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1.
BMC Pregnancy Childbirth ; 22(1): 304, 2022 Apr 10.
Article in English | MEDLINE | ID: covidwho-1779619

ABSTRACT

BACKGROUND: Expectant parents worldwide have experienced changes in the way they give birth as a result of COVID-19, including restrictions relating to access to birthing units and the presence of birthing partners during the birth, and changes to birth plans. This paper reports the experiences of women in England. METHODS: Data were obtained from both closed- and open-ended responses collected as part of the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey (n = 477 families) between 15th July 2020 - 29th March 2021. Frequency data are presented alongside the results of a sentiment analysis; the open-ended data was analysed thematically. RESULTS: Two-thirds of expectant women reported giving birth via spontaneous vaginal delivery (SVD) (66.1%) and a third via caesarean section (CS) (32.6%) or 'other' (1.3%). Just under half (49.7%) of the CS were reported to have been elective/planned, with 47.7% being emergencies. A third (37.4%) of participants reported having no changes to their birth (as set out in their birthing plan), with a further 25% reporting COVID-related changes, and 37.4% reporting non-COVID related changes (e.g., changes as a result of birthing complications). One quarter of the sample reported COVID-related changes to their birth plan, including limited birthing options and reduced feelings of control; difficulties accessing pain-relief and assistance, and feelings of distress and anxiety. Under half of the respondents reported not knowing whether there could be someone present at the birth (44.8%), with 2.3% of respondents reporting no birthing partner being present due to COVID-related restrictions. Parental experiences of communication and advice provided by the hospital prior to delivery were mixed, with significant stress and anxiety being reported in relation to both the fluctuating guidance and lack of certainty regarding the presence of birthing partners at the birth. The sentiment analysis revealed that participant experiences of giving birth during the pandemic were predominately negative (46.9%) particularly in relation to the first national lockdown, with a smaller proportion of positive (33.2%) and neutral responses (19.9%). CONCLUSION: The proportion of parents reporting birthing interventions (i.e., emergency CS) was higher than previously reported, as were uncertainties related to the birth, and poor communication, leading to increased feelings of anxiety and high levels of negative emotions. The implications of these findings are discussed.


Subject(s)
COVID-19 , Cesarean Section , COVID-19/epidemiology , Cesarean Section/psychology , Communicable Disease Control , England/epidemiology , Female , Humans , Pandemics , Parturition/psychology , Pregnancy
2.
Front Public Health ; 10: 766943, 2022.
Article in English | MEDLINE | ID: covidwho-1775976

ABSTRACT

Objectives: There are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries. Methods: A systematic search on the databases of PubMed/MEDLINE, Scopus, and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results. Results: The search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups. Conclusion: Although the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.


Subject(s)
Armed Conflicts , Emigrants and Immigrants , Pregnancy Outcome , Cesarean Section , Emigration and Immigration , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Outcome/epidemiology , Pregnancy Outcome/ethnology , Reproducibility of Results
3.
Eur Rev Med Pharmacol Sci ; 26(5): 1765-1769, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1754186

ABSTRACT

OBJECTIVE: Few data are available on the ICU management and on the possible respiratory complications of invasively ventilated pregnant patients affected by COVID-19 pneumonia, especially in the early phase of pregnancy. Tension pneumothorax has been previously described as a rare cause of respiratory failure after delivery, but its occurrence in the postpartum of COVID-19 patient has not been reported yet. We hereby describe the ICU management of a 23rd gestational week pregnant woman who underwent invasive mechanical ventilation, prone positioning, and cesarean delivery during her ICU stay for COVID-19 related pneumonia. Moreover, we focused on the occurrence and management of recurrent tension pneumothorax after the cesarean delivery. CASE REPORT: A 23rd gestational week pregnant woman was admitted to the ICU for a COVID-19 bilateral pneumonia and underwent invasive mechanical ventilation and prone positioning. Cesarean delivery was planned during the ICU stay, while the patient was receiving invasive mechanical ventilation. After delivery, the patient experienced a recurrent pneumothorax that required the positioning of multiple chest drains. CONCLUSIONS: In pregnant critically ill COVID-19 patients, mechanical ventilation management is particularly challenging, especially in the postpartum period. Prone positioning is feasible and can improve oxygenation and respiratory system compliance, while tension pneumothorax must be suspected if the respiratory function suddenly deteriorates after delivery.


