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Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.
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Background. On March 11, 2020, the World Health Organization announced the status of a global pandemic for the 2019 coronavirus disease (COVID-19). Pregnant women are most vulnerable to being infected with COVID-19 and must take extra care of their health. The impact and risk of COVID-19 on pregnant and lactating women as well as on the fetus and baby are not yet known with certainty. However, due to changes in body shape and immune system, pregnant women are very susceptible to some res-piratory infections. Objective. The purpose of this study was to determine the effect of the COVID-19 pandemic on the quality of antenatal care (ANC) services in Probolinggo Regency. Methods. This analytic research has a cross-sectional design. The participants are 326 pregnant women in the third trimester. Sampling uses simple random sampling. The sample is some pregnant women in the third trimester, as many as 179 people. Chi- square is used for analysis. Results. According to the study's findings, as many as 170 respondents did not confirm that they had COVID-19 (95%). 153 respondents were provided with quality ANC services (85%). Conclusion. The results of the statistical test obtained a value of P=0.09;so there is an influence during the COVID-19 pandemic on the quality of ANC services. Efforts that can be made are health workers limit meetings with pregnant women without reducing the quality of ANC services.Copyright © the Author(s), 2023.
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Introduction: One in five pregnant women in the UKis obese. Obesity is associated with increased risk of both maternal and foetal adverse outcomes. RCOG guidelines [1] recommend that all women with a booking BMI over 40 kg/m2 should be reviewed antenatally by a senior obstetric anaesthetist to guide risk assessment, medical optimisation and shared decision-making. The 2021 MBRRACE report [2] recommends that all women should be reweighed in the third trimester for accurate VTE risk scoring and prophylactic LMWH dosing. In our institution, reconfiguration of hospital areas as part of the COVID-19 response led to loss of designated clinic space for our obstetric anaesthetic clinic. As a result, our practice since has been to initially offer a telephone consultation followed by a face-to-face review if needed. Finding space for the latter has often been a significant logistical challenge. Our project sought to assess whether our practice continued to meet national standards in the wake of these changes. Method(s): Following audit approval, we retrospectively reviewed all women with a BMI >40 kg/m2 undergoing caesarean section (CS) over a six-month period (1/4/22 to 31/9/22). Result(s): 20 women met inclusion criteria (Category 1-3 CS - 12 women;Category 4 CS - 8 women). 100% of patients had booking height, weight and BMI recorded. 20% (4/20) of patients were reweighed in the 3rd trimester. Only 55% (11/20) of patients had been referred to and reviewed in the antenatal obstetric anaesthetic clinic (Figure). Of the 11 patients referred, 6 were referred later than 30 weeks. Of the 9 patients not referred, 8 had a BMI between 40 and 45 kg/m2. By contrast, 87% (6/7) of patients with BMI over 45 kg/m2 were referred and seen. Discussion(s): Our audit showed that we are not meeting national standards. Possible reasons identified were lack of awareness of the RCOG standards and referral criteria (especially for women with a BMI of 40 to 45 kg/m2) and logistical issues in undertaking face-to-face reviews without designated clinic space. Presentation of our results at the joint anaesthetic, obstetric and midwifery governance meeting has helped identify space in the antenatal clinic for face-to-face reviews, to start from March 2023 and to raise awareness of the national standards to ensure referral of all women with a BMI over 40 kg/m2. A reaudit is planned in 6 months. [Figure presented]Copyright © 2023 Elsevier Ltd
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Problem: Several large studies have demonstrated that COVID-19 pregnant individuals are at a significant risk for severe disease and adverse pregnancy outcomes. The mechanisms underlying these phenomena remain to be elucidated and are the focus of our project. Although fetal and placental infection is rare, placental abnormalities and adverse pregnancy outcomes associated with placental dysfunction in COVID-19 cases have been widely reported. In particular, placental thrombosis and lesions consistent with maternal vascular malperfusion (MVM) of the placenta are common in individuals with COVID-19. Since thrombotic complications have been associated with COVID-19, it is not surprising that pregnant individuals with COVID- 19 are at risk for placental thrombosis. Method of Study: Placentas were evaluated histologically. Extracellular vesicles were isolated by serial centrifugation. Result(s): Adverse pregnancy outcomes associated with these placental lesions, including hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), small for gestational age (SGA, birthweight < 10th percentile for gestational age), and preterm birth (PTB, < 37 weeks) are significantly increased among pregnant individuals with COVID-19. Placental infection with SARSCoV- 2 is uncommon, but multiple inflammatory and metabolic factors are likely to affect the placenta, including circulating extracellular vesicles (EVs) derived from various organs that have been associated with COVID-19 pathology and disease severity.We have analyzed over 500 placentas from COVID-19 pregnancies and found marked changes in placental morphology, characterized by abnormal maternal and fetal vessels, intervillous thrombi, and fibrin deposition, even in the face of mild or asymptomatic disease. We detected increased levels of small EVs in maternal serum from COVID-19 cases compared to controls and increased levels of mitochondrial DNA in EVs from COVID-19 cases. In in vitro experiments, we found increased oxidative stress in uterine endothelial cells and primary trophoblasts. Syncytialization of trophoblast cells following exposure to EVs from pregnant COVID-19 patients was markedly reduced. RNAseq of trophoblast cells exposed to EVs from pregnant COVID-19 patients revealed disruption of multiple pathways related to mitochondria function, oxidative stress, coagulation defects, and inflammation. Timing of infection during pregnancy (first, second, and third trimester) altered EV size distribution, cargo content, and functional consequences of trophoblast EV exposure. Conclusion(s): Our studies show that COVID-19 infection during pregnancy has profound effects on placenta morphology and function. It remains to be determined what the long-term consequences are on the offspring.
