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1.
Cochrane Database Syst Rev ; 6: CD014484, 2021 06 22.
Article in English | MEDLINE | ID: covidwho-1453529

ABSTRACT

BACKGROUND: Misoprostol given orally is a commonly used labour induction method. Our Cochrane Review is restricted to studies with low-dose misoprostol (initially ≤ 50 µg), as higher doses pose unacceptably high risks of uterine hyperstimulation. OBJECTIVES: To assess the efficacy and safety of low-dose oral misoprostol for labour induction in women with a viable fetus in the third trimester of pregnancy. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov,  the WHO International Clinical Trials Registry Platform (14 February 2021) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised trials comparing low-dose oral misoprostol (initial dose ≤ 50 µg) versus placebo, vaginal dinoprostone, vaginal misoprostol, oxytocin, or mechanical methods; or comparing oral misoprostol protocols (one- to two-hourly versus four- to six-hourly; 20 µg to 25 µg versus 50 µg; or 20 µg hourly titrated versus 25 µg two-hourly static). DATA COLLECTION AND ANALYSIS: Using Covidence, two review authors independently screened reports, extracted trial data, and performed quality assessments. Our primary outcomes were vaginal birth within 24 hours, caesarean section, and hyperstimulation with foetal heart changes. MAIN RESULTS: We included 61 trials involving 20,026 women. GRADE assessments ranged from moderate- to very low-certainty evidence, with downgrading decisions based on imprecision, inconsistency, and study limitations. Oral misoprostol versus placebo/no treatment (four trials; 594 women) Oral misoprostol may make little to no difference in the rate of caesarean section (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.59 to 1.11; 4 trials; 594 women; moderate-certainty evidence), while its effect on uterine hyperstimulation with foetal heart rate changes is uncertain (RR 5.15, 95% CI 0.25 to 105.31; 3 trials; 495 women; very low-certainty evidence). Vaginal births within 24 hours was not reported. In all trials, oxytocin could be commenced after 12 to 24 hours and all women had pre-labour ruptured membranes. Oral misoprostol versus vaginal dinoprostone (13 trials; 9676 women) Oral misoprostol probably results in fewer caesarean sections (RR 0.84, 95% CI 0.78 to 0.90; 13 trials, 9676 women; moderate-certainty evidence). Subgroup analysis indicated that 10 µg to 25 µg (RR 0.80, 95% CI 0.74 to 0.87; 9 trials; 8652 women) may differ from 50 µg (RR 1.10, 95% CI 0.91 to 1.34; 4 trials; 1024 women) for caesarean section. Oral misoprostol may decrease vaginal births within 24 hours (RR 0.93, 95% CI 0.87 to 1.00; 10 trials; 8983 women; low-certainty evidence) and hyperstimulation with foetal heart rate changes (RR 0.49, 95% CI 0.40 to 0.59; 11 trials; 9084 women; low-certainty evidence). Oral misoprostol versus vaginal misoprostol (33 trials; 6110 women) Oral use may result in fewer vaginal births within 24 hours (average RR 0.81, 95% CI 0.68 to 0.95; 16 trials, 3451 women; low-certainty evidence), and less hyperstimulation with foetal heart rate changes (RR 0.69, 95% CI 0.53 to 0.92, 25 trials, 4857 women, low-certainty evidence), with subgroup analysis suggesting that 10 µg to 25 µg orally (RR 0.28, 95% CI 0.14 to 0.57; 6 trials, 957 women) may be superior to 50 µg orally (RR 0.82, 95% CI 0.61 to 1.11; 19 trials; 3900 women). Oral misoprostol probably does not increase caesarean sections overall (average RR 1.00, 95% CI 0.86 to 1.16; 32 trials; 5914 women; low-certainty evidence) but likely results in fewer caesareans for foetal distress (RR 0.74, 95% CI 0.55 to 0.99; 24 trials, 4775 women). Oral misoprostol versus intravenous oxytocin (6 trials; 737 women, 200 with ruptured membranes) Misoprostol may make little or no difference to vaginal births within 24 hours (RR 1.12, 95% CI 0.95 to 1.33; 3 trials; 466 women; low-certainty evidence), but probably results in fewer caesarean sections (RR 0.67, 95% CI 0.50 to 0.90; 6 trials; 737 women; moderate-certainty evidence). The effect on hyperstimulation with foetal heart rate changes is uncertain (RR 0.66, 95% CI 0.19 to 2.26; 3 trials, 331 women; very low-certainty evidence). Oral misoprostol versus mechanical methods (6 trials; 2993 women) Six trials compared oral misoprostol to transcervical Foley catheter. Misoprostol may increase vaginal birth within 24 hours (RR 1.32, 95% CI 0.98 to 1.79; 4 trials; 1044 women; low-certainty evidence), and probably reduces the risk of caesarean section (RR 0.84, 95% CI 0.75 to 0.95; 6 trials; 2993 women; moderate-certainty evidence). There may be little or no difference in hyperstimulation with foetal heart rate changes (RR 1.31, 95% CI 0.78 to 2.21; 4 trials; 2828 women; low-certainty evidence). Oral misoprostol one- to two-hourly versus four- to six-hourly (1 trial; 64 women) The evidence on hourly titration was very uncertain due to the low numbers reported. Oral misoprostol 20 µg hourly titrated versus 25 µg two-hourly static (2 trials; 296 women) The difference in regimen may have little or no effect on the rate of vaginal births in 24 hours (RR 0.97, 95% CI 0.80 to 1.16; low-certainty evidence). The evidence is of very low certainty for all other reported outcomes. AUTHORS' CONCLUSIONS: Low-dose oral misoprostol is probably associated with fewer caesarean sections (and therefore more vaginal births) than vaginal dinoprostone, and lower rates of hyperstimulation with foetal heart rate changes. However, time to birth may be increased, as seen by a reduced number of vaginal births within 24 hours. Compared to transcervical Foley catheter, low-dose oral misoprostol is associated with fewer caesarean sections, but equivalent rates of hyperstimulation. Low-dose misoprostol given orally rather than vaginally is probably associated with similar rates of vaginal birth, although rates may be lower within the first 24 hours. However, there is likely less hyperstimulation with foetal heart changes, and fewer caesarean sections performed due to foetal distress. The best available evidence suggests that low-dose oral misoprostol probably has many benefits over other methods for labour induction. This review supports the use of low-dose oral misoprostol for induction of labour, and demonstrates the lower risks of hyperstimulation than when misoprostol is given vaginally. More trials are needed to establish the optimum oral misoprostol regimen, but these findings suggest that a starting dose of 25 µg may offer a good balance of efficacy and safety.


