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1.
New Armenian Medical Journal ; 16(2):25-32, 2022.
Article in English | EMBASE | ID: covidwho-2067787

ABSTRACT

Objectives: to assess the effect-related inflammatory and coagulation biomarkers in pregnancy and their connection with the coronavirus disease of 2019 (COVID-19). Method(s): A prospective case-control study was carried out among normal third-trimester pregnant women admitted to the labor room of Dr. Soetomo General Academic Hospital between January until June 2021. Two classified groups of patients were established in accordance with the result of the RT-PCR test. Demographic, clinical and laboratory results data of the two groups were collected and compared. Result(s): Platelet-to-lymphocyte ratio (PLR) was shown to be the only significant biomarkers found in the expectant with COVID-19, which was 35.8% higher compared to the ones free of COVID-19 [212.25 (157.57-269.37) vs 156.29 (128.55-195.3), p=0.048]. Logistic regression analysis of PLR between groups showed that the level of PLR was an independent factor in pregnant women with COVID-19 (OR 4.483, 95%CI 1.262-15.926). The ROC analysis showed that the PLR cut-off among the expectant was 171.335, with both sensitivity and specificity were 66.7% (p=0.021). The result shows no significant differences in leukocyte count, absolute neutrophils - lymphocyte count and percentage, neutrophil-to-lymphocyte ratio (NLR) and D-Dimer level between pregnant women infected with COVID-19 and free of the virus (p>0.05). Conclusion(s): Intriguingly, physiological adaptation during the course of the third trimester of pregnancy found no difference in most inflammation and coagulation markers, both in the condition of infected COVID-19 or not. The evidence from this single-centre study supports the viewpoint that elevated PLR was associated with independent biomarkers and thereby might be helpful to detect expectant with COVID-19. Copyright © 2022, Yerevan State Medical University. All rights reserved.

2.
Journal of Acute Disease ; 11(4):120-126, 2022.
Article in English | EMBASE | ID: covidwho-2066823

ABSTRACT

Unbalanced magnesium levels in the body, like other minerals, are a factor that is important in the severity and mortality of COVID-19. This study was designed to investigate the relationship between serum magnesium levels and clinical outcomes in COVID-19 patients. In this systematic review, a comprehensive search was performed in PubMed, Scopus, and Web of Science databases until September 2021 by using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2, coronavirus disease, SARS- COV-infection 2, SARS-COV-2, COVID 19, and magnesium. End-Note X7 software was used to manage the studies. Articles that evaluated effect of magnesium on COVID-19 were included in the analysis. After reviewing several articles,12 studies were finally included in the ultimate analysis. The studies show that hypomagnesemia and hypermagnesemia are both factors that increase mortality in patients with COVID-19, even in one study, hypomagnesemia is the cause of doubling thedeaths in COVID-19 patients. Some studies have also found a negative correlation between magnesium deficiency and infectionseverity, while some others have reported no correlation between magnesium level and disease severity. According to the important role of magnesium in the body and its involvement in many physiological reactions, as well as differences in physical and physiological conditions of COVID-19 patients, in addition to the need for studies with larger sample sizes, monitoring and maintaining normal serum magnesium levels during the disease seems necessary as a therapeutic target, especially in patients admitted to the intensive care unit.

3.
Open Access Macedonian Journal of Medical Sciences ; 10:1914-1921, 2022.
Article in English | EMBASE | ID: covidwho-2066688

ABSTRACT

BACKGROUND: The fluctuating COVID-19 cases among the pregnant women’s population encountered increased of cases and maternal mortality. AIM: This research aimed to describe the case of maternal deaths caused by COVID-19. CASE REPORT: We present nine serial cases of maternal death caused by COVID-19 who were admitted to Dr. Soetomo General Academic Hospital for 14 days in June. We found 32 positive COVID-19 obstetric cases and reported nine maternal deaths with a fatality rate of up to 28%. Seven of nine patients had reverse transcription-polymerase chain reaction–confirmed SARS-CoV-2 infection, while two had a positive antigen swab. Half of the patients ≥35 years old, and five of nine patients had Class I obesity as preexisting comorbidity. This study reported the death of pregnant woman at their 2nd trimester and 3rd trimester presenting infected by severe COVID-19. The usual symptoms are dyspnea, cough, fever, and decreased consciousness. The result of chest X-ray examination among eight patients showed bilateral pneumonia. Most of cases were referrals from a secondary hospital due to overload hospital capacity. Three patients were directly transferred to the tertiary hospital without receiving initial treatment. Eight of 9 patients (88.9%) were transferred to intensive care unit and intubated due to low oxygen saturation. CONCLUSION: In conclusion, the limited hospital facility and lack of intensive care capacity for obstetric cases during the second wave of the COVID-19 pandemic may enhance the probability of mortality and morbidity in pregnant women infected by COVID-19.