Subject(s)
COVID-19/complications , Cesarean Section , Critical Illness , Pneumothorax/etiology , Postoperative Complications/therapy , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Adult , COVID-19/diagnostic imaging , Female , Humans , Infant, Newborn , Postoperative Complications/diagnostic imaging , Pregnancy , Prone Position , Recurrence , Respiration, Artificial , Respiratory Distress Syndrome/diagnostic imaging , Treatment Outcome
4.
Int J Environ Res Public Health ; 19(6)2022 03 11.
Article in English | MEDLINE | ID: covidwho-1742442

ABSTRACT

The objective of this scoping review is to determine to what extent the recommendations on perinatal care protect breastfeeding during the COVID-19 pandemic. The review follows the PRISMA ScR Extension guidelines. The research was conducted in Scopus, Medline via Pubmed, and Web of Science databases from 1 March 2020 to 31 May 2021, using 392 combinations of keywords. We searched for reviews and original papers published in English providing recommendations on delivery mode, companion during labor, the possibility of skin-to-skin contact (SSC), breastfeeding, and visitors policy. After screening, 86 out of 8416 publications qualified for data extraction. The majority of them indicated that COVID-19 infection is not a sufficient reason for a cesarean section; however, on a national level, cesarean births in severely ill patients were overrepresented. A significant number of recommendations deprived mothers of the necessary support during their labor and stay in the maternity ward. A shared decision-making model was hardly visible. Only the earliest COVID-19 recommendations suspended direct breastfeeding; in later publications, decisions were related to the mother's health, but other options of natural feeding were rarely discussed.


Subject(s)
COVID-19 , Infant Welfare , Perinatal Care , Breast Feeding , COVID-19/epidemiology , COVID-19/prevention & control , Cesarean Section , Female , Humans , Infant, Newborn , Mothers , Pandemics/prevention & control , Pregnancy
5.
J Mother Child ; 25(2): 77-85, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1687887

ABSTRACT

BACKGROUND: Corona virus disease (COVID-19) is an infectious disease caused by the novel corona virus known as severe acute respiratory syndrome corona virus 2 (SARS Cov-2). Physiological changes occurring during pregnancy can have a positive or negative effect on the disease progression. The objective of the study was to evaluate the maternal and neonatal outcomes in pregnant women with COVID-19 compared to pregnant women without COVID-19 and to determine its influence on the healthcare system. MATERIAL AND METHODS: This was a retrospective analytical study conducted at a tertiary care hospital in Odisha, India, over 3 months, from 1 September 2020 until 30 November 2020. Results were compared in both groups. RESULTS: Three hundred and three (303) women delivered, out of whom 92 were COVID-19 positive. Incidence of COVID-19 positivity was 30.3% with 93.47% asymptomatic patients. The majority of the patients were 26-35years of age. Average gestational age at delivery for both groups was 37-40 weeks. COVID-19 positivity was seen more in primigravidas than in multigravidas. Comorbidities such as GDM/type 2 DM, PIH, PROM, APH and jaundice were similar in both groups and statistically non-significant, whereas association of anaemia and hypothyroidism were statistically significant (p<0.05) in the positive group. A single maternal death was reported in the positive group. There was an increase in Caesarean section (p=0.002) with higher incidence of preterm births and lowbirth weights in the positive group. Only 3 babies tested positive for COVID-19, so vertical transmission probability was low. Overall, all babies were healthy and the majority of women were discharged without any complications. CONCLUSION: There was no significant effect of the infection on maternal and fetal outcomes, but further studies and long-term follow-up is needed to look for any delayed effects on the babies and mothers.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/complications , COVID-19/epidemiology , Cesarean Section , Female , Humans , Infant , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Retrospective Studies
6.
Int J Environ Res Public Health ; 19(4)2022 Feb 13.
Article in English | MEDLINE | ID: covidwho-1686780