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Objectives: A 7-month-old boy presented with generalized urticaria since the first week of life, without any other clinical manifestation. Cow's milk allergy was ruled out. His development was normal for his age. Maternal history was significant for COVID-19 infection in the third trimester of pregnancy with mild symptoms. Family history was significant for dermatographism in a maternal uncle. Hives were migratory with no single lesion persisting more than 24 h. There were no recognizable triggers and only relieved for 1-2 days after each vaccination. Patient was treated with optimal doses of antihistamines without improvement. Method(s): Laboratory tests and further studies were performed Results: Laboratory tests were normal including complete blood testing, circulating autoantibodies and infectious studies. C-reactive protein level and erythrocyte sedimentation rate were elevated. Due to chronic urticaria of newborn onset unresponsive to antihistamines a monogenic autoinflammatory disease was suspected. A targeted gene panel covering causative genes revealed the unreported p.Gly307Ala variant in the NLRP3 gene with a variant allele frequency (VAF) of 3% compatible with gene mosaicism. NLRP3 variant was classified as "likely pathogenic" based on its location, where a different variant has been reported as causing a severe form of cryopyrin-associated periodic syndromes (CAPS), and bioinformatic analyses. As expected, the variant was absent in patient's parents supporting for its de novo nature. Vision and hearing exams were normal. Treatment with canakinumab will start soon. Discussion(s): CAPS are dominantly-inherited autoinflammatory diseases caused by gain-of-function NLRP3 variants. These variants are often germline, but in some reported cases the variants are postzygotic causing gene mosaicism as in the patient here described. We believe that the mild presentation in our patient, despite having a likely pathogenic variant, may be explained by the low VAF. The genetic diagnosis in our patient allowed early initiation of anti-IL-1 treatment, which probably will prevent the development of other CAPS manifestations.
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Objective: The factors affecting the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies from mother to newborn and the duration of seropositivity rates in these infants have not yet been clearly demonstrated. The objectives of this study were (1) to assess the levels of SARS-CoV-2 spike-specific immunoglobulin G (IgG) in women infected in the pregnancy period and newborns born to these women and (2) to search the transplacental transfer ratio of spike-specific IgG. Method(s): Seventy pregnant women with symptomatic SARS-CoV-2 infection and their newborns were prospectively followed. Anti-SARS-CoV-2 immunoassay was used for the detection of the in vitro quantitative determination of total antibodies to the SARS-CoV-2 spike protein. Discussion(s): Spike-specific IgG was demonstrated in 89.1% (44 of 46) of pregnant women infected more than 14 days before delivery and in 92.6% (43 of 44) of their newborns. Median transfer ratio of spike-specific Ig was 0.87 (interquartile range [IQR], 0.34-0.90), 1.0 (IQR, 0.9-0.29), and 0.81 (IQR, 0.02-1.0) in first trimester (n = 4), second trimester (n = 14), and third trimester (n = 28) pregnant women, respectively. Antibody transfer ratio was correlated with time elapsed from infection (p < 0.001). Peak antibody transfer ratio above 1 was observed at a median 60 to 120 days after the infection from delivery. Antibody transfer ratio was high in pregnant women infected more than 60 days before delivery (p < 0.001). Transfer ratio was significantly higher in the severe-critically symptomatic women (n = 15) than the mild-moderately symptomatic women (n = 55) (p = 0.001). At 3 months, 18 of 25 infants (72%) had spike-specific IgG. Conclusion(s): Timing from infection to delivery and severity of maternal infection are critical in assessing the antibody generation and transport. Higher antibody transfer ratio can be detected in neonates when SARS-CoV-2 infection is present for more than 60 days before birth. Maternally derived antibody can persist for 3 months after birth.Copyright © 2023. The Author(s).