Subject(s)
Labor, Induced/methods , Misoprostol/administration & dosage , Oxytocics/administration & dosage , Administration, Intravaginal , Administration, Oral , Apgar Score , Cesarean Section/statistics & numerical data , Dinoprostone/administration & dosage , Drug Administration Schedule , Female , Heart Rate, Fetal/drug effects , Humans , Intensive Care, Neonatal/statistics & numerical data , Oxytocin/administration & dosage , Parturition , Placebos/administration & dosage , Pregnancy , Randomized Controlled Trials as Topic , Time Factors , Uterus/drug effects
2.
Taiwan J Obstet Gynecol ; 60(5): 945-948, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1336975

ABSTRACT

OBJECTIVE: Coronavirus-2019 (COVID-19) is a global health crisis. Although pregnant women are a vulnerable population during the infectious pandemics, extremely rare cases of pregnant women infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are described in Taiwan. We share our experience to manage a pregnant women with COVID-19 in the third trimester and subsequent delivery at term. CASE REPORT: A 43-year-old woman presented with sore throat, cough and rhinorrhea was diagnosed as laboratory-confirmed SARS-CoV-2 infection at the 35 gestational weeks (GW). During the hospitalization, the disease progressed with a need of oxygen supplement and prednisolone therapy. She was discharged uneventfully at 37 GW. Finally, she delivered a female baby with Apgar score of 8-9 points at 38 GW by cesarean section due to the deformity of pelvic cavity resulted from previous surgery for pelvic bone tumor. Both mother and her offspring (without SARS-CoV-2 infection) were discharged uneventfully. CONCLUSION: Our report adds the growing body of experience toward management of pregnant women with SARS-CoV-2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.