ABSTRACT

OBJECTIVE: There are few data on the maternal-fetal transmission of SARS-CoV-2 and its outcomes. This study aimed to evaluate pregnancy outcomes of pregnant women infected by SARS-CoV-2, to detect SARS-CoV-2 in placenta and different newborns' samples and search antibodies in cord blood. METHODS: This was a prospective study of pregnant women diagnosed with SARS-CoV-2 infection from May 2020 to May 2021. At delivery, the placentas were investigated for SARS-CoV-2 using RT-PCR, cord blood. Mothers' blood samples were tested by SARS-CoV-2 serology. PCR of nasopharyngeal, anal and gastric swabs (NPSs) of newborns was performed according to pediatric indications. RESULTS: Among 3626 pregnant women presenting at maternity to deliver, 45 mothers had COVID-19 during their pregnancy or at delivery (32 ± 4.8 years). Most of them were multiparous and in the third trimester. There were 35 (77%) women who remained in ambulatory, while 10 (22%) were hospitalized for severe pneumonia, digestive symptoms, and/or fetal tachycardia. Thirty-eight delivered vaginally, and 7 had a cesarean delivery with normal Apgar scores (9 ± 1.6 at 5 min) and umbilical artery pH (7.22 ± 0.08). Two mothers required ICU admission after cesarean section for fetal and maternal distress. Of the 46 newborns, 6 were premature births (13%) and 5 IUGR (intra-uterine growth restriction,11%). RT-PCR SARS-CoV-2 was positive for 1/30 placental, and 1/33 neonatal anal swabs and negative in all other cases and in gastric swabs. SARS-CoV-2 IgG was positive in 20/41 cord blood samples (49%) and their mothers' samples. IgM was negative in the 23 cord blood samples. CONCLUSIONS: Pregnancy outcomes in women diagnosed with COVID-19 during their pregnancy were favorable in most cases. However, some women with severe clinical forms required hospitalization and ICU admission. Preterm births and intrauterine growth retardations were relatively frequent. Vaginal delivery was possible in most cases. SARS-CoV-2 IgG antibodies were positive and elevated in most cord blood samples of newborns. They are possibly of maternal origin, suggesting a probable mechanism of fetal protection against SARS-CoV-2 infection. No SARS-CoV-2 IgM was found in the cord blood samples. Detection of SARS-CoV-2 in placenta is rare.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/epidemiology , Cesarean Section , Child , Female , Fetal Blood , Humans , Immunoglobulin M , Infant, Newborn , Infectious Disease Transmission, Vertical , Placenta , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Prospective Studies , SARS-CoV-2/genetics
7.
BMJ Glob Health ; 7(2)2022 02.
Article in English | MEDLINE | ID: covidwho-1685572

ABSTRACT

INTRODUCTION: Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. METHODS: Mixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting. RESULTS: We identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP. CONCLUSION: Routine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks.


Subject(s)
COVID-19 , Pandemics , Cesarean Section , Delivery of Health Care , Female , Hospitals , Humans , Infant, Newborn , Pregnancy , Referral and Consultation , SARS-CoV-2 , Tanzania
8.
BMJ Case Rep ; 15(2)2022 Feb 08.
Article in English | MEDLINE | ID: covidwho-1685516

ABSTRACT

Intrahepatic cholestasis in pregnancy (ICP) represents, depending on its severity, a serious risk for the fetus. Those cases with unusually high bile acid levels may be resistant to pharmaceutical treatment and can be treated with plasma exchange or albumin dialysis. However, the success rate of these therapeutic options and the factors influencing therapeutic response are unknown. Furthermore, if these options fail to improve ICP and serum bile acid levels are very high (>200 µm/L), there are no clear recommendations when delivery should be planned. Here, we report a patient with severe ICP resistant to both therapeutic plasma exchange and albumin dialysis. Caesarean section was performed at 32 weeks of gestation followed by rapid remission of ICP.