4.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P269, 2022.
Article in English | EMBASE | ID: covidwho-2064421

ABSTRACT

Introduction: The global pandemic caused by the novel coronavirus (SARS-CoV-2), commonly known as COVID-19, has had profound effects at every level of society. Other known viral illnesses during pregnancy, such as cytomegalovirus, can affect the developing fetus and cause congenital hearing loss. The long-term effects of COVID-19, including the risk of congenital hearing loss, are not currently established. Method(s): A retrospective cohort study was performed at a quaternary care facility. Sixty-four consecutive patients with a COVID-19 infection during pregnancy were identified. Charts were reviewed for trimester of positive COVID-19 test, maternal and neonatal comorbidities, symptomatology, vaccination status, and results of newborn screening and follow-up hearing testing, if performed. Result(s): Sixty-four women with positive COVID-19 test during pregnancy (6 in second trimester, 59 in third trimester) were identified. Most (n=54, 84.4%) patients were asymptomatic at time of positive test and 29.7% (n=19) had received at least 1 dose of a COVID-19 vaccine. Newborn hearing screening was performed in 58 patients (90.6%). Failed initial screening occurred in 3 (5.2%) right ears and 4 (7.0%) left ears. Two patients passed on repeat screening, and the remaining 1 patient was found to have a mild conductive hearing loss in the right and middle ear dysfunction on the left. Conclusion(s): This study demonstrates no significant increased risk of congenital hearing loss in prenatal COVID-19 infection. Additional investigation into timing of infection and effect of vaccination status will be performed to provide guidance to women navigating pregnancy during the pandemic.

5.
Chest ; 162(4):A828, 2022.
Article in English | EMBASE | ID: covidwho-2060697

ABSTRACT

SESSION TITLE: Close Critical Care Calls SESSION TYPE: Case Reports PRESENTED ON: 10/18/2022 11:15 am - 12:15 pm INTRODUCTION: Heparin is the preferred anticoagulant for use in pregnancy while on extracorporeal membrane oxygenation (ECMO) (1). Alternatives to heparin in this patient population are not well studied as heparin-induced thrombocytopenia is rare in pregnancy. Parenteral non-heparin anticoagulants available in the United States include the direct thrombin inhibitors argatroban and bivalirudin, both of which are utilized in ECMO. Guidelines recommend avoidance of these agents in pregnancy if at all possible (2). Whereas case reports support the safe use of argatroban in pregnancy, to our knowledge, there are no known documented reports of bivalirudin use in this patient population (3). Here we describe the successful use of bivalirudin during pregnancy. CASE PRESENTATION: A 25 year old G2P1 was transferred to our institution at 28 weeks gestation for further management of acute hypoxic respiratory failure secondary to COVID-19. On hospital day 2 the patient was urgently placed on venovenous (VV) ECMO for refractory hypoxemia, high dead space with acidosis, and the inability to provide adequate gas exchange and lung protection with mechanical ventilation alone. Following ECMO cannulation with a 25f cannula in the right femoral vein and a 21f cannula in the right internal jugular vein, she was anticoagulated with heparin at a rate of 12 units/kg/hr. This was titrated to target a PTT goal of 60-80 seconds. On ECMO day 2, the TEG demonstrated a markedly hypocoagulable state, and the heparin nomogram called for increasing heparin dosing based on PTT. Given the already high dose of heparin that the patient was on (32.9 units/kg/hr), the decision was made to switch from heparin to bivalirudin to prevent over anticoagulation and reduce bleeding risk. Bivalirudin was titrated to a goal PTT of 50-60 seconds, with an initial rate of 0.15 mg/kg/hr (dose range 0.15-0.22 mg/kg/hr). Therapy was continued and on ECMO day 11, at 29w6d the patient delivered via cesarean section. Bivalirudin was discontinued 2.5 hours prior to the surgical procedure which resulted with no fetal bleeding complications. The patient was decannulated from ECMO on day 20 and was later discharged from the hospital. The newborn is developing well and meeting age adjusted milestones. DISCUSSION: Bivalirudin was selected based on institutional experience and the pharmacokinetic properties of the drug (half-life of 25 minutes) as we considered a situation where an emergent delivery may be indicated. Bivalirudin successfully prevented clotting of the circuit with no maternal or fetal bleeding complications during its use. CONCLUSIONS: Our case report describes a multidisciplinary approach to managing a pregnant patient on ECMO requiring anticoagulation using an alternative medication to heparin. This is the first documented use of bivalirudin in pregnancy. Reference #1: ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Extracorporeal Life Support Organization, Version 1.4 August 2017. Ann Arbor, MI, USA www.elso.org. Reference #2: Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(Suppl): e691S–736S Reference #3: Young SK, Al-Mondhiry HA, Vaida SJ, et al. Successful use of argatroban during the third trimester of pregnancy: case report and review of the literature. Pharmacotherapy 2008;28: 1531–6. DISCLOSURES: No relevant relationships by Jacqueline Finger No relevant relationships by Caitlin Gluck No relevant relationships by Cameron Hypes No relevant relationships by John Rathbun

6.
Journal of Clinical and Diagnostic Research ; 16(9):QD04-QD05, 2022.
Article in English | EMBASE | ID: covidwho-2044191