Subject(s)
COVID-19 , Cesarean Section , Pregnancy Complications, Infectious , Pregnancy Trimester, Third , Adult , Apgar Score , COVID-19/therapy , Female , Glucocorticoids/therapeutic use , Humans , Infant, Newborn , Oxygen Inhalation Therapy , Prednisolone/therapeutic use , Pregnancy , Pregnancy Complications, Infectious/therapy
3.
Taiwan J Obstet Gynecol ; 60(5): 942-944, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1336974

ABSTRACT

OBJECTIVE: A real-Taiwan experience to deal with near-term pregnant woman infected by severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (coronavirus disease 2019, COVID-19) is extremely limited. We described the first case in Taiwan. CASE REPORT: A 30-year-old woman, primigravida had a laboratory-confirmed COVID-19 infection at 36 gestational weeks (GW). She was asymptomatic. Ten days later, she was hospitalized and receive a selective cesarean section with a term baby weighted 3142 gm (Apgar score 8 and 9 at 1st and 5th minute, respectively) at 38 GW. No evidence of in utero and direct transmission was found and newborn was free of COVID-19. CONCLUSION: It is still uncertain whether timing or mode of delivery is appropriate in SARS-CoV-2 infected pregnant woman in near term, but we suggested that a selective delivery time at 38 GW or later, regardless of which mode of delivery is finally decided, can be considered.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Adult , Apgar Score , Asymptomatic Diseases , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , Taiwan
4.
Infect Dis Obstet Gynecol ; 2021: 9952701, 2021.
Article in English | MEDLINE | ID: covidwho-1277021

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks postdischarge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6-40) and 3077.50 ± 697.64 gr (1720-3900), respectively. Apgar score of the first and fifth minutes in all neonates was ≥8 and ≥9 out of 10, respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP) in three infants are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results similar to those described for nonpregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.


Subject(s)
COVID-19/epidemiology , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/epidemiology , Respiratory Distress Syndrome, Newborn/epidemiology , SARS-CoV-2/isolation & purification , Apgar Score , Birth Weight , COVID-19/complications , COVID-19/diagnosis , COVID-19/transmission , COVID-19 Nucleic Acid Testing/statistics & numerical data , Female , Follow-Up Studies , Gestational Age , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Iran/epidemiology , Lung/diagnostic imaging , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/virology , RNA, Viral/isolation & purification , Respiratory Distress Syndrome, Newborn/diagnosis , Respiratory Distress Syndrome, Newborn/virology , Retrospective Studies , SARS-CoV-2/genetics
5.
BMC Pregnancy Childbirth ; 21(1): 378, 2021 May 17.
Article in English | MEDLINE | ID: covidwho-1232423

ABSTRACT

BACKGROUND: Physiological changes during pregnancy put pregnant women at higher risk for COVID-19 complications. The objective of this study was to evaluate clinical and laboratory characteristics and outcomes of 24 COVID-19 pregnant patients and their newborns referred to the Al-Zahra tertiary maternity hospital in Tabriz, Iran. METHODS: Clinical records of 24 COVID-19 confirmed pregnant patients were retrospectively reviewed from10 March 2020 to 15 April 2020. Vertical transition was assessed through neonatal pharyngeal swab samples. The study has been approved by the Tabriz University Medical Ethics Committee (IR.TBZMED.REC.1399.497). RESULTS: There were 24 hospitalized cases with clinical symptoms and confirmed diagnosis of COVID-19. The mean age of cases was 26.5 years; most were nulliparous (54.2%), in their third trimester (62.5%) and were in the type A blood group. Clinical symptoms in order of prevalence were cough, fever, dyspnea, myalgia, anosmia, and diarrhea. Oxygen saturation (SpO2) in 70.8% cases was in the normal range (greater than 93%). The risk of premature labor or abortion in cases showed no increase. 12 cases were in ongoing normal status; on follow up, 11 cases had delivered their babies at term and one had ended in IUFD because of pregnancy-induced hypertension. All delivered babies were healthy. Caesarean section in all cases was performed under obstetric indications or maternal demand, and no relation was found between COVID-19 and Caesarean delivery. Neonatal outcomes according to gestational age in 8 cases out of 11 (72.72%) were desirable; neonatal morbidity and mortality resulted from pregnancy complications. Blood pH in 6 neonates was assessed due to immaturity and NICU admission, all of which were in normal ranges except one case related to HELLP syndrome. There was no evidence of vertical transmission. CONCLUSIONS: Findings suggest that clinical symptoms in pregnancy were similar to non-pregnant women, no rise in risk of premature labor or abortion was seen, and vertical transmission was not observed in none of cases. Lymphopenia was the leading laboratory change. Given asymptomatic cases despite severe forms of infection in pregnancies, we propose screening in all suspected cases. All placentas and newborns should be tested in the field for vertical transmission.