Subject(s)
Cholestasis, Intrahepatic , Pregnancy Complications , Albumins , Cesarean Section , Cholestasis, Intrahepatic/therapy , Female , Humans , Plasma Exchange , Pregnancy , Pregnancy Complications/therapy , Renal Dialysis
9.
Taiwan J Obstet Gynecol ; 61(2): 378-381, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1677188

ABSTRACT

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the coronavirus disease 2019 (COVID-19) pandemic. Owing to limited information, the impact and clinical course of COVID-19 in pregnant women and newborns remain unclear. Here, we report the clinical course of a full-term pregnant woman with COVID-19 and her newborn. CASE REPORT: A 27-year-old pregnant woman with a fever and sore throat was diagnosed with COVID-19. To prevent and control SARS-CoV-2 infection to the newborn and medical staff, delivery was performed via cesarean section. Reverse-transcription quantitative polymerase chain reaction results of the placenta, umbilical cord, cord blood, amniotic fluid, vaginal fluid, breastmilk, newborn anal wipes, and nasopharyngeal samples were negative for SARS-CoV-2. An acute increase in maternal blood pressure and HELLP syndrome-like blood data fluctuations were observed after delivery. CONCLUSION: Perinatal management of patients with COVID-19 could be safely performed for medical staff and newborns under adequate infection control measures.


Subject(s)
COVID-19 , Adult , Amniotic Fluid , Cesarean Section , Female , Humans , Infant, Newborn , Japan , Pregnancy , Pregnant Women , SARS-CoV-2
10.
J Gynecol Obstet Hum Reprod ; 51(3): 102328, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1654804

ABSTRACT

INTRODUCTION: The effect of coronavirus disease (COVID-19) on pregnancy outcome in women with sickle cell disease (SCD) is unknown. OBJECTIVES: To analyze the severity of the SARS-CoV-2 infection in pregnant women with SCD and its impact on pregnancy. METHODS: This retrospective cohort study included SCD pregnant women tested positive for COVID-19 between March 2020 - February 2021. The primary endpoint was the severity of the COVID-19 infection. Secondary endpoints were pregnancy complications and fetal outcomes. RESULTS: During the study period among 82 pregnant women with SCD, 8 have presented symptoms suggestive of COVID-19 and were tested positive. A common mild clinical presentation was observed in 6 women (75%), one woman was asymptomatic and one required oxygen. The latter was admitted to the Intensive Care Unit and a cesarean section was performed in the context of an ongoing vaso-occlusive crisis and acute chest syndrome together with incidental preeclampsia. Labor was induced in another patient who developed a vaso-occlusive crisis after COVID-19 remission. Fetal outcomes were good with an average Apgar score of 10 and normal umbilical blood pH at birth. Two newborns were small-for-gestational-age as expected on the ultrasound follow-up before occurrence of COVID-19. CONCLUSION: COVID-19 infection in our population of pregnant women with SCD had typical presentation and rarely triggered a sickle cell crisis or other complications. Fetal outcomes were good and did not seem to be directly influenced by the SARS-CoV-2 virus. Further studies are required to confirm these observations as compared to the population of women with SCD without COVID-19 infection.