ABSTRACT

Recent studies have reported that Coronavirus Disease 2019 (COVID-19) can be the cause of peripheral facial paralysis and neurological symptoms may be the only manifestation of the disease. Hereby, the authors report an interesting case of a pregnant COVID-19 positive female with Bell's palsy, in third trimester of pregnancy. A 33-year-old female, G3P0L0A2, presented with left-side deviation of angle of mouth, excessive lacrimation and redness of right eye for the past three days. She had involuntary drooling on right and left side labial commissural deviation, absence of forehead frowning, inability to close her right eye (positive Bell’s phenomena), and ipsilateral lagophthalmos. No lesions were seen on the external ear and otoscopy was normal. She was confirmed to have right-sided facial nerve palsy. She had an uneventful course of pregnancy till term and underwent caesarean section at 40 weeks, in view of foetal distress. Pregnancy and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, both are immunocompromised state, and hence could be a risk factor for Bell’s palsy. But larger studies with more cases are required to prove the causal association.

7.
Clinical Epidemiology and Global Health ; 17, 2022.
Article in English | EMBASE | ID: covidwho-2041611

ABSTRACT

COVID pandemic has massively hit every nook of the world. Millions of people were infected and lost their lives to the deadly pandemic. This novel virus destroyed the essential healthcare service globally. Mass vaccination is the only option to halt the virus transmission. This study aimed to estimate the acceptance of the COVID vaccine among pregnant women and breastfeeding mothers. Method: We followed Cochrane collaboration guidelines and the PRISMA reporting system. Studies were identified through a systematic search of indexed articles in Medline (PubMed), Clinical key, Google Scholar, Cochrane Library, and CINAHL databases until March 10, 2022, 26,995 articles were identified in the initial search and 24 articles were included in the review. Result: Twenty four studies comprise 22,947 pregnant and 11,022 breastfeeding women. About 54% of pregnant women and 59% of breastfeeding mothers intended to take the COVID vaccination. Among the pregnant mothers, 21% with comorbidities, 14% in the first trimester, 34% in the second trimester, and 51% in the third trimester were willing to take the COVID vaccine. Risks of infections and comorbidities were the reasons for acceptance of the COVID vaccine in pregnant women. Similarly, adverse effects and safety concerns were top indicators for the rejection of the COVID vaccine. Conclusion: The acceptance of COVID vaccination among pregnant women and breastfeeding mothers are not satisfactory. Therefore, timely guidance would help to address the negative perceptions of vaccines among pregnant women.

8.
Voprosy Ginekologii, Akusherstva i Perinatologii ; 21(3):28-35, 2022.
Article in Russian | EMBASE | ID: covidwho-2033519

ABSTRACT

Objective. To assess the effectiveness of different preventive measures for novel coronavirus infection in pregnant women. Patients and Methods. This study included 125 pregnant women hospitalized with moderate to severe laboratory-confirmed SARS-CoV-2 infection between September and November 2021 (the fourth pandemic wave), and 175 pregnant women who were not infected with COVID-19 during the same period. All women in these two groups were comparable for gestational age (II–III trimesters, 24–39 weeks), age (20–40 years), social status, parity, body mass index, and had no known COVID-19 risk factors. Results. Our findings revealed that vaccination 3-5 months before pregnancy (OR = 4.12;95% CI 1.28–13.27;χ2 = 0.022), inconsistent use and/or non-timely replacement of face masks (OR = 5.71;95% CI 2.83–11.51) were associated with the increased risk of COVID-19 in the second and third trimesters of gestation. It was showed that systematic (once in the morning at 24–48-hour intervals) intranasal administration of recombinant interferon alpha-2b (IFN-α;Grippferon) as compared with a single application after exposure to COVID-19 reduced the disease incidence rate and there was no evident risk of illness (OR = 0.08;95% CI 0.05–0.14;19.2% vs 74,3%, p < 0.001). This can be explained by the fact that women were mostly infected in unpredictable conditions (e.g., 29.2% of pregnant women were infected from family members, 23.9% had unknown source of exposure). The use of umifenovir, not currently authorised for the medication-assisted prevention of COVID-19 in pregnant women, and rectal administration of IFN-α suppositories did not reduce the disease incidence rate. Rectal use of IFN-α suppositories by pregnant women off-label increased the incidence (32.0 vs 15.4%, p = 0.001) and risk of developing novel coronavirus infection (OR = 2.58;95% CI 1.48–4.50). Conclusion. There is a need to improve awareness among pregnant women about the mandatory and timely vaccination against COVID-19 during pregnancy and the importance of strict adherence to wearing face masks. Increased efforts should be made to monitor and inform pregnant women about the use of only authorised medication-assisted preventive measures of SARS-CoV-2 infection, such as intranasal administration of recombinant IFN α-2b (Grippferon). During the epidemic rise in COVID-19 cases, the systematic intranasal administration of recombinant interferon-based medication Grippferon (once in the morning at 24–48-hour intervals) is recommended for pregnant women.

