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1.
International Journal of Environmental Research and Public Health ; 19(9), 2022.
Article in English | EMBASE | ID: covidwho-1818136

ABSTRACT

The aim of the study was to investigate the challenges of involuntary separation experienced by women during pregnancy and childbirth in the time of the COVID-19 pandemic. The study was conducted by the means of a self-administered questionnaire. One thousand and eleven women (1011) from Poland took part in the study, with an average age of approximately 30 years. The study was approved by the Research Ethics Committee of Warmia and Mazury University in Olsztyn, Poland. The results show that the majority of the surveyed women experienced involuntary separation from their partners during pregnancy and childbirth: 66.27% had no choice but to give birth alone and 84.37% had not been able to attend medical appointments with their partners. Solitary encounters with healthcare were associated with the feeling of fear (36.4%), anger (41%), a sense of injustice (52.2%), acute sadness (36.6%) and a sense of loss (42.6%), with all the reported levels higher in younger women. Over 74% of respondents were afraid of childbirth without a partner present. Almost 70% felt depressed because of a lonely delivery experience. Nearly a quarter of the mothers surveyed declared that if they could go back in time, they would not have made the decision to become pregnant during the pandemic. Based on our study, we found that adjustments to prenatal and neonatal care arrangements under COVID-19-related regimens are needed. Our pro-posal is to implement at least three fundamental actions: (1) risk calculations for pandemic-related cautionary measures should take into account the benefits of the accompanied medical appointments and births, which should be restored and maintained if plausible;(2) medical personnel should be pre-trained to recognise and respond to the needs of patients as a part of crisis prepared-ness. If the situation does not allow the patient to stay with her family during important moments of maternity care, other forms of contact, including new technologies, should be used;(3) psychological consultation should be available to all patients and their partners. These solutions should be included in the care plan for pregnant women, taking into account a risk-benefit assessment.

2.
Frontiers in Pediatrics ; 9, 2021.
Article in English | EMBASE | ID: covidwho-1817994

ABSTRACT

Objective: We sought to compare the clinical characteristics of pediatric respiratory tract infection and respiratory pathogen isolations during the coronavirus disease (COVID-19) pandemic to those of cases in 2018 and 2019. Methods: Our study included all children from 28 days to 15 years old with respiratory tract infections who were admitted to the Department of Respiration, in the Children's Hospital of Soochow University, between January 2018 and December 2020. Human rhinovirus (HRV) and human metapneumovirus (hMPV) were detected by reverse transcription polymerase chain reaction (RT-PCR). Mycoplasma pneumoniae (MP) and human bocavirus (HBoV) were detected by real-time fluorescence quantitative polymerase chain reaction (qPCR);In parallel, Mycoplasma pneumoniae was detected by enzyme-linked immunosorbent assays, and bacteria were detected by culture in blood, bronchoalveolar lavage specimen, and pleural fluid. Results: Compared to 2018 and 2019, the pathogen detection rate was significantly lower in 2020. With regard to infections caused by single pathogens, in 2020, the detection rates of MP were the lowest and those of HRV were the highest when compared to those in 2018 and 2019. Meanwhile, the positive rates of respiratory syncytial virus (RSV) and hMPV reported in 2020 were less than those recorded in 2018 but similar to those recorded in 2019. Also, the 2020 rate of adenovirus (ADV) was lower than that recorded in 2019, but similar to that recorded in 2018. There were no statistical differences in the positive rates of HBoV and PIV III over the 3 years surveyed. Infections in infants were significantly less common in 2020, but no significant difference was found among children aged 1 to 3 years. The detection rate of pathogens in children old than 5 years in 2020 was significantly lower than those recorded in the previous 2 years. Notably, the pathogen detection rates in the first and second quarters of 2020 were similar to those recorded in the previous 2 years;however, the rates were reduced in the third and fourth quarters of 2020. As for co-infections, the positive rate was at its lowest in 2020. In the previous 2 years, viral–MP was the most common type of mixed infection. By contrast, in 2020, viral–viral infections were the most common combination. Conclusion: The pathogen detection rate was significantly reduced in Suzhou City during the COVID-19 pandemic. Public interventions may help to prevent respiratory pathogen infections in children.