Subject(s)
Anemia, Sickle Cell , COVID-19 , Pregnancy Complications, Infectious , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/epidemiology , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome/epidemiology , Pregnant Women , Retrospective Studies , SARS-CoV-2
11.
BMC Pregnancy Childbirth ; 22(1): 51, 2022 Jan 20.
Article in English | MEDLINE | ID: covidwho-1643117

ABSTRACT

BACKGROUND: Lockdowns, pregnant women's fear from hospitalization in addition to uncertainties about appropriate birthing practices at the beginning of the pandemic may have affected the health outcomes of mother-infant couples. We aimed to explore whether pregnancy outcomes including the rates of cesarean delivery (CS), preterm, and low birth weight (LBW) births have changed during the pandemic period compared with the pre-pandemic period. METHODS: We applied a population-based retrospective cohort, before-after approach in 2020 vs. similar calendar months in 2019 for five periods [Jan-Feb (pre-pandemic); March-May (1st wave and lockdown); June-August; September-October; November-December (2nd wave and lockdown)]. The data was modelled through multiple logistic regressions using key outcomes; CS, preterm, and LBW births as the dependent variables, and adjustments were made for independent variables in SPSS software. We evaluated the modification of years by periods by adding interaction term (yearXperiod) to the model. RESULTS: The rate of CS in hospital births increased from 57.7% in 2019 to 60.2% in 2020. CS rates were significantly increased during the 3rd and 4th periods. The overall preterm rate was 11%. When singleton pregnancies were considered, adjusted multivariable analyses showed a decrease in preterm proportions during all time periods with respect to the pre-pandemic period. The percentage of LBW was 7.7% during the pandemic period and was found to be significantly reduced compared to the pre-pandemic period. There was a significant reduction in LBW rates in all periods except the second lockdown period. CONCLUSIONS: Our findings suggested significant reductions in preterm and LBW births possibly due to the indirect effects of the pandemic. Moreover, strategies need to be considered to address the increased CS rates and shifting of maternity service utilization to private facilities.


Subject(s)
COVID-19/epidemiology , Cesarean Section/statistics & numerical data , Hospitals , Infant, Low Birth Weight , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Adult , Cohort Studies , Delivery, Obstetric/statistics & numerical data , Female , Humans , Infant, Newborn , Logistic Models , Pregnancy , Quarantine , Retrospective Studies , SARS-CoV-2 , Time Factors , Turkey/epidemiology
12.
Clin Obstet Gynecol ; 65(1): 179-188, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1634419

ABSTRACT

The purpose of this review is to describe updates following initial recommendations on best anesthesia practices for obstetric patients with coronavirus disease 2019. The first surge in the United States prompted anesthesiologists to adapt workflows and reconsider obstetric anesthesia care, with emphasis on avoidance of general anesthesia, the benefit of early neuraxial labor analgesia, and prevention of emergent cesarean delivery whenever possible. While workflows have changed to allow sustained safety for obstetric patients and health care workers, it is notable that obstetric anesthesia protocols for labor and delivery have not significantly evolved since the first coronavirus disease 2019 wave.


Subject(s)
Anesthesia, Obstetrical , COVID-19 , Cesarean Section , Female , Humans , Practice Guidelines as Topic , Pregnancy , United States
13.
BMJ Case Rep ; 15(1)2022 Jan 19.
Article in English | MEDLINE | ID: covidwho-1631871

ABSTRACT

Headache is a common presentation to the physician. Although most causes of a headache in pregnancy are benign, the pregnant woman is at risk of a life-threatening secondary headache such as eclampsia, venous sinus thrombosis or posterior reversible encephalopathy syndrome (PRES). Pregnancy and the puerperium are prothrombotic risk factors. Although the aetiology of PRES remains to be fully elucidated, hypertension with failed autoregulation results in brain oedema. An alternative hypothesis includes endothelial injury and hypoperfusion leading to an alteration in the integrity of the blood-brain barrier. It occurs in complex, systemic conditions such as pre-eclampsia, following bone marrow transplantation, chemotherapy, sepsis and autoimmune diseases. The most common clinical presentation is headache, altered alertness, seizures and visual disturbance such as hemianopia, visual neglect and cortical blindness. It can also develop in normotensive individuals. Symmetric vasogenic oedema in a watershed distribution involving the parieto-occipital regions are typically evident on MRI. Management is determined by the underlying aetiological risk factor. The authors present the case of a 32-year-old multiparous woman presenting with tonic-clonic seizures 16 days following an elective caesarean section. Her pregnancy was complicated by hypertension and headache. There was no history of pre-eclampsia. She required intubation and ventilation. The diagnosis of PRES was established on MRI. Early recognition and treatment provide a favourable prognosis as the clinical symptoms and imaging characteristics are reversible in a large cohort of affected individuals.