Subject(s)
COVID-19/epidemiology , Hospitalization , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Adolescent , Adult , Apgar Score , Birth Weight , Cesarean Section/statistics & numerical data , Delivery, Obstetric , Female , Humans , Infant, Newborn , Iran/epidemiology , Leukocyte Count , Oxygen/blood , Pre-Eclampsia , Pregnancy , Retrospective Studies , Young Adult
6.
Int J Environ Res Public Health ; 18(9)2021 04 30.
Article in English | MEDLINE | ID: covidwho-1231474

ABSTRACT

Neonatal brain injury or neonatal encephalopathy (NE) is a significant morbidity and mortality factor in preterm and full-term newborns. NE has an incidence in the range of 2.5 to 3.5 per 1000 live births carrying a considerable burden for neurological outcomes such as epilepsy, cerebral palsy, cognitive impairments, and hydrocephaly. Many scoring systems based on different risk factor combinations in regression models have been proposed to predict abnormal outcomes. Birthweight, gestational age, Apgar scores, pH, ultrasound and MRI biomarkers, seizures onset, EEG pattern, and seizure duration were the most referred predictors in the literature. Our study proposes a decision-tree approach based on clinical risk factors for abnormal outcomes in newborns with the neurological syndrome to assist in neonatal encephalopathy prognosis as a complementary tool to the acknowledged scoring systems. We retrospectively studied 188 newborns with associated encephalopathy and seizures in the perinatal period. Etiology and abnormal outcomes were assessed through correlations with the risk factors. We computed mean, median, odds ratios values for birth weight, gestational age, 1-min Apgar Score, 5-min Apgar score, seizures onset, and seizures duration monitoring, applying standard statistical methods first. Subsequently, CART (classification and regression trees) and cluster analysis were employed, further adjusting the medians. Out of 188 cases, 84 were associated to abnormal outcomes. The hierarchy on etiology frequencies was dominated by cerebrovascular impairments, metabolic anomalies, and infections. Both preterms and full-terms at risk were bundled in specific categories defined as high-risk 75-100%, intermediate risk 52.9%, and low risk 0-25% after CART algorithm implementation. Cluster analysis illustrated the median values, profiling at a glance the preterm model in high-risk groups and a full-term model in the inter-mediate-risk category. Our study illustrates that, in addition to standard statistics methodologies, decision-tree approaches could provide a first-step tool for the prognosis of the abnormal outcome in newborns with encephalopathy.


Subject(s)
Brain Injuries , Epilepsy , Apgar Score , Electroencephalography , Female , Humans , Infant , Infant, Newborn , Pregnancy , Retrospective Studies , Seizures/epidemiology
7.
Anaesthesia ; 76(8): 1051-1059, 2021 08.
Article in English | MEDLINE | ID: covidwho-1199638

ABSTRACT

General anaesthesia is known to achieve the shortest decision-to-delivery interval for category-1 caesarean section. We investigated whether the COVID-19 pandemic affected the decision-to delivery interval and influenced neonatal outcomes in patients who underwent category-1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre-COVID-19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID-19 pandemic (1 April 2020-1 July 2020) (post-COVID-19 group). Primary outcome measures were: decision-to-delivery interval; number of caesarean sections achieving decision-to-delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5-min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre- and post-COVID-19 groups (risk ratio 0.48 (95%CI 0.37-0.62); p < 0.0001). Compared with the pre-COVID-19 group, the post-COVID-19 group had an increase in median (IQR [range]) decision-to-delivery interval (26 (18-32 [4-124]) min vs. 27 (20-33 [3-102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision-to-delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre- and post-COVID-19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision-to-delivery interval observed during the COVID-19 pandemic did not adversely affect neonatal outcomes.