3.
Int J Neonatal Screen ; 7(4)2021 Oct 29.
Article in English | MEDLINE | ID: covidwho-1818152

ABSTRACT

Due to the impact worldwide of COVID-19, the 12th European ISNS meeting planned to be live in Luxembourg in November 2020 became Luxembourg Going Virtual in November 2021. The conference theme derived from the geographic location of Luxembourg was retained: Newborn screening-working together in the heart of Europe. Abstracts of the newborn screening experience and knowledge shared in both oral presentations and posters at the symposium are gathered here to assist in selecting presenters to attend virtually and posters to view online. Some abstract highlights include findings from pilot studies of new screening disorders, the value of screening older previously unscreened children, and benefits of second tier testing.

4.
Global Health ; 18(1):46, 2022.
Article in English | PubMed | ID: covidwho-1817230

ABSTRACT

BACKGROUND: Urbanization challenges the assumptions that have traditionally influenced maternal and newborn health (MNH) programs. This landscaping outlines how current mental models for MNH programs have fallen short for urban slum populations and identifies implications for the global community. We employed a three-pronged approach, including a literature review, key informant interviews with global- and national-level experts, and a case study in Bangladesh. MAIN BODY: Our findings highlight that the current mental model for MNH is inadequate to address the needs of the urban poor. Implementation challenges have arisen from using traditional methods that are not well adapted to traits inherent in slum settings. A re-thinking of implementation strategies will also need to consider a paucity of available routine data, lack of formal coordination between stakeholders and providers, and challenging municipal government structures. Innovative approaches, including with communications, outreach, and technology, will be necessary to move beyond traditional rural-centric approaches to MNH. As populations continue to urbanize, common slum dynamics will challenge conventional strategies for health service delivery. In addition, the COVID-19 pandemic has exposed weaknesses in a system that requires intersectoral collaborations to deliver quality care. CONCLUSION: Programs will need to be iterative and adaptive, reflective of sociodemographic features. Integrating the social determinants of health into evaluations, using participatory human-centered design processes, and innovative public-private partnerships may prove beneficial in slum settings. But a willingness to rethink the roles of all actors within the delivery system overall may be needed most.