Subject(s)
Eclampsia , Posterior Leukoencephalopathy Syndrome , Adult , Cesarean Section , Female , Humans , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/etiology , Postpartum Period , Pregnancy
14.
15.
J Korean Med Sci ; 36(44): e309, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1593105

ABSTRACT

BACKGROUND: We assessed maternal and neonatal outcomes of critically ill pregnant and puerperal patients in the clinical course of coronavirus disease 2019 (COVID-19). METHODS: Records of pregnant and puerperal women with polymerase chain reaction positive COVID-19 virus who were admitted to our intensive care unit (ICU) from March 2020 to August 2021 were investigated. Demographic, clinical and laboratory data, pharmacotherapy, and neonatal outcomes were analyzed. These outcomes were compared between patients that were discharged from ICU and patients who died in ICU. RESULTS: Nineteen women were included in this study. Additional oxygen was required in all cases (100%). Eight patients (42%) were intubated and mechanically ventilated. All patients that were mechanically ventilated have died. Increased levels of C-reactive protein (CRP) was seen in all patients (100%). D-dimer values increased in 15 patients (78.9%); interleukin-6 (IL-6) increased in 16 cases (84.2%). Sixteen patients used antiviral drugs. Eleven patients were discharged from the ICU and eight patients have died due to complications of COVID-19 showing an ICU mortality rate of 42.1%. Mean number of hospitalized days in ICU was significantly lower in patients that were discharged (P = 0.037). Seventeen patients underwent cesarean-section (C/S) (89.4%). Mean birth week was significantly lower in patients who died in ICU (P = 0.024). Eleven preterm (57.8%) and eight term deliveries (42.1%) occurred. CONCLUSION: High mortality rate was detected among critically ill pregnant/parturient patients followed in the ICU. Main predictors of mortality were the need of invasive mechanical ventilation and higher number of days hospitalized in ICU. Rate of C/S operations and preterm delivery were high. Pleasingly, the rate of neonatal death was low and no neonatal COVID-19 occurred.


Subject(s)
COVID-19/mortality , Pregnancy Complications, Infectious/mortality , Puerperal Disorders/mortality , SARS-CoV-2 , Adult , Antiviral Agents/therapeutic use , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/therapy , Cesarean Section , Combined Modality Therapy , Critical Illness/mortality , Delivery, Obstetric/statistics & numerical data , Female , Hospital Mortality , Humans , Infant, Newborn , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Lung/diagnostic imaging , Oxygen Inhalation Therapy , Pregnancy , Pregnancy Outcome , Respiration, Artificial , Retrospective Studies , Treatment Outcome , Young Adult
16.
Medwave ; 21(11): e8500, 2021 Dec 15.
Article in Spanish, English | MEDLINE | ID: covidwho-1574130