9.
Annals of the Rheumatic Diseases ; 81:1700, 2022.
Article in English | EMBASE | ID: covidwho-2009137

ABSTRACT

Background: Due to the SARS-CoV-2 pandemic, an increase in stress, anxiety, and depression has been seen, as well as greater use of substances and a decrease in prenatal care in pregnant women. (1) Women of childbearing age with autoimmune rheumatic diseases (ARDs) experience greater psychological stress, which can negatively influence behavior. (2) Objectives: This study aims to compare changes in prenatal laboratory and ultrasound tests by trimester, as well as the detection of anxiety and depression in pregnant women with ARDs due to the SARS CoV-2 pandemic. Methods: This study was carried out on pregnant patients with ARDs from the Pregnancy and Rheumatic Diseases clinic of the rheumatology department of the University Hospital 'Dr. José Eleuterio González' during the period from February 2018 to August 2021. Two standardized evaluations of anxiety and depression were carried out using the Inventory of Trait and State Anxiety (IDARE) and the Edinburgh Postpartum Depression Scale (EPDS) respectively in the third trimester of pregnancy. Maternal report of alcohol consumption during any trimester of pregnancy, as well as adherence to routine laboratory studies such as structural ultrasound and gesta-tional diabetes screening, was addressed. Positive COVID-19 nasopharynx PCR results were evaluated during pregnancy beginning in the pandemic period (March 2020). The pre-pandemic recruited group was compared with the pandemic group. The comparison of the groups was carried out using the Chi-Square and Fisher tests. A significant value of p < 0.05 was considered. Statistical analysis was performed using the IBM SPSS v.25 program. Results: 50 pregnant patients with ARDs were recruited, of which 24 were included in the pre-pandemic group and 26 in the pandemic group. Compared with the pre-pandemic group, pregnant women recruited during the pandemic had a statistically signifcant higher positivity for state anxiety (p=0.023), likewise trait anxiety, depression, and suicidal ideation were detected more frequently, but the difference was not statistically signifcant, a higher rate of adherence to laboratory and cabinet studies was found, being signifcant for laboratories performed in the 1st and 2nd trimesters (0.005 and 0.025 respectively). See Table 1. Conclusion: A higher frequency of positivity for state anxiety was demonstrated in pregnant women with ARDs recruited during the pandemic, as well as higher trait anxiety, depression, and suicidal ideation, although this increase was not statistically signifcant. On the other hand, concern about the pandemic and health status could positively influence better adherence to screening and routine studies during pregnancy.

10.
Journal of Obstetrics and Gynaecology Canada ; 44(5):607-608, 2022.
Article in English | EMBASE | ID: covidwho-2004257

ABSTRACT

Objectives: Evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Methods: Ontario population-based retrospective cohort between December 14, 2020 and September 30, 2021 using linkage of provincial birth registry and COVID-19 immunization databases. Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI), adjusted for temporal, socio-demographic, and clinical factors using propensity scores. Obstetric (postpartum hemorrhage, chorioamnionitis, cesarean birth) and newborn (NICU admission and 5-minute Apgar<7) outcomes were compared for those who received ≥1 dose of COVID-19 vaccine during pregnancy with 2 unexposed groups—Group 1: individuals vaccinated postpartum, Group 2: never vaccinated. Results: Among 97 590 individuals, 22 660 (23%) received ≥1 dose of vaccine during pregnancy (64% received dose 1 in 3rd trimester). Compared with those vaccinated postpartum, we found no increased risks of postpartum hemorrhage (aRR 0.91, 95% CI 0.82–1.02);chorioamnionitis (aRR 0.92, 95% CI 0.70–1.21);or cesarean (aRR 0.92, 95% CI 0.89–0.95) following COVID-19 vaccination, nor any increased risk of NICU admission or 5-minute Apgar <7. All findings were similar when compared with individuals who did not receive COVID-19 vaccination at any point. We did not observe any difference according to vaccine product, number of doses received during pregnancy, or trimester of dose 1. Conclusions: As of late 2021, there is limited evidence from comparative studies in large populations on outcomes following COVID-19 vaccination during pregnancy. Our study of births up to September 30, 2021 did not identify any increased adverse peripartum outcomes associated with later pregnancy COVID-19 vaccination. Once more individuals vaccinated earlier in pregnancy deliver, we will report on other important obstetric and perinatal outcomes. Keywords: COVID-19 vaccine;pregnancy;epidemiology