5.
Respirology ; 27(SUPPL 1):118, 2022.
Article in English | EMBASE | ID: covidwho-1816644

ABSTRACT

Introduction/Aim: Children with wheeze and asthma present with airway epithelial vulnerabilities, such as impaired responses to viral infection. It is postulated that the in utero environment may contribute to the development of such airway epithelial vulnerabilities, that may predispose children to wheeze and asthma outcomes. To explore developmental mechanisms, further research is required using epithelial samples at birth. Our study asked whether amniotic epithelial samples from placentas show similar viral receptor expression to nasal epithelial cells at birth. We aimed to investigate expression of respiratory viral receptors for human rhinovirus (HRV), respiratory syncytial virus (RSV) and COVID-19-causing coronavirus (SARS-CoV-2) in nasal and amniotic epithelial samples. Methods: Unmatched nasal (n = 20 births) and amniotic (n = 33 newborns) epithelial samples were collected from ORIGINS cohort participants recruited into the AERIAL study. Using purified RNA, receptor expression for HRV (ICAM-1, LDLR, CDHR3), RSV (NCL, TLR4) and SARSCoV- 2 (ACE2, TMPRSS2) was assessed by qPCR. In addition, receptor protein expression was quantified through western blot and localized using immunohistochemistry in amniotic samples only. Results: Nasal epithelial and amniotic samples expressed various receptors for HRV, RSV and SARS-CoV-2 at the gene level in nasal (median(IQR) arbitrary units (AU);ICAM-1: 11.44(63.18);LDLR: 4.00(7.32);CDHR3: 0.40 (1.14);NCL: 2.32(2.18);CX3CR1: 2.17(2.33);TLR4: 2.20 (6.20);TMPRSS2: 1.99(4.85);ACE2: 0.36(0.52) AU) and amnion (ICAM-1: 0.69(2.21);LDLR: 0.39(1.38);CDHR3: 1.0 x 10-4(3.0x10-4);NCL: 1.03(0.55);CX3CR1: 0.12(0.24);TLR4: 0.10(0.13);TMPRSS2: 3.0 x 10-4 (16.0x10-4);ACE2: 0.01(0.02) AU). Amniotic samples also expressed these receptors at the protein level (ICAM-1: 0.03(0.05);LDLR: 0.06(0.03);CDHR3: 0.28(0.15);NCL: 0.96(1.19);CX3CR1: 0.08(0.08);TMPRSS2: 0.09(0.06);ACE2: 0.34(0.92) AU) and expression within the amniotic epithelium was confirmed by immunohistochemistry. Conclusion: Newborn nasal and amniotic epithelial samples expressed receptors for respiratory viruses, HRV, RSV, SARS-CoV-2. These findings warrant further investigation of the clinical significance of receptor expression in relation to prenatal and postnatal exposures, as well as childhood asthma development.

6.
Seminars in Fetal and Neonatal Medicine ; 27(1), 2022.
Article in English | EMBASE | ID: covidwho-1815169
7.
Pakistan Armed Forces Medical Journal ; 72(1):288, 2022.
Article in English | ProQuest Central | ID: covidwho-1812580

ABSTRACT

Objective: To assess outcomes of neonates born to mothers who were COVID-19 positive. Study Design: Prospective observational study. Place and Duration of Study: Secondary and Tertiary Care Hospitals of the Armed Forces, Pakistan, from Apr to Aug 2020. Methodology: We studied 106 pregnant women who tested positive for SARS-CoV-2. Stable asymptomatic newborn babies were kept in SARS-CoV-2 specified incubators, at specially designated areas for observation. Nasopharyngeal swabs were taken at first 24 hours and if negative, babies were handed over to clinically stable mothers who were educated regarding use of facemasks and proper hand washing. Neonates who tested positive for SARS-CoV-2 were evaluated for SARS-CoV-2 again at 48 hours and then every 48-72 hours, until found to be negative. Results: Total 106 women were found to be SARS-CoV-2 positive during the study period. All the women delivered singleton babies. Of the 106 babies, 5 (4.71%) were found to be positive for SARS-CoV-2 at 24 hours and only 1 (0.94%) baby was found to be positive at 48 hours and then tested negative at 7th day. Conclusion: Babies born to SARS-CoV-2 mothers were mostly asymptomatic and there was no increased risk of morbidity or mortality to the neonates suffering from the infection.

8.
Annals of Clinical and Analytical Medicine ; 13(3):314-316, 2022.
Article in English | Web of Science | ID: covidwho-1810949

ABSTRACT

Aim: In this study, we aimed to determine whether the COVID-19 pandemic has a negative effect on quantitative birth data by comparing it with the prepandemic normal period. Material and Methods: In our tertiary center, 4743 births in the March 2019-February 2020 pre-pandemic normal period were quantitatively compared and analyzed with 4522 births in the March 2020- February 2021 pandemic period. Results: In the pandemic period, the number of births decreased by 4.66% compared to the normal period. The mean gestational week was prolonged during the pandemic period. In pre-pandemic and pandemic periods, there was no statistically significant difference between the mode of delivery, cesarean section type, preterm birth, stillbirth, newborn birth weight and Apgar score (<= 7). Discussion: When we evaluated the annual quantitative data of the normal and pandemic periods, it was seen that the COVID-19 pandemic did not have a significant negative effect on births, except for a slight decrease in the birth rate. However, this does not mean that COVID-19 protection and hygiene measures will be abandoned until the pandemic process is over.