ABSTRACT

Introduction: COVID-19 disease affects newborns, but its middle and long-term effects are still unclear. Objective: To describe the clinical and epidemiological characteristics and follow-up of newborns infected with SARS-CoV-2. Methods: An observational and descriptive study. We included newborns with SARS-CoV-2 positive RT-PCR born from SARS-CoV-2 seropositive mothers. Delivery and newborn care were provided at the 'Instituto Nacional Materno Perinatal' from Peru between June 1 and September 30, 2020. Perinatal information was collected from medical records. Remote follow-up and face-to-face evaluations gathered epidemiological and clinical information, in addition to serological and RT-PCR tests for SARS-CoV-2. Descriptive statistics were used for analysis. Results: During the study period, 4733 neonates were born at the institution. We found that 1488 (31.4%) were born from seropositive for SARS-CoV-2 mothers. Finally, we included the 34 (2.3%) newborns with positive RT-PCR for SARS-CoV-2. Regarding the included newborns, 29.4% were delivered by cesarean section, 26.5% had low birth weight, 11.8% were preterm, 26.5% were hospitalized, and one died. Twenty-eight had a remote follow-up, and 18 also had a face-to-face follow-up. A total of 64.3% were exclusively breastfed, 28.6% were mixed breastfed, and 7.1% used a substitute formula. The face-to-face evaluation was performed between one and four months of chronological age. We found that 100% had negative control RT-PCR test for COVID-19, 38.9% had a negative serological test (IgM, IgG), and 61.1% positive IgG. Conclusions: Neonatal SARS-CoV-2 infection is rare, and most infected infants are asymptomatic. Vaginal delivery, breastfeeding, and joint isolation did not related with complications during hospital care. Infants under remote and in-person follow-up showed favorable clinical evolution during the study period.


Introducción: La enfermedad por COVID-19 ha sido reportada en recién nacidos; sin embargo, aún no son claros sus efectos en el seguimiento de neonatos. Objetivo: Describir las características clínicas, epidemiológicas y el seguimiento de recién nacidos infectados con SARS-CoV-2. Métodos: Estudio observacional y descriptivo. Participaron recién nacidos que tuvieron PCR-TR positivo a SARS-CoV-2, hijos de madres seropositivas a SARS-CoV-2. La atención del parto y del recién nacido fueron en el Instituto Nacional Materno Perinatal de Perú, entre el 1 de junio y el 30 de septiembre de 2020. Se recogió información perinatal de registros médicos. Se realizó seguimiento remoto y evaluación presencial para descripción epidemiológica, clínica y resultados de pruebas serológicas y PCR-TR para SARS-CoV-2. En el análisis se usó estadística descriptiva. Resultados: Durante el período de estudio nacieron 4733 recién nacidos. De estos niños, 1488 (31,4%) procedieron de gestantes seropositivas a SARS-CoV-2 y de ellos 34 (2,3%) tuvieron PCR-TR positivo a SARS-CoV-2. De los 34 recién nacidos 29,4% nació por cesárea, 26,5% tuvo bajo peso, 11,8% fue prematuro 26,5% tuvo indicación de hospitalización por patología y un neonato falleció. De los 34 neonatos, 28 tuvieron seguimiento remoto y de ellos 18 tuvieron además seguimiento presencial post alta. El 64,3% recibía lactancia materna exclusiva, 28,6% lactancia mixta y 7,1% usaba un sucedáneo. La evaluación presencial se realizó entre uno a cuatro meses de edad cronológica. El 100% tuvo prueba de PCR-TR de control para coronavirus negativa y 38,9% tuvo prueba serológica (IgM, IgG) negativa y 61,1% IgG positiva. Conclusiones: La infección neonatal por SARS-CoV-2 es poco frecuente, la mayoría de infectados fueron asintomáticos. El parto vaginal, la lactancia materna y aislamiento conjunto no reportaron complicaciones en la evolución durante la atención hospitalaria. Los infantes en seguimiento remoto y presencial mostraron evolución clínica favorable durante el período de estudio.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Cesarean Section , Female , Follow-Up Studies , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/epidemiology , SARS-CoV-2
18.
Infect Dis Now ; 51(5): 435-439, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1574384