11.
International Journal of Obstetric Anesthesia ; 50:93, 2022.
Article in English | EMBASE | ID: covidwho-1996269

ABSTRACT

Introduction: Cardiac disease is the leading cause of maternal death in the UK [1].We present the case of awoman with late intrauterine fetal death (IUFD) and intrapartum cardiac ischaemia. A family history of limb girdle muscular dystrophy (LGMD) may be relevant. Case Report: A 23-year-old nulliparous woman at 39 weeks of gestation presented with reduced fetal movements and IUFD was confirmed. She had no medical history, and despite two first degree relatives with LGMD, she was asymptomatic and had not been tested. Uterine contractions started and epidural analgesia was initiated. Shortly thereafter, the woman was found to be bradycardic at 35– 40 beats/min. All other observations were normal and she was asymptomatic with no detectable sensory or motor block. A 12 -lead ECG showed inferior T-wave inversion and serial troponins were markedly elevated. Caesarean section (CS) under general anaesthesia was performed at maternal request and was uneventful. Postpartum echocardiogram demonstrated a dilated left atrium, left ventricular akinesis and an ejection fraction of 45–50%. The next day the woman developed chest pain and desaturated. CTPA and CT coronary angiogram were normal. Oxygenation improved and other than sporadic chest heaviness she remained well and was discharged 4 days post CS. Cardiology follow-up did not occur due to a communication breakdown. Post-mortem of the fetus found no cause for the IUFD and no features of LGMD. Thewoman suffered a miscarriage four months after this but delivered a healthy baby at elective CS two years later. During the latter pregnancy cardiology input from a tertiary centrewas requested but did not occur due to the COVID-19 pandemic. An echocardiogram in the third trimester was normal and the woman has been well since. Discussion: Troponin rise is abnormal in pregnancy and requires investigation. IUFD in itself can lead to sequelae requiring a low threshold for investigation. The family history in this case is autosomal dominant type 1B LGMD, associated with cardiomyopathy and arrhythmias [2]. The woman has declined testing and the cause for the peripartum cardiac disease remains unknown. The recovery and recent uneventful pregnancy suggest Takotsubo’s cardiomyopathy or coronary vasospasm as additional possible diagnoses. This case also underlines the importance in sensitive communication in cases of IUFD to ensure women are investigated and not lost to follow-up.

12.
Obstetrics, Gynecology and Reproduction ; 16(1):81-89, 2022.
Article in Russian | EMBASE | ID: covidwho-1979782

ABSTRACT

Thrombosis of the umbilical cord vessels is a rare complication of pregnancy, combined with a high level of perinatal morbidity and mortality. Anomalies of vascular attachment (velamentous attachment), pathology of the umbilical cord (hyperspiralization, short or long umbilical cord), intrauterine infections, maternal diabetes mellitus and preeclampsia as well as meconium found in the amniotic fluid are among the risk factors of developing thrombosis in the umbilical cord vessels. Here we present two clinical observations of umbilical vein thrombosis at full-term pregnancy. In both cases, during pregnancy and childbirth, no signs of umbilical cord pathology were found according to cardiotocography and Doppler ultrasound;despite this, the children were born in hypoxic state. Both newborns were transferred to the second stage of treatment due to suspected intrauterine pneumonia. Velamentous attachment, intrauterine infections as well as meconium found in the amniotic fluid were the risk factors of developing umbilical vein thrombosis described in case 1 and case 2, respectively. During pregnancy, both female patients suffered from clinically confirmed novel coronavirus infection (COVID-19) and contacted patients with COVID-19 in the third trimester of gestation. It is likely that endothelial damage caused by the novel coronavirus SARS-CoV-2 was one of the risk factors for the development of umbilical vein thrombosis, but this issue requires to be further explored.

13.
Medicina (Brazil) ; 55(2), 2022.
Article in English | EMBASE | ID: covidwho-1979700

ABSTRACT

Objectives: To describe the epidemiological profile of pregnant and postpartum women with severe acute respiratory syndrome (SARS) caused by severe acute respiratory syndrome corona virus (SARS-CoV-2) in Amazonas. Methods: This quantitative, cross-sectional study extracted data from pregnant and postpartum women residing in the state of Amazonas who were notified in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and had a confirmed diagnosis of SARS during corona virus disease (COVID-19) from February 16, 2020, to December 31, 2021. Sociodemographic data and clinical characteristics, such as admission to the intensive care unit, use of ventilatory support, use of antiviral therapy, and outcomes were collected. Data were analyzed and presented with relative frequencies. Results and Discussion: During the study period, Amazonas recorded 828 cases of SARS caused by SARS-CoV-2 in pregnant and postpartum women. Of these, 58 patients remained in progress with no outcomes. Most women were aged between 20 and 34 years, educated to high school level, lived in urban areas, and were in the third trimester of pregnancy at the time of diagnosis. Predominant clinical manifestation was cough, respiratory distress, fever, and dyspnea. The most frequent comorbidities were asthma, chronic cardiovascular diseases, diabetes mellitus, and obesity. 19.7% of pregnant and postpartum women were admitted to the intensive care unit (ICU). Of these, 70.6% needed invasive mechanical ventilation, 80.2% antiviral therapy, and 79 patients (10.3%) died. Conclusion: This study characterized the epidemiological profile of pregnant and postpartum women with SARS caused by SARS-CoV-2 in Amazonas and showed a high death rate during the study period, especially in the capital.

