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Aim: In light of the severe acute respiratory syndrome by a coronavirus-2 (SARS-CoV-2) pandemic, it was proposed that a variety of complications have occurred in women during pregnancy, which has further extended to the fetus, causing higher rates of morbidity and mortality. The objective of this study was to identify the complications that arose due to the coronavirus and asses how it impacted the pregnancy, the fetus, and the neonate. Materials and methods: Our study was a descriptive and observational study, which investigated the various aspects, obstetric, fetal and neonatal outcomes, and the complications arising in mothers affected with by SARS-CoV-2 virus. All women who tested positive after 20 weeks of gestation were included in the study and their pregnancy was followed up till delivery, and neonatal outcomes were noted. Results: About 220 women infected with SARS-CoV-2 were studied and outcomes were illustrated. The mean age of the study population was 26.87 years [±4.96 Standard Deviation (SD)]. About 90% of the study population had a mild illness. The main obstetric outcomes noted were preterm labor, preeclampsia, eclampsia, intrauterine growth restriction (IUGR), and intrauterine fetal demise (IUD). Only 4.1% required a cesarean section for worsening conditions. Neonatal intensive care unit (ICU) admissions were also noted to be higher, with a possibility of vertical transmission in six babies. Conclusion: Severe acute respiratory syndrome by a coronavirus-2 can have serious implications and can pose a great risk in pregnancy if not caught and treated early. Therefore, it is vital to screen those at high risk for the virus to prevent severe complications from taking a toll on the mother and fetus. Clinical significance: By identifying the main complications occurring in pregnancy, we can prevent the same by anticipating and monitoring carefully, thereby reducing mortality and morbidity rates.
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Aqui va el texto que falta: Fabry's disease (EF) [OMIM 301500] is a lysosomal deposit disease, linked to an X chromosome, caused by the deficiency of the α-galactosidase enzyme (α gal), which generates the progressive accumulation of globotriaosylceramide (GB3)(2) mainly in vascular endothelium, producing endotheliopathy with important systemic manifestations(3). The factors for critical disease by SARSCov-2, identified in the general population, overlap with symptoms seen in adult patients with EF. Objective: Report the case of a patient with EF type I who presented infection by the SARSCov-2 virus during the third pregnancy quarter. Results: Pregnancy evolved at term without complications;the resolution was segmental cesarean section due to dilatation dystocia, obtaining a single male product in good general conditions, without exacerbation of the symptoms of the EF;The bimonthly trend scheme was maintained with home infusion Agalsidase B. Conclusion: Pregnancy can evolve without complications in patients with EF;that enzymatic replacement therapy is safe during it, and despite the vulnerability of EF patients, SARS COV-2 infection can evolve in a benign way.
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BACKGROUND: A complication of elective cesarean section (CS) delivery is its interference with the normal intestinal colonization of the infant, affecting the immune and metabolic signaling in early life- a process that has been associated with long-term morbidity, such as allergy and diabetes. We evaluate, in CS-delivered infants, whether the normal intestinal microbiome and its early life development can be restored by immediate postnatal transfer of maternal fecal microbiota (FMT) to the newborn, and how this procedure influences the maturation of the immune system. METHODS: Sixty healthy mothers with planned elective CS are recruited and screened thoroughly for infections. A maternal fecal sample is taken prior to delivery and processed according to a transplantation protocol. After double blinded randomization, half of the newborns will receive a diluted aliquot of their own mother's stool orally administered in breast milk during the first feeding while the other half will be similarly treated with a placebo. The infants are clinically followed, and fecal samples are gathered weekly until the age of 4 weeks, then at the ages of 8 weeks, 3, 6, 12 and 24 months. The parents fill in questionnaires until the age of 24 months. Blood samples are taken at the age of 2-3 days and 3, 6, 12 and 24 months to assess development of major immune cell populations and plasma proteins throughout the first years of life. DISCUSSION: This is the first study to assess long-time effects on the intestinal microbiome and the development of immune system of a maternal fecal transplant given to term infants born by CS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04173208 , registration date 21.11.2019.
Subject(s)
Gastrointestinal Microbiome , Cesarean Section/adverse effects , Child, Preschool , Feces , Female , Humans , Infant , Infant, Newborn , Intestines , Milk, Human , Pregnancy , Randomized Controlled Trials as TopicABSTRACT
COVID-19 has and continues to affect healthcare across the world. Pregnant women have been identified as a moderate-risk group with regards to clinical susceptibility to COVID-19. Acute liver injury in pregnancy secondary to COVID-19 has been documented sparsely across the world. In this report, we describe the case of a pregnant women who presented with COVID-19 liver injury. A second women with a similar presentation and outcome also presented during the same COVID-19 wave but contact details were lost and consent not gained. Description The cases occurred in December 2020 during which time the predominant reported variant was the alpha strain of COVID-19. Patient A was a multiparous woman, who presented to the labour ward at 37 weeks, a few days after a positive COVID-19 test with vomiting. Investigations revealed significant derangement of liver function tests (LFTs) but with normal bilirubin and clotting. On a working diagnosis of acute fatty liver of pregnancy and with breech presentation, she underwent a caesarean section. Liver enzymes continued to deteriorate with a mild coagulopathy. A non-invasive liver screen and ultrasound did not reveal any significant abnormalities. She was discussed with the tertiary liver centre and started on a Nacetylcysteine infusion with some additional vitamin K. A few days later LFTs began to improve and she was discharged home with follow-up in the community. Her baby was treated with antibiotics for 5 days empirically due to the unknown nature of the transaminitis but remained well. Following further discussion with the tertiary centre, a diagnosis of acute liver injury secondary to COVID-19 was made. Discussion Extra-pulmonary features of COVID-19 have been reported in the literature. A number of theories have been postulated to describe the hepatic effects. This has mainly manifested itself as a transaminitis with varying outcomes. The prevalence in the obstetric population has been more sparsely reported but most isolated cases have been relatively self-limiting with positive outcomes [1]. This case also highlighted the diagnostic difficulties with other severe hepatic diseases of pregnancy. A handful of case reports have already described some of the crossover and difficulty in decisionmaking when these patients present acutely unwell to hospital [2]. The severity and rapid progression of some hepatic disorders in pregnancy not only warrants decisive decision-making but also involvement of the multidisciplinary team.