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Problem: Despite being over 3 years into the pandemic, infants remain highly undervaccinated and at a high risk for hospitalization due to COVID-19. Further investigation as to how maternal health decisions for immunization can reduce morbidity from infant COVID-19 by providing passive immunity is necessary. The objective of this study was to describe the rates of SARS-CoV-2 variant antibody transfer from mother to infant cord blood by trimester ofmaternal vaccination. Methods of study: This is an observational cohort study including mother-infant dyads receiving primary or subsequent booster COVID- 19 vaccines during pregnancy.Unvaccinated, but SARS-CoV-2 infected dyads with were included as a comparison group. We quantified median titer and interquartile range (IQR) for SARS-CoV-2 receptor binding domain (RBD) IgG in infant cord blood samples at delivery using the mesoscale discovery platform (electrochemiluminescence). Primary outcome was infant cord IgG titer by trimester of vaccination for the WA1/2022 RBD IgG and current circulating, immune evasive XBB RBD IgG. Secondary outcome is the percent detectable IgG for each variant. Sensitivity analysis was performed based on known SARS-CoV-2 infection. Result(s): Eighty-three mother-infant dyads were included in this analysis. Seven were vaccinated in the first trimester, 37 in the second trimester, 33 in the third trimester, and 6 were unvaccinated and infected. Twenty-three (30%) of the vaccinated group had known SARS-CoV-2 infection. Most received monovalent mRNA COVID-19 vaccines during pregnancy, aside from two who received the viralvectored Ad26.COV2.S, and two received the bivalent mRNA vaccine during pregnancy. The median cord blood WA1/2020 RBD IgG titer was 5370 (412-7296) for first, 1225 (589-3289) for second, 2623 (664-5809) for third trimester in individuals who received aCOVID-19 vaccine dose during pregnancy, and 45 (10-187) in those unvaccinated and infected. After excluding thosewith infection, the cord blood IgG was 514 (106-4182), 1070 (518-2317), and 2477 (664-4470) for first, second, and third trimester, respectively. The rate of detectable WA1/2020 RBD IgG was 100% for all three trimesters, even when excluding infected individuals. For theXBBvariant, cord bloodRBDIgG titer was 284 (43-1296) for first, 66 (32-227) for second, 173 (45-389) for third trimester, and 10 (10-11) in the unvaccinated/infected group. Excluding infections, the cord blood XBB RBD IgG was 54 (10-128), 44 (25-181), and 152 (45-360) for first, second, and third trimester vaccination, respectively. The rate of detectable XBB IgG in those who received a vaccine during pregnancy were 83%, 91%, and 90% for first, second, and third trimester respectively, compared to 17% in the unvaccinated/infected group. Excluding infections, the rate of XBB RBD IgG detection was 66%, 89%, and 95% for first, second, and third trimester vaccination, respectively. Conclusion(s): Vaccination during pregnancy leads to high rates of detectable cord blood IgG specific to SARS-CoV-2 WA1/2020 variant and current circulating variants (XBB), regardless of trimester of vaccination. Infection history leads to higher cord blood IgG in vaccinated;however, infection alone without vaccination leads to lower titer and greater rates of undetectable cord IgG at delivery.
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Background: The US Food and Drug Administration under an Emergency Use Authorization approved use of Paxlovid (nirmatrelavir and ritonavir) for the treatment of mild-to-moderate COVID-19 in adults and children with a positive test for SARS-Co-2 and who are at high risk for progression to severe COVID-19. Pregnant women are at increased risk of severe complications resulting from COVID-19 infection;however, minimal data on the safety of Paxlovid in human pregnancy are available. Objective(s): The objectives of this study are to assess risks of major congenital malformations, spontaneous abortion, elective termination, stillbirth, preterm delivery, small for gestational age infants at birth, or infants who were small for age at one year in pregnancies/infants prenatally exposed to Paxlovid in pregnancy compared to individuals who did not receive this treatment. Design(s): This study involves prospective data from the Organization of Teratology Information Specialists (OTIS) Pregnancy Registry which enrolls pregnant women residing in the US or Canada and captures data through maternal interviews and ion of medical records. Result(s): Among pregnant women participating in the OTIS Pregnancy Registry as of February 1, 2023, 59 reported exposure to Paxlovid in pregnancy;25.4% exposed within 30 days prior to the last menstrual period and through the first trimester, 42.4% exposed in second trimester, and 32.2% exposed in the third trimester. As of January 2023, 17 of those enrolled have completed pregnancy outcomes. One was lost to follow-up. Of the remainder, there were no adverse pregnancy outcomes reported. Conclusion(s): Very limited data are available on this potentially beneficial treatment in pregnancy. To date, no serious signals for this exposure have been detected.