14.
BJOG: An International Journal of Obstetrics and Gynaecology ; 129:148, 2022.
Article in English | EMBASE | ID: covidwho-1956659

ABSTRACT

Objectives: Dengue is a vector borne infectious disease, endemic in the tropical regions, that may be associated with significant maternal and fetal morbidity and mortality. However, literature is sparse on the rate and factors associated with stillbirths in women suffering from dengue. In this study, we aimed to explore the frequency of stillbirths in dengue infection in pregnancy during the COVID pandemic. We also studied the effect of severity of the disease on fetal morbidity and mortality. Design: Retrospective review of registers and case records Method: We reviewed the data of pregnant women admitted for dengue in the Obstetrics & Gynecology department in a tertiary care hospital of Northern India between September and December, 2021. Data collected included the age, parity, gestation at admission, severity of the maternal disease, other comorbities, maternal outcome, obstetrical outcome during the dengue disease and fetal outcome. Results: Twenty three pregnant women were admitted to the department between September and December 2021. The average age of the women was 26+/-5 years. Half of these women were primigravidas (12 out of 25). Most women were in the third trimester, while one woman each presented in second trimester and the postpartum period. Eleven mothers presented with severe dengue, 11 had dengue with warning signs and only one woman had dengue without warning signs. There were 7 maternal deaths. Three mothers died undelivered. There were 10 stillbirths of 20 deliveries and 22 babies. Majority of the woman delivered preterm. There were 2 twin deliveries. Of the babies who delivered at term, most were liveborn(6 of 7). The stillbirth rate was higher in the severe dengue group, dengue with warning signs and dengue without warning signs were 60%, 36% and nil respectively. Conclusions: The stillbirth rate is high in women with dengue in pregnancy, especially in the third trimester. The chances of stillbirth escalate with the severity of dengue. Maternal mortality is high in women admitted with dengue in pregnancy. Public health strategies to prevent dengue should be strengthened to avoid high stillbirth rates and maternal mortality. The data is limited by the retrospective design and skewed as women with only severe form of dengue would have been admitted.

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927756

ABSTRACT

Introduction: Antisynthetase syndrome is a rare autoimmune disease. Clinical characteristics include interstitial lung disease (ILD), myositis, Raynaud's phenomenon, mechanic's hands, and arthritis. The condition is characterized by antibodies targeting an aminoacyl transfer RNA synthetase. Compared to other inflammatory myopathies, there is a higher prevalence and increased severity of ILD. Case Report: A 34-year-old female with a history of polycystic ovarian syndrome presented with progressive dyspnea during her third trimester of pregnancy. Initial computed tomography angiography (CTA) chest showed widespread multifocal and multilobar ground-glass opacities and nodular areas of consolidation. COVID-19 testing was negative. She went into preterm labor and delivered her baby at 30 weeks. About 10 days after delivery, her respiratory symptoms worsened. Transbronchoscopic lung biopsy was nondiagnostic. She subsequently underwent surgical lung biopsy which revealed organizing pneumonia and interstitial fibrosis. Laboratory studies revealed a high Jo-1 antibody of 1033U (normal less than 20U), positive ANA, creatine kinase 186 U/L, as well as aldolase 22.3 U/L leading to a diagnosis of antisynthetase syndrome. The patient continued to be dyspneic and developed increased oxygen requirements. Treatment was initiated with 1 dose of 125 mg of methylprednisolone followed by 1 g of methylprednisolone for 3 days, after which she was continued on oral prednisone. She was additionally started on 250 mg of mycophenolate mofetil. Despite these therapies she continued to have increased oxygen requirements, eventually requiring noninvasive positive pressure ventilation and ultimately intubation with mechanical ventilation. Chest x-ray demonstrated worsening bilateral patchy infiltrates. Given her clinical deterioration, she underwent 5 treatments of plasma exchange after which she received 1000 mg of rituximab. The patient improved on this therapy and was able to be extubated after 3 days. Her oxygen requirements subsequently decreased and she was discharged on a prednisone taper;mycophenolate with a goal dose of 1000 mg twice daily;and plan for continued rituximab infusions. At 2 months follow-up, the patient was doing well without the need for supplemental oxygen. Discussion: This case demonstrates a rare disease in a peripartum patient. A high suspicion for antisynthetase syndrome is required to initiate autoimmune testing, particularly since there can be ILD predominant phenotypes without significant evidence of a myositis. Treatment is not standardized but typically consists of corticosteroids and other immunosuppressive agents. In severe cases of antisynthetase syndrome that are refractory to initial corticosteroid therapy, therapeutic plasma exchange can be performed.

