity analyses for key parameter values, and 1000 iterations for quantification of uncertainty. We simulated pregnant individuals at 32 weeks of gestation, invasively ventilated because of COVID-19-related acute respiratory distress syndrome. In the elective delivery strategy, pregnant individuals received immediate cesarean delivery. In the expectant management strategy, pregnancies continued until spontaneous labor or obstetrical decision to deliver. For both pregnant individuals and neonates, model outputs were hospital or perinatal survival, life expectancy, and quality-adjusted life expectancy denominated in years, summarized by the mean and 95% credible interval. Maternal utilities incorporated neonatal outcomes in accordance with best practices in perinatal decision analysis. RESULTS: Model outputs for pregnant individuals were similar when comparing elective delivery at 32 weeks' gestation with expectant management, including hospital survival (87.1% vs 87.4%), life-years (difference, -0.1; 95% credible interval, -1.4 to 1.1), and quality-adjusted life expectancy denominated in years (difference, -0.1; 95% credible interval, -1.3 to 1.1). For neonates, elective delivery at 32 weeks' gestation was estimated to lead to a higher perinatal survival (98.4% vs 93.2%; difference, 5.2%; 95% credible interval, 3.5-7), similar life-years (difference, 0.9; 95% credible interval, -0.9 to 2.8), and higher quality-adjusted life expectancy denominated in years (difference, 1.3; 95% credible interval, 0.4-2.2). For pregnant individuals, elective delivery was not superior to expectant management across a range of scenarios between 28 and 34 weeks of gestation. Elective delivery in cases where intrauterine death or maternal mortality were more likely resulted in higher neonatal quality-adjusted life expectancy, as did elective delivery at 30 weeks' gestation (difference, 1.1 years; 95% credible interval, 0.1 - 2.1) despite higher long-term complications (4.3% vs 0.5%; difference, 3.7%; 95% credible interval, 2.4-5.1), and in cases where intrauterine death or maternal acute respiratory distress syndrome mortality were more likely. CONCLUSION: The decision to pursue elective delivery vs expectant management in pregnant individuals with COVID-19-related acute respiratory distress syndrome should be guided by gestational age, risk of intrauterine death, and maternal acute respiratory distress syndrome severity. For the pregnant individual, elective delivery is comparable but not superior to expectant management for gestational ages from 28 to 34 weeks. For neonates, elective delivery was superior if gestational age was ≥30 weeks and if the rate of intrauterine death or maternal mortality risk were high. We recommend basing the decision for elective delivery vs expectant management in a pregnant individual with COVID-19-related acute respiratory distress syndrome on gestational age and likelihood of intrauterine or maternal death.

CONGENITAL INFECTION CAUSED BY THE SARS-CоV-2: LITERATURE REVIEW AND FIRST CLINICALCASE

COVID-19 is a disease caused by the novel SARS-CoV-2, is a severe systemic thrombotic syndrome with respiratory tract damage that emerged in 2019 in China with the development of a subsequent pandemic. Over the past two years, very little information has been accumulated on the prevalence, transmission routes, and the clinical picture of the disease among newborn infants. Given the limited data in the domestic literature, authors present not only a description of the first clinical observation of confirmed new coronavirus infection in a premature newborn, but also a brief review of the literature on the description of the epidemiology, clinic and methods of therapy for COVID-19 in infants. © 2022, Pediatria Ltd. All rights reserved.