Subject(s)
Anesthesia, General/statistics & numerical data , COVID-19 , Cesarean Section/statistics & numerical data , Clinical Decision-Making , Pregnancy Outcome , Adolescent , Adult , Apgar Score , Female , Humans , Infant, Newborn , Middle Aged , Pregnancy , Retrospective Studies , SARS-CoV-2 , Time Factors , United Kingdom , Young Adult
8.
Int J Gynaecol Obstet ; 153(3): 449-456, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1103309

ABSTRACT

OBJECTIVE: To determine the maternal and neonatal outcomes of pregnant women with COVID-19 infection. METHODS: A cohort study was conducted on 56 pregnant women with COVID-19 and 94 healthy pregnant women during the COVID-19 epidemic in Iran. Two groups were followed until childbirth. Demographic and obstetric information, clinical symptoms, laboratory and radiographic findings of the patients, and maternal and neonatal outcomes of the two groups were gathered by a checklist. Data were analyzed using SPSS version 16. A P value < 0.05 was considered significant. RESULTS: The two groups were similar in terms of maternal age, gravida, parity, and co-morbidities (P > 0.05). The rate of cesarean delivery in the exposed group was higher than that in the control group (P = 0.027; relative risk [RR] =2.23). Pre-eclampsia was seen in 19.8% of the exposed group and 7.4% of the control group (P = 0.037; RR = 2.68). The rate of preterm labor in the exposed group was higher than that in the control group (P = 0.003; RR = 2.70). Fetal distress was seen in 16.1% of the exposed group and 4.3% of the control group (P = 0.016; RR = 3.84). CONCLUSION: Pregnant women with COVID-19 had an increased risk of pre-eclampsia, preterm labor, and cesarean delivery. Their fetal and neonatal outcomes were fetal distress, newborn prematurity, and low Apgar score.


Subject(s)
COVID-19/epidemiology , Fetal Distress/epidemiology , Obstetric Labor, Premature/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy Complications/epidemiology , Premature Birth/epidemiology , Adult , Apgar Score , Cesarean Section/statistics & numerical data , Cohort Studies , Female , Humans , Infant, Newborn , Iran/epidemiology , Pregnancy , Prospective Studies , SARS-CoV-2 , Young Adult
9.
J Perinat Med ; 49(3): 263-268, 2021 Mar 26.
Article in English | MEDLINE | ID: covidwho-902091

ABSTRACT

OBJECTIVES: Data regarding the pathogenesis and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, however, there's limited data in regard to maternal and neonatal outcomes. Therefore, we conducted a retrospective analysis of all pregnant women who tested positive for SARS-CoV-2 within Nuvance Health system. METHODS: Data were abstracted from the medical records of each patient and descriptive analysis was performed. Variables included demographics, COVID testing results, symptoms, management, labor course, neonatal information, and complications. RESULTS: Total of 40 patients were identified. Average age was 29.6 years old, 35% were Hispanic, and approximately one in three patients had comorbidities. Of the patients who had repeated testing, the average number of days between first positive test and negative test was 36.8 days (± 19.9 days). Three out of four women reported symptoms. Of the 40 pregnant women who were positive for SARS-CoV-2, 25 of them delivered. About 84% of the women delivered after 37 weeks. Twelve percent of the women delivered under 33 and 6/7 weeks. Most patients had vaginal deliveries (68%) and the remaining had cesarean deliveries. Neonatal outcomes included: mean 1 and 5 min Apgar scores of 8 and 8.8, respectively and the mean birth weight was 3212 g. Twenty neonates were tested for SARS-CoV-2 and were all found to be negative. CONCLUSIONS: Overall, with routine prenatal care and preventive measures, pregnant patients and neonates in our study had good outcomes. At this time, there appears to be no evidence of vertical transmission.


Subject(s)
COVID-19 Testing , COVID-19 , Infectious Disease Transmission, Vertical , Perinatal Care/methods , Pregnancy Complications, Infectious , Adolescent , Adult , Apgar Score , Birth Weight , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19/transmission , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Infectious Disease Transmission, Vertical/statistics & numerical data , Male , New York/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome , Retrospective Studies , Treatment Outcome , Young Adult
10.
BMC Pregnancy Childbirth ; 20(1): 511, 2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-744979

ABSTRACT

BACKGROUND: It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. CASE PRESENTATION: A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. CONCLUSIONS: This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.