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has spread rapidly across the world. Given the sharply increased infection rate, the number of pregnant women and children with COVID-19 is correspondingly on the rise. SARS-CoV-2 infection is transmitted through droplets; though hypothesized, other transmission routes have not been confirmed. As of now, it remains unclear whether and how SARS-CoV-2 can possibly be transmitted from the mother to the fetus. METHOD: This study examines the medical records of 30 neonates born to women with COVID-19, the objective being to provide documented information on maternal-child transmission and infant outcomes. RESULTS: Out of the 30 newborns, 28 had negative PCR test results for SARS-CoV-2; among their mothers, fifteen had fever, nine had cough and twenty had delivered by cesarean section. The median birth term was 37wk2dy, and twenty of the neonates were male. Most of them were asymptomatic, except for the three who presented with shortness of breath. Two of them were intubated and both died, the first because of severe sepsis and the second due to severe hyaline membrane disease. As regards the two infected neonates, the first represents a probable case of congenital SARS-CoV-2 infection, which appears unlikely in the second case. The outcome for both of them was good, without any complications. CONCLUSION: Maternal-fetal transmission of the SARS- CoV-2 virus was not detected in the majority of the reported cases, although two of 30 neonates had positive qRT-PCR test results. Our study supports the hypothesis that though it seldom actually occurs, in utero SARS-CoV-2 vertical transmission is possible.


Subject(s)
COVID-19/transmission , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/virology , Adult , COVID-19/diagnosis , Cesarean Section/statistics & numerical data , Female , Fever/epidemiology , Humans , Infant, Newborn , Male , Mothers , Polymerase Chain Reaction , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , Pregnant Women , SARS-CoV-2/isolation & purification
19.
J Addict Nurs ; 32(4): 260-262, 2021.
Article in English | MEDLINE | ID: covidwho-1574196

ABSTRACT

BACKGROUND: In December 2019, the novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China, and now, it has spread all over the world. Pregnant women are a susceptible population, but there is scant information about COVID-19 in this population. Here, we report a case of a mother with substance use disorders who was infected with COVID-19 in her pregnancy. CASE: The patient was a 29-year-old, primigravida mother at the 37th gestational week who was referred to our center because of vaginal bleeding and severe uterine contractions. The patient was abusing opioids. With the suspicion of placental abruption, she was admitted for cesarean section. One day after delivery, she developed dyspnea, rhinorrhea, and vomiting. These were thought of as withdrawal signs. Despite methadone administration, these signs persisted. After ruling out deprivation syndrome and possible obstetric causes, a SARS-CoV-2 Polymerase chain reaction (PCR) test was ordered; the result was positive. CONCLUSION: In this case, because of the flu-like symptoms of substance withdrawal and postpartum causes of shortness of breath, the medical team's attention was drawn to these causes. SARS-CoV-2 infection should be considered as a differential diagnosis for these patients.


Subject(s)
COVID-19 , Substance-Related Disorders , Adult , Cesarean Section , Female , Humans , Mothers , Placenta , Pregnancy , SARS-CoV-2 , Substance-Related Disorders/complications
20.
Viruses ; 13(12)2021 12 15.
Article in English | MEDLINE | ID: covidwho-1572671

ABSTRACT

Neonatal COVID-19 is rare and mainly results from postnatal transmission. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), however, can infect the placenta and compromise its function. We present two cases of decreased fetal movements and abnormal fetal heart rhythm 5 days after mild maternal COVID-19, requiring emergency caesarean section at 29 + 3 and 32 + 1 weeks of gestation, and leading to brain injury. Placental examination revealed extensive and multifocal chronic intervillositis, with intense cytoplasmic positivity for SARS-CoV-2 spike antibody and SARS-CoV-2 detection by RT-qPCR. Vertical transmission was confirmed in one case, and both neonates developed extensive cystic peri-ventricular leukomalacia.


Subject(s)
Brain Injuries/etiology , COVID-19/complications , Placenta/virology , Pregnancy Complications, Infectious/virology , Adult , Brain Injuries/pathology , COVID-19/physiopathology , COVID-19/virology , Cesarean Section , Female , Fetal Movement , Humans , Infant, Newborn , Infant, Premature , Infectious Disease Transmission, Vertical , Leukomalacia, Periventricular/etiology , Leukomalacia, Periventricular/pathology , Placenta/pathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , SARS-CoV-2/isolation & purification
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