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Background: COVID-19 infection is a contemporary global concern with serious ramifications. This disease is caused by a virus belonging to the Coronaviridae family named SARS-CoV-2. Immunologic and physiologic changes during pregnancy make pregnant women more susceptible to viral infection, especially COVID-19. Objective(s): The present study aimed to identify the clinical manifestations, radiologic findings, indications for cesarean delivery, underlying conditions, and the critical outcome of mothers and newborns regarding COVID-19 women who had cesarean sections and terminated pregnancies. Method(s): This cross-sectional study was conducted on the mortality and morbidity rates of 98 women with terminated pregnancies infected with COVID-19 at the time of their cesarean delivery. The demographic, clinical, and pregnancy data were collected from Razi Teaching Hospital between March 2020 and March 2021 and analyzed using SPSS version 24. Result(s): The mean age was 31.31 +/- 7.16, and the mean gestational age was 36.45 +/- 3.334 weeks. The most prevalent cause of cesarean section was fetal distress (28%), followed by preeclampsia and meconium aspiration. The most common symptoms were sore throat, cough, fever, nausea, diarrhea, and weakness;moreover, hypothyroidism and diabetes mellitus were the most predominant underlying diseases. The mean duration for hospitalization was 5.21 +/- 4.584 days, the maternal death rate was 5.1%, and the neonatal death rate was 2%. Conclusion(s): The majority of women infected with COVID-19 had cesarean sections and terminated pregnancies in the third trimester. This highlights the need for better care and education for mothers in this period. The body mass index (BMI) level and obesity are strongly associated with COVID-19 severity. Furthermore, healthcare workers should pay more attention to underlying diseases during pregnancy.Copyright © 2023, Author(s).
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Background: Limited evidence exists on the pandemic's role in limiting access and use of prenatal care services and the quality of care for pregnant women. We aimed to investigate the impact of the pandemic restrictions on in-person prenatal care visits (PNCV) and the quality of prenatal care. Method(s): Using the mother-infant-linked administrative health databases in Manitoba, Canada, we conducted a province-wide population-based cohort study among independent pregnancies. We examined the quarterly rates of PNCV before (October 2016-March 2020) and during (April 2020-March 2021) the pandemic. Quality of prenatal care was categorized using the Revised Graduated Prenatal Care Utilization Index (R-GINDEX) into inadequate (<50% visits), intermediate (50%-80% visits), adequate (>80% visits), intensive (high-risk), and no care. Interrupted time series analyses were conducted to assess the immediate and lagged changes in PNCV and quality of care after the implementation of pandemic restrictions. Result(s): Amongst 70,931 pregnancies, we observed no significant mean difference in the overall numbers of PNCV during the pandemic compared to prepandemic (8.2 vs. 8.6,p=0.0837). Prenatal care utilization was 3.4% inadequate and 34.7% adequate before the pandemic and 4.8% and 26.6% during the pandemic, respectively. Restrictions were associated with an abrupt decline in adequate and intermediate care during the first trimester by 11.3% (p<0.001) and 11.98%, respectively, followed by non-significant change throughout the pandemic (beta3=-0.25,p=0.694 and beta3=-0.96,p=0.192, respectively). Moreover, restrictions were associated with an increased rate of inadequate care during the first (beta2=1.52,p=0.007) and second trimesters (beta2=0.78,p=0.208), and not among third trimesters (beta2=-0.44,p=0.094). During the pandemic, we found no significant differences in the rates of intensive prenatal care during the first (p=0.478), second (p=0.614), and third (p=0.608) trimesters compared to pre-pandemic. Conclusion(s): Our findings suggest a decline in adequacy levels of prenatal care services after COVID-19 restrictions were enacted, with a higher impact on pregnancies during their first and second trimesters. Although the overall adequacy of care decreased, there were no changes to the rates of intensive visits. This study will further investigate the impact of the pandemic on virtual PNCV and assess the association between the quality of prenatal care and adverse maternal and neonatal outcomes.