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Introduction: Intensification of immune system sensitivity after pregnancy with cytokine storm caused by Covid 19 can lead to coagulation disorders and increase the amount of bleeding after delivery. Since bleeding following cesarean section is more likely to occur in women with Covid-19 than in women without the disease, the present study was performed aimed to investigate the amount of bleeding during caesarean section in women with covid-19. Method(s): This descriptive-analytical study was performed on 396 clinical files of women after cesarean section (35 women with Covid 19 and 361 women without Covid 19) in Al-Zahra and Imam Reza hospitals of Tabriz. Demographic information, history of midwifery and bleeding volume, platelets, prothrombin time, and relative thromboblastin time were extracted for each individual. Data were analyzed by SPSS statistical software (version 21) and student's t-test, chi-square and multivariate regression. P< 0.05 was considered statistically significant. Result(s): The rate of bleeding in patients with Covid 19 (1259.59 +/- 127.69 ml) was significantly higher than patients without Covid 19 (351.74 +/- 11.94 ml) (p=0.005). The rate of bleeding during cesarean section for patients with Covid 19 based on the severity of the disease indicated that the higher the severity of the disease, the higher the bleeding during cesarean section (P=0.001). Finally, it was found that severe Covid 19 increases the bleeding of cesarean section by 12.95 times (95% CI: 8.35-15.95). Conclusion(s): Infection to high intensity Covid 19 can increase the risk of bleeding during cesarean section;therefore, measures and planning such as blood preparation and access to appropriate veins for blood transfusion management should be considered. Copyright © 2022, Mashhad University of Medical Sciences. All rights reserved.
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COVID-19 first time appeared in December 2019 in Wuhan, China. The number of cases increased rapidly in china and outside and the World Health Organization declared a pandemic on 11th March 2020. The pregnant and postpartum women, child, and neonatal populations are vulnerable to this disease due to immunological and physiological changes. This paper analyzed the published evidence for assessing the effect of COVID-19 on neonatal health and health care. Online published literature was searched from PubMed, Google Scholar, and other official webpages using keywords: "coronavirus/COVID-19/new coronavirus 2019"/SARS-CoV-2 and neonatal health/care/outcomes" and reviewed to prepare this article. COVID-19 is the potential to transmit either mother to fetus or mother/caregiver to neonates. However, neonates born from infected mothers did not show significant clinical features. Pharyngeal-swab, amniotic-fluid, cord-blood, and breast-milk test results were not found positive. Health facility-based vaginal/caesarian delivery was considered a low risk of transmission. However, recommended to separate neonates with infected mothers/caregivers and test immediately after birth to avoid the possible transmission. Mothers/caregivers should take routine preventive measures such as washing hands frequently and avoiding contact with infected people. If neonates suffered from the server acute respiratory distress requires intensive care urgently. Despite the possibility of the intrauterine transmission of COVID-19 direct evidence is still lacking so it needs more studies for further confirmation. The International Pediatric Association suggested preventive programs, curative care, vaccination, and telemedicine care as the minimum services and called on its members to address these cares during the pandemic. Copyright © 2020, Kathmandu University. All rights reserved.
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Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women. Aim(s): to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy. Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020-2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1-57 patients with asymptomatic and mild form of verified COVID-19;Group 2-50 patients with COVID-19 of moderate and severe course;Group 3-52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19. Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries - 54 (94.7 %) and 38 (76.0 %) (chi2 = 7.76) respectively, as well as a significantly lower number of premature births - 3 (5.3 %) and 12 (24.0 %) (chi2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births - 33 (57.8 %) and 42 (80.8 %) (chi2 = 6.63) respectively, but a greater rate of caesarean section - 24 (42.0 %) and 10 (19.2 %) (chi2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) - 16 (28.1 %) and 2 (6.3 %) (chi2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia - 5 (8.8%) and 42 (84.0%) (chi2 = 61.2;p < 0.001) respectively, increased aspartate aminotransferase - 4 (7.0 %) and 38 (76.0 %) (chi2 = 53.15;p < 0.001), lactate dehydrogenase (LDH) - 0 (0.0 %) and 12 (24.0 %) (chi2 = 15.41;p < 0.001), C-reactive protein (CRP) - 6 (10.5 %) and 49 (98.0 %) (chi2 = 81.58;p < 0.001), creatinine reduction - 0 (0.0 %) and 11 (22.0 %) (chi2 = 13.98;p < 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase;a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level. Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity. Copyright © 2022 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.