9.
Indian Journal of Ophthalmology ; 70(2):702-703, 2022.
Article in English | MEDLINE | ID: covidwho-1810689
10.
Infectious Disease Reports ; 14(2):220, 2022.
Article in English | ProQuest Central | ID: covidwho-1809841

ABSTRACT

Background: Vertical transmission of HIV infection may occur during pregnancy, at childbirth or through breastfeeding. Recommendations on the safety of breastfeeding of HIV-infected women on effective antiretroviral treatment are not univocal among international guidelines (WHO 2010, EACS 2017, DHHS 2017), leaving space for variability at the patient’s level. Methods: We collected clinical, laboratory and outcome data from 13 HIV-infected pregnant women who, between March 2017 and June 2021, elected to breastfeed their children against specific medical advice. All mothers were on antiretroviral therapy with darunavir or raltegravir plus emtricitabine/tenofovir disoproxil and remained HIV-RNA undetectable and >400 cells/mmc CD4+ lymphocytes during pregnancy and breastfeeding. Prophylactic antiretroviral therapy (zidovudine for 4 weeks) was started immediately after birth in all newborns. The mean duration of breastfeeding was 5.4 months. Newborns were tested for HIV-RNA multiple times: at birth, 1, 3, and 6 months after birth, and 1, 3 and 6 months after the end of breastfeeding. Results: None of the infants were infected by HIV. Conclusions: Our experience, gathered in the setting of freedom of choice on the patient’s side, while insufficient to address the eventual safety of breastfeeding in HIV-infected mothers since the represented cohort is numerically irrelevant, supports the extension of the U=U (Undetectable Equals Untransmittable) paradigm to this setting. Since breastfeeding is often requested by women with HIV planning pregnancy, more extensive comparative studies should be performed.

11.
Front Pediatr ; 10:859092, 2022.
Article in English | PubMed | ID: covidwho-1809484

ABSTRACT

INTRODUCTION: Acute respiratory syndrome secondary to SARS-CoV-2 virus infection has been declared a pandemic since December 2019. On neonates, severe presentations are infrequent but possible. Lung ultrasound (LUS) has been shown to be useful in diagnosing lung involvement and following up patients, giving more information, and reducing exposure compared to traditional examination. METHODS: LUS was performed after the diagnosis of SARS-CoV-2 infection with respiratory Real Time Polymerase Chain Reaction RT-PCR with portable equipment protected with a silicone sleeve. If hemodynamic or cardiology consultation was necessary, a prepared complete ultrasound machine was used. Ten regions were explored (anterior superior and inferior, lateral, and posterior superior and inferior, right and left), and a semiquantitative score (LUSS) was calculated. Disease severity was determined with a pediatric modified score. RESULTS: Thirty-eight patients with positive RT-PCR were admitted, 32 (81%) of which underwent LUS. Included patients had heterogenous diagnosis and gestational ages as expected on a referral neonatal intensive care unit (NICU) (median, ICR: 36, 30-38). LUS abnormalities found were B-line interstitial pattern 90%, irregular/interrupted/thick pleural line 88%, compact B-lines 65%, small consolidations (≤5 mm) 34%, and extensive consolidations (≥5 mm) 37%. Consolidations showed posterior predominance (70%). LUSS showed a median difference between levels of disease severity and ventilatory support (Kruskal-Wallis, p = 0.001) and decreased with patient improvement (Wilcoxon signed-rank test p = 0.005). There was a positive correlation between LUSS and FiO(2) needed (Spearman r = 0.72, p = 0.01). The most common recommendation to the attending team was pronation (41%) and increase in positive end expiratory pressure (34%). Five patients with comorbidities died. A significant rank difference of LUSS and FiO(2) needed between survivors and non-survivors was found (Mann-Whitney U-test, p = 0.005). CONCLUSION: LUS patterns found were like the ones described in other series (neonatal and pediatrics). Eighty-eight percent of the studies were performed with handheld affordable equipment. While there is no specific pattern, it varies according to gestational age and baseline diagnosis LUS, which were shown to be useful in assessing lung involvement that correlated with the degree of disease severity and respiratory support.