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Intro: COVID-19 pandemic era makes quality of obstetric triage care including caesarean section in obstetric true emergency cases delayed. Maternal fetal triage index (MFTI) score is an instrument used to define true emergency in obstetric cases. Decision to delivery interval (DDI) is time interval from caesarean section decision to delivery within <30 minutes standard in emergency cases.This study was designed to evaluate the decision to delivery time interval and its effect on perinatal outcomes and the associated factors during category-1 emergency caesarean section deliveries. Method(s): A prospective observational descriptive study was conducted from 2020-2022 at Kariadi tertiary Hospital. A total of 40 clients who were undergone category-1 emergency caesarean section were included in this study. This is a indepht analysis pregnant women confirmed with COVID-19 infection and had true emergency cases based on MFTI score (stat-priority 1). Finding(s): Among 346 pregnant women with COVID-19, total 160 C-section cases with 40 eligible data were included in this study. Gestational age mostly in their second and third trimester. Maternal comorbidities were diabetes in pregnancy, HIV, pre eclampsia, SLE and thyroid disease. This study showed that DDI <30 minutes were found in 34 cases (85%), DDI 30-60 minutes as many as 6 (15%), and no (0%) DDI >60 minutes. Emergency cases with the shortest DDI were umbilical cord prolapse 3 (100%), fetal distress 14 (93%), placental abruption 5 (83%), impending uterine rupture 5 (83%), and antepartum hemorrhage 7 (70%). Perinatal outcome were Apgar score lower than 7 at 1 minutes (25%) and stillbirth (5%). Conclusion(s): Most of DDI in this study met the recommendation of <30 minutes, but some cases did not meet the standard. This can be caused by multifactorial factors such as advice from the doctor in charge, patient transfer distance, operating room preparation, and anesthetic preparation due to COVID-19.Copyright © 2023
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Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.
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Vaccination is essential to manage the COVID-19 pandemic. Vaccination significantly protects against severe COVID-19, hospitalization and death;it also protects against symptomatic infection and reduces the risk of transmission to other people. Protection against the new SARS-CoV-2 variants may be lower, but protection against severe course and death remains high. Two mRNA vaccines (BNT162b2 and mRNA-1273) and two vector vaccines (AZD1222 and Ad26.COV2.S) are currently available in the Czech Republic. Vaccination of persons over 60 years of age and immunocompromised persons, who are demonstrably at the highest risk of a serious course of the disease, is of the utmost importance. In order to achieve adequate vaccination coverage, it is necessary to motivate other groups of people to be vaccinated, including children over 12 years of age and young adults. Vaccination is also recommended in preg-nant women in the 2nd and 3rd trimesters and in breastfeeding women. For selected groups of vaccines, a third dose of vaccination is recommended (additional third dose 4 weeks after the second dose or a booster dose 8 to 12 months after the second dose). The side effects are usually mild, with serious complications (including anaphylaxis, thrombocytopenia with thrombosis syndrome, myocardi-tis, Guillain-Barre syndrome and capillary leak syndrome) being rare.Copyright © 2021, Trios spol. s.r.o.. All rights reserved.
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Introduction: During the COVID-19 pandemic the number of solid organ transplants (SOT) lessened globally due probably to decreased donation and detour of resources to other prioritized activities [1, 2]. The aim of this paper is to analyze the SOT behavior during the COVID- 19 pandemic in this city. Method(s): An exploratory analysis was performed on the data of the Statistics on donation and transplant of organs and tissues in Bogota from 2018 until the third trimester of 2022 [3]. Result(s): 416 SOT from 365 organ donors were performed in Bogota during 2018. The first COVID-19 case in Colombia was documented in March 2020. During the following two years there was a decline in the number of performed SOT and total organ donors, as shown in Table 1. During 2020 there was a drastic reduction on the total SOT, compared with 2018. During 2021 there was a slight recovery in the total SOT, and in the first three trimesters of 2022 there was a drastic increase in the total SOT with 380 procedures performed and 380 organ donors. There was a steeper reduction in the number of heart and lung transplants during 2020 and 2021. The SOT waiting lists remained stable from 2018 to 2022, with 1804 patients in 2021, up to 1950 patients in 2022. Conclusion(s): The reduction in SOT might be due to COVID-19 in donors, reduced incidence of brain death and lessened capability to preserve viable organ donors. The SOT waiting list didn't increase possibly caused by high mortality due to end-stage organ failure. The SOT increase during 2021 coincides with a decrease in COVID-19 lethality in Bogota. This decline in SOT was observed globally during 2020, whilst the rapid recovery in SOT and availability of organ donors during 2022 is a phenomenon that has not been described yet to our knowledge.