Subject(s)
Blood Coagulation Disorders/blood , Cesarean Section , Coronavirus Infections/blood , Liver Diseases/blood , Obesity, Maternal , Pneumonia, Viral/blood , Pregnancy Complications, Infectious/blood , Adult , Antithrombin III/metabolism , Apgar Score , Betacoronavirus , Blood Coagulation Disorders/etiology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Diagnosis, Differential , Female , Fibrin Fibrinogen Degradation Products/metabolism , HELLP Syndrome/diagnosis , Humans , Infant, Newborn , Infant, Premature , L-Lactate Dehydrogenase/blood , Liver Diseases/etiology , Lung/diagnostic imaging , Male , Pandemics , Partial Thromboplastin Time , Platelet Count , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , SARS-CoV-2 , Sweden , Tomography, X-Ray Computed
11.
Syst Rev ; 9(1): 161, 2020 07 18.
Article in English | MEDLINE | ID: covidwho-656809

ABSTRACT

BACKGROUND: Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. RESEARCH QUESTIONS: This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? METHOD: The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. DISCUSSION: This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. SYSTEMATIC REVIEW REGISTRATION: This systematic review has been registered and published with Prospero ( CRD42020172773 ).


Subject(s)
Coronavirus Infections/drug therapy , Maternal Mortality , Perinatal Mortality , Pneumonia, Viral/drug therapy , Pregnancy Complications, Infectious/drug therapy , Apgar Score , Betacoronavirus , Breast Feeding , COVID-19 , Female , Humans , Infant, Newborn , Pandemics , Postpartum Hemorrhage/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy , SARS-CoV-2 , Sepsis/epidemiology , Treatment Outcome
12.
Eur J Obstet Gynecol Reprod Biol ; 252: 286-293, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-624641

ABSTRACT

OBJECTIVE: To determine the cardiotocograph (CTG) changes in women with symptomatic COVID-19 infection. STUDY DESIGN: 12 anonymised CTG traces from 2 hospitals in Spain were retrospectively analysed by 2 independent assessors. CTG parameters were studied based on fetal pathophysiological responses to inflammation and hypoxia that would be expected based on the pathogenesis of COVID-19 patients. Correlation was made with perinatal outcomes (Apgar score at 5 min and umbilical cord pH). RESULTS: All fetuses showed an increased baseline FHR > 10 percent compared to the initial recording, in addition to absence of accelerations. 10 out of 12 CTG traces (83.3 percent) demonstrated late or prolonged decelerations and 7 out of 12 fetuses (58.3 percent) showed absence of cycling. Not a single case of sinusoidal pattern was observed. ZigZag pattern was found in 4 CTG traces (33 percent). Excessive uterine activity was observed in all CTG traces where uterine activity was monitored (10 out of 12). Apgar scores at 5 min were normal (>7) and absence of metabolic acidosis was found in the umbilical cord arterial pH (pH > 7.0) in the cases that were available (11 and 9, respectively). CONCLUSION: Fetuses of COVID-19 patients showed a raised baseline FHR (>10 percent), loss of accelerations, late decelerations, ZigZag pattern and absence of cycling probably due to the effects of maternal pyrexia, maternal inflammatory response and the "cytokine storm". However, the perinatal outcomes appear to be favourable. Therefore, healthcare providers should optimise the maternal environment first to rectify the reactive CTG changes instead of performing an urgent operative intervention.


Subject(s)
Betacoronavirus , Cardiotocography , Coronavirus Infections/physiopathology , Heart Rate, Fetal , Pneumonia, Viral/physiopathology , Pregnancy Complications, Infectious/physiopathology , Adult , Apgar Score , COVID-19 , Coronavirus Infections/embryology , Female , Fetal Heart/virology , Humans , Hydrogen-Ion Concentration , Infant, Newborn , Male , Pandemics , Pneumonia, Viral/embryology , Pregnancy , Pregnancy Complications, Infectious/virology , Retrospective Studies , SARS-CoV-2 , Spain , Umbilical Cord
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