12.
BMC Pregnancy Childbirth ; 22(1):342, 2022.
Article in English | PubMed | ID: covidwho-1808349

ABSTRACT

BACKGROUND: Mental health has long fallen behind physical health in attention, funding, and action-especially in low- and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs. METHODS: The landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scopus. Titles and s were reviewed before a multidisciplinary team conducted data extraction and analysis on relevant articles. Second, 44 key informant interviews and two focus group discussions were conducted with mental health, MNCAH, humanitarian, nutrition, gender-based violence (GBV), advocacy, and implementation research experts. Finally, reviewers completed a document analysis of relevant mental health policies from 19 countries. RESULTS: The LA identified risk factors for CPMDs, maternal mental health interventions and implementation strategies, and remaining knowledge gaps. Risk factors included social determinants, such as economic or gender inequality, and individual experiences, such as stillbirth. Core components identified in successful perinatal mental health (PMH) interventions at community level included stepped care, detailed context assessments, task-sharing models, and talk therapy;at health facility level, they included pre-service training on mental health, trained and supervised providers, referral and assessment processes, mental health support for providers, provision of respectful care, and linkages with GBV services. Yet, significant gaps remain in understanding how to address CPMDs. CONCLUSION: These findings illuminate an urgent need to provide CPMD prevention and care to women in LMICs. The time is long overdue to take perinatal mental health seriously. Efforts should strive to generate better evidence while implementing successful approaches to help millions of women "suffering in silence."

14.
Australian & New Zealand Journal of Obstetrics & Gynaecology ; : 1, 2022.
Article in English | Academic Search Complete | ID: covidwho-1807001

ABSTRACT

Background Aims Materials and method Results Conclusion Pregnant women are at increased risk for severe COVID‐19 and are a priority group for vaccination. The discrepancy in vaccination rates between pregnant and non‐pregnant cohorts is concerning.This study aimed to assess the perceptions and intentions of pregnant women toward COVID‐19 vaccination and explored vaccine uptake and reasons for vaccine hesitancy.A cross‐sectional exploratory design was performed evaluating pregnant women receiving care in two metropolitan maternity units in Western Australia. The main measurable outcomes included vaccination status, intention to be vaccinated, and reasons for delaying or declining vaccination.In total, 218 women participated. Of these, 122 (56%) had not received either dose of the COVID‐19 vaccine. Sixty (28%) claimed that vaccination was not discussed with them and 33 (15%) reported being dissuaded from vaccination by a healthcare practitioner. Compared to vaccinated women, those who had not accepted vaccination were less likely to have had vaccination discussed by maternity staff, less aware that pregnant women are a priority group, and less aware that pregnancy increased the risk of severe illness. Unvaccinated women were concerned about the side effects of the vaccine for their newborn and their own health, felt there was inadequate information on safety during pregnancy, and felt that a lack of community transmission in Western Australia reduced the necessity to be vaccinated.Vaccine delay and hesitancy is common among pregnant women in Western Australia. Education of healthcare professionals and pregnant women on the recommendation for COVID‐19 vaccination in pregnancy is required. [ FROM AUTHOR] Copyright of Australian & New Zealand Journal of Obstetrics & Gynaecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