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Objectives: The aim of this study is to evaluate the effect of coronavirus disease 2019 (COVID-19) diagnosed in the third trimester of pregnancy on maternal, fetal, and obstetric outcomes. Method(s): This retrospective study included 109 pregnant women hospitalized with a diagnosis of COVID-19 during the third trimester of pregnancy (28-40 weeks) in a tertiary center between March 1 and December 31, 2020. Demographic characteristics, clinical signs, and obstetric outcomes of the patients were searched for analysis. Laboratory and x-ray results were reported, and treatment methods were summarized. Finally, mother-newborn results were recorded. Result(s): We included one hundred nine pregnant women in this study. We divided the patients into two groups as those with positive PCR test (n = 59) and negative PCR test and possible covid patients (n = 50) whose symptoms and histories meet the covid criteria. The mean age of the patients was 28.90 +/- 6.21 years, and the mean week of gestation was 37.45 +/- 2.29 weeks. Half of the patients were asymptomatic (n = 57, 47.7%), and 69% of all patients were delivered by cesarean section. The hospitalization time of antigen-positive cases was between 2-9 days. The mean lymphocyte count was 1.37 +/- 0.45 x103/mL in the PCR positive patient group, and this value was 1.67 +/- 0.54 103/mL in the PCR negative patients (p = 0.007). While the mean neutrophil count was 8.13 +/- 3.16 x 103/mL in the PCR positive patient group, this value was 10.99 +/- 4.14 x 103/mL in the PCR negative patients (p < 0.001). Fifteen patients required intensive care unit follow-up, and 2 of them died while receiving mechanical ventilator support. Conclusion(s): COVID-19 infection in the third trimester of pregnancy does not affect fetal and maternal outcomes if the disease is under control at an early stage. In hospitalized patients, symptoms are more precious than antigen testing.Copyright © 2023 by Prusa Medical Publishing.
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Background: As a quality service improvement response since elexacaftor/ tezacaftor/ivacaftor (ELX/TEZ/IVA) became available and the yearly average number of cystic fibrosis (CF) pregnancies (n = 7 pre-2020, n = 33 in 2021) increased significantly at an adult CF center (~600 people with CF), a monthly multidisciplinary CF-maternal health virtual clinic was established with antenatal virtual CF exercise classes dedicated to providing adaptive, specialist support to this cohort, aswell as outreach guidance and education to local obstetric teams. Method(s): This was a single-center retrospective reviewof Royal Brompton Hospital CF-Maternal Health multidisciplinary team clinic records and a patient survey from March 2020 to March 2022. Result(s): Of 47 pregnancies in 41 women (median age 30;) eligible for ELX/ TEZ/IVA at start of pregnancy, 40% (n = 19) were unplanned, and 19% (n = 9) used assisted conception. Three women with a history of infertility conceived naturally, having required assisted conception for previous pregnancies, and five women had multiple pregnancies during the study period. ELX/TEZ/IVA was continued in 60% (n = 28), delayed in 28% (n = 13), and stopped in 13% (n = 6) of pregnancies through maternal choice and careful clinical counselling. Pre-pregnancy pulmonary status was poorer in women who continued than in those who delayed or stopped (Table 1). Of those who stopped, 85% (n = 5) restarted because of pulmonary deterioration by the third trimester. Prenatal CF complications included at least one episode of minor hemoptysis in 21% (n = 9/41) of women, at least one infective exacerbation in 55% of pregnancies (n = 26/47), and noninvasive ventilation in one woman. Other pregnancy-associated complications included one case of ovarian hyperstimulation syndrome, one case of sub-segmental pulmonary embolism, and two cases of pregnancy-induced hypertension. Excluding 10 first trimester terminations, 10 current pregnancies, and one patient relocation, obstetric outcomes available for 26 pregnancies confirmed a live birth rate of 85% (n = 22/26) and a 15% first-trimester miscarriage rate (n = 4). Obstetric complications included preterm delivery rate of 23% (n = 6/26), including two cases of COVID infection resulting in two neonatal intensive care unit admissions, one case of endometritis after cesarean section, and a fourthdegree perineal tear. There were no ectopic pregnancies, maternal or neonatal deaths, or reports of infant cataracts or congenital malformations. Median gestational age was 37/40 weeks (range 29-40). Mode of delivery was via cesarean section in 45% (n = 10/22, of which twowere emergency) and vaginal in 55% (n = 12/22), of which 83% (n = 10/12) were via induction of labor for diabetes (CF or gestational) indication. Deliveries were supported and occurred equally at local obstetric units and in tertiarycare obstetric hospital settings (50%, n = 11/22). Patient-experience survey responses cited high levels of confidence in health optimization and prioritization during pregnancy and praised excellent inter-health care provider communication and peer-to-peer emotional support provided among expectant mothers in the virtual prenatal exercise groups. Table 1. Baseline demographic and clinical characteristics of elexacaftor/tezacaftor/ivacaftoreligible expectant mothers according to therapeutic decision (Table Presented) Conclusion(s): In the absence of clinical trial safety data, the novel approach of a dedicated CF-maternal health multidisciplinary team clinic with local obstetric outreach support has ensured regular specialist clinical and emotional peer-to-peer support for this cohort of women eligible for ELX/ TEZ/IVA to ensure optimal outcomes and experiences of their pregnancies, where appropriate, close to home.