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1.
BMC Pregnancy Childbirth ; 22(1): 454, 2022 May 31.
Article in English | MEDLINE | ID: covidwho-1866292

ABSTRACT

BACKGROUND: The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes. METHODS: We searched for publications that compared SMBP with clinic-based monitoring during antenatal care. We included studies measuring any of the following outcomes: maternal mortality, pre-eclampsia, long-term risk and complications, autonomy, HELLP syndrome, C-section, antenatal hospital admission, adverse pregnancy outcomes, device-related issues, follow-up care with appropriate management, mental health and well-being, social harms, stillbirth or perinatal death, birthweight/size for gestational age, and Apgar score. After abstract screening and full-text review, we extracted data using standardized forms and summarized findings. We also reviewed studies assessing values and preferences as well as costs of SMBP. RESULTS: We identified 6 studies meeting inclusion criteria for the effectiveness of SMBP, 6 studies on values and preferences, and 1 study on costs. All were from high-income countries. Overall, when comparing SMBP with clinic-monitoring, there was no difference in the risks for most of the outcomes for which data were available, though there was some evidence of increased risk of C-section among pregnant women with chronic hypertension. Most end-users and providers supported SMBP, motivated by ease of use, convenience, self-empowerment and reduced anxiety. One study found SMBP would lower health sector costs. CONCLUSION: Limited evidence suggests that SMBP during pregnancy is feasible and acceptable, and generally associated with maternal and neonatal health outcomes similar to clinic-based monitoring. However, more research is needed in resource-limited settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021233839 .


Subject(s)
COVID-19 , Hypertension, Pregnancy-Induced , Pre-Eclampsia , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Female , Humans , Hypertension, Pregnancy-Induced/diagnosis , Infant, Newborn , Pre-Eclampsia/diagnosis , Pregnancy
2.
Acta Obstet Gynecol Scand ; 101(7): 803-808, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1819875

ABSTRACT

INTRODUCTION: The association between preeclampsia and coronavirus disease 2019 (COVID-19) is under study. Previous publications have hypothesized the existence of shared risk factors for both conditions or a deficient trophoblastic invasion as possible explanations for this association. The primary aim of this study was to examine baseline risk factors measured in the first-trimester combined screening for preeclampsia in pregnant women with COVID-19 compared with the general population. A secondary aim of this study was to compare risk factors among patients with mild and severe COVID-19. MATERIAL AND METHODS: This was an observational retrospective study conducted at Vall d'Hebron Hospital Campus (Catalonia, Spain). Study patients were 231 pregnant women undergoing the first-trimester screening for preeclampsia and positive for severe acute respiratory syndrome coronavirus 2 between February 2020 and September 2021. The reference cohort were 13 033 women of the general population from six centers across Catalonia from May 2019 to June 2021. Based on the need for hospitalization, patients were classified in two groups: mild and severe COVID-19. First-trimester screening for preeclampsia included maternal history, mean arterial blood pressure, mean uterine artery pulsatility index (UtAPI), placental growth factor (PlGF), and pregnancy-associated plasma protein-A (PAPP-A). RESULTS: The proportion of cases at high risk for preeclampsia was significantly higher among the COVID-19 group compared with the general population (19.0% and 13.2%, respectively; p = 0.012). When analyzing risk factors for preeclampsia individually, women with COVID-19 had higher median body mass index (25.2 vs 24.5, p = 0.041), higher UtAPI multiple of the median (MoM) (1.08 vs 1.00, p < 0.001), higher incidence of chronic hypertension (2.8% vs 0.9%, p = 0.015), and there were fewer smokers (5.7% vs 11.6%, p = 0.007). The MoMs of PlGF and PAPP-A did not differ significantly between both groups (0.96 vs 0.97, p = 0.760 and 1.00 vs 1.01, p = 0.432; respectively). CONCLUSIONS: In patients with COVID-19, there was a higher proportion of women at high risk for preeclampsia at the first-trimester screening than in the general population, mainly because of maternal risk factors, rather than placental signs of a deficient trophoblastic invasion.


Subject(s)
COVID-19 , Pre-Eclampsia , Biomarkers , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Placenta/metabolism , Placenta Growth Factor , Pre-Eclampsia/diagnosis , Pre-Eclampsia/epidemiology , Pregnancy , Pregnancy Trimester, First/physiology , Pregnancy-Associated Plasma Protein-A , Retrospective Studies , Risk Factors , Uterine Artery
3.
Am J Obstet Gynecol MFM ; 4(3): 100613, 2022 05.
Article in English | MEDLINE | ID: covidwho-1739502