15.
The Lancet ; 399(10335):1578-1580, 2022.
Article in English | ProQuest Central | ID: covidwho-1805371

ABSTRACT

A major gap is the absence of recommendations to address the high incidence and prevalence of health and social care needs that can persist for months or even years after birth, even among apparently healthy women.2 Instead, recommendations reflect evidence derived to fit a traditional model of postnatal care that has been described as “not fit for purpose”.6 Maternal recommendations do not tackle longer-term health impacts of prepregnancy and pregnancy complications, despite consequences for future maternal and child health.6 All women would benefit from post-partum assessment of risk for future metabolic and cardiovascular diseases to ensure those who have missed antenatal screening are identified. Given the global burden of chronic maternal morbidity and impacts on infant health,7 with more than 90% of this burden expected in low-income and middle-income countries (LMICs), these are important omissions. Since maternal morbidity can persist beyond the first 6 weeks after birth8 (the standard definition of the postnatal period), contacts with health workers at child health clinics within the first year of birth could be used for treatment of anaemia, screening and treatment of reproductive tract infections and cervical cancer, and provision of family planning counselling and contraception. Structured pelvic floor muscle exercises in early pregnancy for continent women could prevent onset of urinary incontinence in late pregnancy and up to 6 months postnatally, an intervention of potential benefit for millions of women.12 A recommendation that women should be screened for post-partum depression and anxiety with appropriate diagnostic and management services for those who screen positive requires considerable system change and clinical training to implement, with ongoing evaluation of benefit.

17.
Cirugia Cardiovascular ; 2022.
Article in English | EMBASE | ID: covidwho-1800145

ABSTRACT

The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2020 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the most of Spanish centres. This article is complementary to the 2020 cardiovascular surgery annual report, and they are published together. In 2020, seriously damaged by the COVID-19 pandemic related to all sanitary fields, we observe a 14% drop in our congenital activity compared with 2019. Data from the previous 9 years are included, in order to obtain real information related to our activity in these relatively scarce pathologies. In the last nine years, a total of 18526 congenital heart surgeries were performed, accounting for 9.6% of major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81% of them required extracorporeal circulation and 19% not. We highlight the interventions in neonates and adult patients, which represent respectively 19% and 21% of the whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.1% (Aristotle-6.48), and without cardiopulmonary bypass 2.41% (Aristotle-4.81). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allow us to compare ourselves within an international framework, and to organize strategies directed to improve our results.

18.
South African Medical Journal ; 112(4):279-287, 2022.
Article in English | EMBASE | ID: covidwho-1798764

ABSTRACT

Background. Major causes of under-5 child deaths in South Africa (SA) are well recognised, and child mortality rates are falling. The focus of child health is therefore shifting from survival to disease prevention and thriving, but local data on the non-fatal disease burden are limited. Furthermore, COVID-19 has affected children's health and wellbeing, both directly and indirectly. Objectives. To describe the pattern of disease on admission of children at different levels of care, and assess whether this has been affected by COVID-19. Methods. Retrospective reviews of children's admission and discharge registers were conducted for all general hospitals in iLembe and uMgungundlovu districts in KwaZulu-Natal Province, SA, from January 2018 to September 2020. The Global Burden of Disease framework was adapted to create a data capture sheet with four broad diagnostic categories and 37 specific cause categories. Monthly admission numbers were recorded per cause category, and basic descriptive analysis was completed in Microsoft Excel. Results. Overall, 36 288 admissions were recorded across 18 hospital wards, 32.0% at district, 49.8% at regional and 18.2% at tertiary level. Communicable diseases, perinatal conditions and nutritional deficiencies (CPNs) accounted for 37.4% of admissions, non-communicable diseases (NCDs) for 43.5% and injuries for 17.1%. The distribution of broad diagnostic categories varied across levels of care, with CPNs being more common at district level and NCDs more common at regional and tertiary levels. Unintentional injuries represented the most common cause category (16.6%), ahead of lower respiratory tract infections (16.1%), neurological conditions (13.6%) and diarrhoeal disease (8.4%). The start of the local COVID-19 outbreak coincided with a 43.1% decline in the mean number of monthly admissions. Admissions due to neonatal conditions and intentional injuries remained constant during the COVID-19 outbreak, while those due to other disease groups (particularly respiratory infections) declined. Conclusions. Our study confirms previous concerns around a high burden of childhood injuries in our context. Continued efforts are needed to prevent and treat traditional neonatal and childhood illnesses. Concurrently, the management of NCDs should be prioritised, and evidence-based strategies are sorely needed to address the high injury burden in SA.