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Objective: Can a way forward be created to establish baseline criteria to better assist aeromedical transport crews with optimizing care and increasing the probability of survival of acutely distressed women in their third trimester of pregnancy with SARS-COV-2 symptoms? Information has been derived from a mixed methods research approach. Pregnant individuals with SARS-COV-2 are at increased risk of intensive care unit admission, mechanical ventilation, and death compared with both pregnant individuals without SARS-CoV-2 infection and nonpregnant adults with SARS-CoV-2 infection1. Hypertensive disorders of pregnancy affect up to 20% of pregnancies in the United States and are leading causes of serious obstetric morbidity1. The focus of this research included nearly 2,400 pregnant women infected with SARS-CoV-2 and found that those with moderate to severe infection were more likely to have a cesarean delivery, to deliver preterm, to die around the time of birth, or to experience serious illness from hypertensive disorders of pregnancy, postpartum hemorrhage, or from infection other than SARS-CoV-2. They were also more likely to lose the pregnancy or to have an infant die during the newborn period. Mild or asymptomatic infection was not associated with increased pregnancy risks. Method(s): We intend to develop an algorithm based on current guidelines to smooth the transition of care from prehospital to intrahospital. We will use the guidelines set forth by The American College of Obstetrics and Gynecology (ACOG). In addition, we will take an example of the policies and procedures from a prehospital care aeromedical flight service for inclusion in our proposed treatment recommendation(s). Result(s): We will then use the guidelines to make an all-encompassing protocol to guide the whole trip from onset of symptoms to in hospital care. We believe that a protocol that encompasses the whole of both systems, prehospital flight and in hospital, will help to streamline patient care tasks and reduce the probabilities of morbidity and mortality. Conclusion(s): The aeromedical community should seek out partnerships with the appropriate entities to provide invaluable information about a critical time of transitioning the patient from the point of access to the healthcare system to the appropriate definitive care facility. The aeromedical community has specialized paramedics, nurses, and physicians with knowledge and experience that cannot easily be quantified. These efforts could result in treatment modalities addressing acute management intra/inter hospital upon initial publication and equip air medical personnel with additional critical care education and knowledge to take back to their perceptive communities to enhance the probability of survival with pregnant women adversely affected by SARS-COV-2.Copyright © 2022
ABSTRACT
Objective: To investigate the laboratory and instrumental characteristics of fetal growth restriction (FGR) secondary to novel coronavirus infection (NCI) to identify pathogenetically relevant predictive markers. Material(s) and Method(s): During the epidemic activity of the NCI Delta strain, 140 high-risk pregnant women were tested at 18-21 weeks and 26-34 weeks of gestation. Retrospectively, taking into account the fact of NCI disease and the exclusion of severe somatic and obstetric comorbidities, 2 groups were formed. Group 1 (n=32) included pregnant women with FGR, without a history of NCI. Group 2 (n=41) included pregnant women with FGR who recovered from NCI by the end of the second and third trimesters. Thirty healthy pregnant women served as the controls. In addition to ultrasound assessment of the fetal placental unit, patients underwent testing for markers of inflammation, endothelial hemostasis dysfunction, decidualization, placental angiogenesis, and pathological insulin resistance. Result(s): Pregnant women with a history of NCI had a higher incidence of FGR (1.3 times;OR 2.41 [95% CI 1.12-5.17]), more severe forms of FGR (2 times;OR 3.27 [95% CI 1.22-8.76]), more severe fetal-placental blood flow abnormalities (3.5-fold;OR 11.07 [95% CI 3.68-33.27]), and oligohydramnios (4.5-fold;OR 8.94 [95% CI 3.65-30.17]). The impact of NCI on the formation of placental insufficiency was expressed by an increase in systemic changes (thrombopoiesis, apoptosis), modulation of local processes (decidualization, placental angiogenesis), and the development of pathological insulin resistance and hyperinsulinemia, an immunopathological process of endotheliocytes. The identification of the most informative markers of FGR due to NCI allowed the development of a predictive index. Conclusion(s): An in-depth study of the impact of NCI on the formation of FGR has important scientific and practical implications for the optimization of FGR prediction, which may help identify appropriate patient management strategies for high-risk pregnant women.Copyright © 2023, Bionika Media Ltd.. All rights reserved.