16.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927734

ABSTRACT

Introduction: COVID-19 magnified the importance of health systems' readiness for scarce resource allocation during times of potential crisis-related shortages. Understanding how ethical values of laypeople differ from that of healthcare workers (HCW) is crucial to ensure a widely accepted policy. We intended to better understand how the values of laypeople, licensed independent practitioners (LIP), and non-LIP HCW align and differ regarding scarce resource allocation, particularly on exemptions and adjustments to ICU triage decisions, which could otherwise undermine public trust if not appropriately understood. Methods: Data were collected from a web-based national survey aimed at understanding the effects of the COVID-19 pandemic. We analyzed 1934 adult respondents, including 1353 lay-people, 200 LIPs and 381 non-LIP HCW. Respondents' values were assessed by 9- point Likert scale, (1= should be less likely to receive, 5 = should not influence, 9 = should be much more likely to receive ICU care), comparing responses using Kruskal-Wallis tests. Results: All groups equally prioritized ICU care for pregnant persons in first trimester. Agreement on prioritization was stronger for 3rd trimester pregnancy, where LIP rated agreement higher than other HCW (P=0.020). Laypeople favored a principle of reciprocity, prioritizing front-line health workers more than either LIP or other HCW (8 vs 7 vs 6, respectively, P<0.001). Laypersons rated their trust that health systems would apply SRA policy in a fair and consistent way slightly lower compared to either LIP or other HCW, but this was not significant (6 vs 7 vs 7, P=0.5). All groups felt similarly anxious and worried when thinking about policies like this (median score 7 where 9 = “I feel very anxious when thinking about this”, P=0.9). Discussion/Conclusions: In creating policies for scarce resource allocation, it is important to consider the nuanced values of all groups affected by these policies. In particular, while concern may exist that systems using non-healthrelated factors in treatment decisions may be less agreeable, we found similar levels of agreement when prioritizing on two key groups: pregnancy and at-risk health worker status. While our survey showed all groups lean towards trusting the healthcare system to fairly allocate resources, the range of responses and the consistent anxiety surrounding these policies emphasizes the importance of trying to understand and accommodate the priorities of affected groups as able. (Table Presented).

17.
American Journal of Reproductive Immunology ; 87(SUPPL 1):91, 2022.
Article in English | EMBASE | ID: covidwho-1927549

ABSTRACT

Primary versus recurrent herpes simplex virus 1 or 2 (HSV-1 or HSV- 2) infection during pregnancy carries a higher risk of neonatal herpes suggesting that placental transfer of antibodies protects against transmission and infection. Murine and clinical studies demonstrate that antibody-dependent cellular cytotoxicity (ADCC) provides greater protection than neutralizing antibodies (nAbs) against disseminated neonatal disease. To quantify the relative transfer of HSV-specific Abs with different functions and targets and whether SARS-CoV-2 coinfection modified transfer, we conducted a prospective cohort study of mother-infant dyads prior to and during COVID-19. Total and HSV lysate, glycoprotein D (gD) and glycoprotein B (gB)- specific IgG, IgG1 and IgG3, nAbs, and ADCC were quantified in paired 3rd trimester maternal and cord blood. Transfer ratios (TR) were defined as cord: maternal Ab levels. IgG1 and IgG3 subclass and gD or gB-specific Abs were isolated by column purification and glycan profiles were assessed using mass spectrometry. The pre-COVID study population included 21 term and 15 preterm dyads who were HSV-1 (± HSV-2) seropositive (+) enrolled between 2018-2019 and the peri- COVID cohort included 25 HSV-1 (±HSV-2)+term dyadswhosemothers were also SARS-CoV-2 PCR and COVID Ab+ at delivery;14 were asymptomatic and 11 had mild-moderate COVID disease. None of the mothers had active genital HSV lesions during delivery. HSV-specific IgG, IgG1, and IgG3 TR were higher in term compared to preterm pre-COVID dyads (all p< 0.05). Similarly, the neutralizing Ab TR was 2.4[1.5, 4.0] in term vs 0.8[0.6, 1] in preterm (median [95%CI], p< 0.0001) but the ADCC TR was < 1.0 for both groups. To determine if the low ADCC TR reflected antigenic target, subclass, and/or glycans, we enriched for anti-gD and anti-gB specific and IgG1 and IgG3 Abs. These envelope glycoproteins are primary targets of neutralizing and ADCC responses, respectively. The anti-gD Abs were exclusively IgG1 and had only neutralizing activity. In contrast, anti-gB Abs were both IgG1 and IgG3;the IgG1 gB Abs had both neutralizing and ADCC activity whereas the IgG3 were only neutralizing. The anti-gD Abs were enriched for glycans associated with an affinity for FcRn, whereas anti-gB Abs expressed glycans associated with both FcRn and FcγRIIIa (receptor-associated with ADCC activity) binding. There was no significant difference in HSV-specific IgG TR in pre-COVID vs COVID dyads (0.42) but the nAb TR was lower (p = 0.018) and ADCC TR higher (p<0.001) in COVID compared to pre-COVID patients. Studies are in progress to assess whether this reflects increased placental colocalization of FcRn and FcgRIIIA, which would favor the transfer of ADCCAbs or modified Fc glycans. ADCC Abs transfer relatively inefficiently compared to nAbs, particularly in preterm infants and this may contribute to an increased risk of HSV disease. ADCC Ab transfer increased with SARS-CoV-2 coinfection, which may reflect differences in glycans and/or alterations in the placental architecture. Defining the determinants of ADCC transfer has implications for future vaccine and monoclonal Ab strategies to prevent/treat neonatal herpes. We speculate that increasing the transfer of ADCC may be a key element in providing immune protection.