19.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 2):64, 2022.
Article in English | EMBASE | ID: covidwho-1798720

ABSTRACT

Introduction: Corona Virus Disease 2019 (COVID-19) is an infectious disease caused by SARS-COV-2. First identified in December 19 in Wuhan, China On March 12,2020, WHO announced corona virus outbreak as pandemic. Till September 14, in India >48,50,887 confirmed cases, >9,90,502 active cases, >37,79,927 recovered cases reported. In karnataka 4,59,445 confirmed, 99,203 active, 3,52,958 recovered, 7265 death reported. Aim: To study maternal and fetal outcome in COVID-19 positive pregnant patients admitted in MIMS, Mandya (from 1s t wave to 3r d wave). Materials and methods: This is a prospective study conducted in the Department of OBG, MIMS, Mandya, of a study period of 15 months from June 2020 to November 2021. All cases of confirmed COVID- 19 patients admitted in the Department of OBG are included in the study period ,using medical case records, OT registered - age ,parity ,mode of presentation, investigations, management and outcome of delivery were observed among the COVID-19 patients Results: Out of 216 admissions in 1 s t wave 139 cases delivered and in these 84 (60.4%) vaginal deliveries and 55 (39.5%) c-section ,among which 1 VBAC, 1 breech, 1 vaccum, 3 PPH, 2 IUD, 1 maternal death and 40 NICU admissions and among which 4 babies were positive and 1 neonatal death. During 2nd wave, out of 355 admissions 168 delivered and in these 98(58.3%) vaginal deliveries and 70 (41.6%) c-section, among them 8 vaccum deliveries, 4 IUD, 1 breech, 1 VBAC, 4 PPH , 1 MRP, 5 MVA and 1 ectopic pregnancy and 10 maternal death and 15 NICU admissions among them 8 COVID-19 positive babies and 1 neonatal death. In the emerge of 3r d wave 1 case we have documented and it is LSCS on 2/11/21 baby COVID-19 negative. Conclusion: Compared to 1st wave and 2nd wave there is increase in disease severity and number of cases. Burden of disease has drastically increased. Early diagnosis and prompt treatment can reduce the mortality rate in COVID-19 patients.

20.
American Journal of Obstetrics and Gynecology ; 2022.
Article in English | ScienceDirect | ID: covidwho-1797270

ABSTRACT

Background The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes has been reported;however, a detailed understanding of the effect of maternal positivity, delivery mode and perinatal practices on fetal and neonatal outcomes is urgently needed. Objective To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of the mode of delivery, breastfeeding and early neonatal care practices on the risk of mother-to-child transmission. Study Design In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-exposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding and hospital neonatal care practices. Results A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean section (52.8% compared to 38.5% for those without COVID-19 diagnosis, p<0.01) and pregnancy related complications such as hypertensive disorders of pregnancy and fetal distress, all with p-value < 0.001, compared to women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (p ≤0.001) and lower neonatal weight (p ≤0.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in-utero exposure was significantly correlated to the risk of the neonate testing positive (OR, 4.5;95% CI 2.2-9.4 for length of in-utero exposure > 14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean section was a risk factor for them testing positive for COVID-19 (OR 2.4, 95% CI 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of Intensive Care Unit admission, fever, gastrointestinal and respiratory symptoms and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis, as well as hospital neonatal care practices including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. Conclusions In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean section was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother to child skin-to-skin contact, rooming-in and direct breastfeeding did not represent risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

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