ABSTRACT
Introduction: Pregnancy-related acute kidney injury (PR-AKI) in India is largely showing a declining trend due to improved and accessible obstetric care. Nevertheless, PR-AKI continues to cause significant maternal and fetal morbidity and mortality. This study was taken up with the intention to study the incidence and clinical spectrum of AKI in pregnancy in recent times and assess maternal and neonatal outcomes Methods: All pregnant women admitted in the Department of Obstetrics and Gynecology at St John's Medical College Hospital, Bengaluru between January 2018 to June 2020 were screened for AKI with the following criteria 1. Increase in serum creatinine to >0.8mg/dL and/or a sudden increase in serum creatinine by more than 50% when prior renal function was normal. 2. Oligo-anuria 3. Need for renal replacement therapy Women with preexisting CKD were excluded. Patient's clinical and laboratory details recorded. Dialysis support was provided if indicated. The clinical profile and renal outcome of the mother and fetal outcome was assessed at the time of discharge. Mothers' were also followed up at the end of 3 months of postpartum period. Recovery was categorized as Complete recovery- normal serum creatinine (<0.8 mg/dL) or a previously known baseline and no proteinuria /hypertension at the end of 3 months Partial recovery- renal function improved but serum creatinine did not return to normal range and patient was dialysis independent. No recovery- patient continued to require dialysis at the end of 3months. Result(s): Of the 2650 deliveries in the study period 42 women (Mean age 26.9 +/-3.6 years) were diagnosed AKI during pregnancy (1.58%). Baseline characteristics and outcomes are depicted in table 1. Majority of women (n=37) were referred from peripheral hospitals. Hypertension and decreased fetal movements were the common reasons for referral. Third trimester was the most common time of presentation (76.1%). Severe Preeclampsia and HELLP syndrome was the leading cause of AKI (59.5%).ATN secondary to obstetric complications, sepsis and hemolytic uremic syndrome were the other causes. One case each of cortical necrosis, acute fatty liver of pregnancy and COVID 19 associated AKI was seen. Mean duration of hospital stay was 12.1+/-6.9 days. More than one third patients' required ICU stay (35.7%).12 patients (28.5%) required renal replacement therapy. Of them, 3 were dialysis dependent at the end of 3 months and 4 had partial renal recovery. 3 patients expired during hospital stay. Fetal survival was 69.04%.13 babies' required NICU care (44.8%). Neonatal outcomes are summarized in table 2. Close to one third of the pregnancies with AKI were associated with intrauterine fetal demise (28.5%). Low birth weight and prematurity were the common reasons for NICU admission with mean NICU stay of 8.2 +/-2.3 days [Formula presented] [Formula presented] Conclusion(s): Severe preeclampsia was the most common cause of AKI in our study. PR-AKI continues to be a significant problem in the peripheries of developing countries where availability of health care facilities is meager, with late referral to tertiary care centers. One third of the patients required ICU stay & dialytic support. Women who required dialysis had poorer renal prognosis. There was 30% fetal loss seen in PR-AKI and also a higher incidence of low birth weight and prematurity. No conflict of interestCopyright © 2023
ABSTRACT
Objective: To investigate the laboratory and instrumental characteristics of fetal growth restriction (FGR) secondary to novel coronavirus infection (NCI) to identify pathogenetically relevant predictive markers. Material(s) and Method(s): During the epidemic activity of the NCI Delta strain, 140 high-risk pregnant women were tested at 18-21 weeks and 26-34 weeks of gestation. Retrospectively, taking into account the fact of NCI disease and the exclusion of severe somatic and obstetric comorbidities, 2 groups were formed. Group 1 (n=32) included pregnant women with FGR, without a history of NCI. Group 2 (n=41) included pregnant women with FGR who recovered from NCI by the end of the second and third trimesters. Thirty healthy pregnant women served as the controls. In addition to ultrasound assessment of the fetal placental unit, patients underwent testing for markers of inflammation, endothelial hemostasis dysfunction, decidualization, placental angiogenesis, and pathological insulin resistance. Result(s): Pregnant women with a history of NCI had a higher incidence of FGR (1.3 times;OR 2.41 [95% CI 1.12-5.17]), more severe forms of FGR (2 times;OR 3.27 [95% CI 1.22-8.76]), more severe fetal-placental blood flow abnormalities (3.5-fold;OR 11.07 [95% CI 3.68-33.27]), and oligohydramnios (4.5-fold;OR 8.94 [95% CI 3.65-30.17]). The impact of NCI on the formation of placental insufficiency was expressed by an increase in systemic changes (thrombopoiesis, apoptosis), modulation of local processes (decidualization, placental angiogenesis), and the development of pathological insulin resistance and hyperinsulinemia, an immunopathological process of endotheliocytes. The identification of the most informative markers of FGR due to NCI allowed the development of a predictive index. Conclusion(s): An in-depth study of the impact of NCI on the formation of FGR has important scientific and practical implications for the optimization of FGR prediction, which may help identify appropriate patient management strategies for high-risk pregnant women.Copyright © 2023, Bionika Media Ltd.. All rights reserved.