18.
Sleep ; 45(SUPPL 1):A292, 2022.
Article in English | EMBASE | ID: covidwho-1927432

ABSTRACT

Introduction: The COVID-19 pandemic has negatively impacted sleep and mood on a global scale. To date, a handful of studies have reported on sleep and mood in perinatal women during the pandemic. They suggest that many pregnant women have poor sleep quality and depression. However, since these studies are cross-sectional with no comparison group, it is difficult to determine whether they are suffering more now. Methods: The current study compared sleep quality and the presence of likely clinical depression in perinatal women from two studies (one prior to the pandemic (∼1998)) and one during the pandemic (Aug 2020 - April 2021). All women had a history of MDD/PPD. Sleep quality and depression were ascertained at ∼36 weeks and 4 weeks postpartum for both groups. Sleep quality was characterized by the Pittsburgh Sleep Quality Index (PSQI). Depression was ascertained by the Hamilton Depression Rating Scale (HRDS) for the non-pandemic group and the Edinburgh Postnatal Depression Scale (EPDS) for the pandemic group. PSQI scores were analyzed continuously and categorically, while the depression scales were categorized according to published cutoffs. Results: The Mage = 31.1 (4.2) and did not differ between groups;84% were White. Sleep quality in late pregnancy did not differ between groups (7.62 (3.5) vs 7.16 (3.8), (ns), prepandemic vs pandemic), but they did differ at 1 month PP (7.10 (3.1) vs 8.7 (2.6), P < .001). The number of women who met criteria for depression in late pregnancy differed (28(41.1%) vs 7 (7.5%) X2 = 26.1, P < .001), but not at 1 month PP (9 (13.2%) vs 18(19.3%), X2 = 1.05, P = .31). Sleep quality in late pregnancy was correlated with whether a woman met criteria for depression during pregnancy (r = .22, P = .005), but not at 1-month postpartum (ns). Conclusion: Our findings suggest that the pandemic negatively impacted sleep quality in the first month postpartum, but not the rate of depression. We interpret these findings with caution due to varying methodologies. The pre-pandemic group was a RCT of 4 drug treatment groups in postpartum, and the pandemic group women used the SNOO®, a robotic, responsive bassinet.

19.
Journal of SAFOG ; 14(2):136-143, 2022.
Article in English | EMBASE | ID: covidwho-1917986

ABSTRACT

Aim: We have witnessed diverse presentations of coronavirus disease-2019 (COVID-19) in pregnant females during first and second waves. The aim of this study was to evaluate the usefulness of chest X-ray and its correlation of severity scoring with clinical, laboratory parameters and maternal-fetal outcome during management of COVID-19 pregnant women in low resource settings. Methodology: This was a retrospective observational study conducted at the Government Institute of Medical Sciences, Greater Noida, from May 2020 to May 2021. The study included 185 pregnant women in second and third trimesters with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 disease. The chest radiographs of all patients were analyzed and severity scoring was done using modified radiographic assessment of lung edema (RALE) criteria. The correlation of severity index with clinical and biochemical profile of patients with normal and abnormal X-ray findings was compared. Two-tailed p-value of <0.05 was considered significant in our study. Results: Out of 185 patients, 38 had abnormal X-ray findings, whereas 147 had normal X-ray. A significant difference was observed in mean values of lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), D-dimer, total leukocyte count (TLC), and interleukin 6 (IL-6) levels across both X-ray groups. The proportion of pregnant mothers with live birth, high-risk pregnancy, steroid treatment, oxygen supplementation, invasive ventilation, and number of presenting symptoms varied statistically across both the X-ray groups (p-value <0.05). Receiver-operating characteristic (ROC) analysis revealed that an X-ray score of “5.5” has the best prognostic significance of maternal death with sensitivity of 87.5 and 96.6% specificity. Conclusion: Chest radiography for the assessment of disease status in COVID-19 pregnancies is an effective and affordable alternative to CT scan in low resource settings.

20.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):124-125, 2022.
Article in English | EMBASE | ID: covidwho-1916238

ABSTRACT

Background: Tocilizumab reduces the need for mechanical ventilation and improves survival in COVID-19 patients. There is limited evidence on Tocilizumab use in pregnant patients with COVID-19. Methods: Case series of pregnant patients with COVID-19 treated with Tocilizumab during hospitalisation between June to November 2021. Demographic data, maternal morbidity and neonatal outcomes were collected. Results: Ten pregnant patients received Tocilizumab. Six patients received a single dose of 800 mcg, 2 patients received a single dose of 600 mcg, and 2 patients received a double dose of 800 mcg and 600 mcg respectively. Three patients received Tocilizumab postpartum, with 6 receiving it in the second and third trimester (mean gestational age 29.5 +/- 3.9 weeks). Antenatal patients received Tocilizumab at a median of 84 (IQR 63) days before delivery. In five patients, there was a trend in improvement of respiratory rate following administration of Tocilizumab (Table1). Birth outcomes were available for 8 patients. There were no significant adverse maternal outcomes or opportunistic infections, with only 1 patient experiencing chorioamnionitis with no long term sequalae. All neonates were born with Apgar of 91 and 95. One infant was identified as having Lenticulostriatal vasculopathy and another was diagnosed with gastroenteritis, but no causative bacterial or viral organism was identified. One infant tested positive for COVID-19 on Day 5. Out of the 8 neonates who were born, 7 were breastfed and none of the neonates in this study experienced any adverse outcomes until discharge. Conclusions: Tocilizumab is efficacious and safe for COVID- 19 in pregnancy for the women and neonates. (Table Presented).

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