ABSTRACT

BACKGROUND: New-onset postpartum preeclampsia has a higher risk of maternal morbidity and mortality than preeclampsia with antepartum onset, underscoring the need for earlier identification of elevated blood pressure among patients with this condition. Given the decrease in healthcare engagement, which is typical of the postpartum period, new-onset postpartum hypertension often goes unrecognized. Currently, there are no recommendations for universal postpartum blood pressure surveillance in women without hypertensive disorders of pregnancy. With the shift to telemedicine because of the COVID-19 pandemic, our institution's approach was to distribute blood pressure cuffs to women receiving any portion of their prenatal care virtually, thus also providing access to an opportunity for blood pressure measurement during the postpartum period for all women. OBJECTIVE: To explore the feasibility of a patient-driven universal postpartum home blood pressure monitoring program in women without a previous diagnosis of a hypertensive disorder. STUDY DESIGN: This was a prospective observational study of all postpartum women who were discharged from our institution from July 2020 through June 2021 and who were not previously identified to have hypertension. A clinical algorithm was developed and followed. All the women received discharge educational materials and were called at a 1-week interval by a nurse to review blood pressure and preeclampsia symptoms. The maternal demographics and delivery outcomes were recorded. RESULTS: Of the 10,092 deliveries during the study period, 5959 (59%) were successfully contacted. 352 were excluded, as they did not deliver at the primary hospital; 1052 (18%) had a previous hypertensive disorder of pregnancy diagnosis; 1522 (26%) did not have a blood pressure cuff; and 1841 (31%) planned to take their blood pressure at a later time. Precautions and blood pressure parameters were given to this last group. Of the remaining 1192, 222 (19%) had an initial elevated blood pressure. Of these, 98 had a second elevated blood pressure on recheck; 17 were referred to the emergency room for evaluation, with 8 being diagnosed with severe preeclampsia; and the remainder were recommended to follow with their obstetrical provider and enrolled in our institution's remote blood pressure management program. Of the 1192 women, 8% potentially had a new diagnosis of a hypertensive disorder of pregnancy, with 0.7% having severe hypertension. Women with elevated blood pressures were more likely to be of non-Hispanic Black race and have a higher early pregnancy body mass index than those without elevated blood pressures. CONCLUSION: Our study indicates that a patient-driven postpartum blood pressure monitoring program is feasible and may be incorporated using existing resources. In addition, our findings suggest that the incidence of new-onset postpartum hypertensive disorders of pregnancy may be higher than previously assessed in retrospective cohorts. Thus, there may be a role for closer surveillance of all women with patient-driven home blood pressure monitoring, particularly those with risk factors or in the setting of limited resources.


Subject(s)
COVID-19 , Hypertension, Pregnancy-Induced , Pre-Eclampsia , Puerperal Disorders , Blood Pressure , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Feasibility Studies , Female , Humans , Hypertension, Pregnancy-Induced/diagnosis , Hypertension, Pregnancy-Induced/epidemiology , Hypertension, Pregnancy-Induced/prevention & control , Male , Pandemics , Postpartum Period/physiology , Pre-Eclampsia/diagnosis , Pre-Eclampsia/epidemiology , Pre-Eclampsia/prevention & control , Pregnancy , Puerperal Disorders/diagnosis , Puerperal Disorders/epidemiology , Retrospective Studies
4.
Sci Rep ; 12(1): 4109, 2022 03 08.
Article in English | MEDLINE | ID: covidwho-1735290

ABSTRACT

Preeclampsia and cardiovascular disease (CVD) share multiple features and risk factors. Circulating angiotensin-converting enzyme 2 (ACE2) is increased in CVD and mediates SARS-CoV-2 entry into host cells, causing COVID-19 infection. The role of ACE2 in preeclampsia pathophysiology is unknown. We hypothesized that circulating ACE2 is increased in mid-pregnancy in women later developing preeclampsia. We included 296 women later developing preeclampsia (cases) and 333 women with a continuous healthy pregnancy (controls). Circulating ACE2 was measured with an immunoassay based on proximity extension assay technology, with levels being expressed as relative quantification on a log2 scale. Median (interquartile range) ACE2 levels were higher in cases than in controls; 3.84 (3.50-4.24) vs. 3.72 (3.45-4.04), p = 0.002. Adjusted logistic regression models showed a 60% increased risk for later development of preeclampsia with one unit elevation of ACE2 (adjusted odds ratio (aOR) 1.60, 95% confidence intervals (CI) 1.17-2.18). Preterm preeclampsia (diagnosis before 37 gestational weeks, n = 97) seemed to have a stronger ACE2 association than term preeclampsia, n = 199 (aORs, 95% Cis 2.14, 1.15-3.96 and 1.52, 1.04-2.23, respectively). Circulating ACE2 is increased at mid-pregnancy in women later developing preeclampsia, particularly preterm preeclampsia. Thus, our finding indicates a partly shared pathophysiological pathway between preeclampsia and CVD.


Subject(s)
Angiotensin-Converting Enzyme 2/blood , Pre-Eclampsia/diagnosis , Adult , Body Mass Index , Cardiovascular Diseases/complications , Cardiovascular Diseases/pathology , Case-Control Studies , Female , Gestational Age , Hospitals, University , Humans , Logistic Models , Odds Ratio , Pre-Eclampsia/pathology , Pregnancy , Risk Factors , Sweden
8.
J Obstet Gynaecol Can ; 44(2): 193-195, 2022 02.
Article in English | MEDLINE | ID: covidwho-1458741

ABSTRACT

BACKGROUND: Hypertension, proteinuria, and hepatic dysfunction have been described as manifestations of coronavirus disease 2019 (COVID-19) and are generally accepted as poor prognostic factors. However, these same findings can also occur in pregnant women with preeclampsia, thus creating a diagnostic challenge. CASE: We report a case of COVID-19 infection in an otherwise healthy pregnant patient with secondary hypertension, proteinuria, and significant hepatic dysfunction. Maternal placental growth factor (PlGF) testing was used to rule out preeclampsia. The patient received supportive care and improved significantly. She went on to have a spontaneous vaginal term delivery of a healthy male baby. CONCLUSION: COVID-19 infection in pregnancy may present as preeclampsia-like syndrome. PlGF testing can be used to differentiate preeclampsia from COVID-19 and facilitate appropriate management.


Subject(s)
COVID-19 , Pre-Eclampsia , Biomarkers , Female , Humans , Male , Placenta Growth Factor , Pre-Eclampsia/diagnosis , Pregnancy , SARS-CoV-2 , Vascular Endothelial Growth Factor Receptor-1
10.
CMAJ ; 193(22): E813-E822, 2021 05 31.
Article in French | MEDLINE | ID: covidwho-1249582

ABSTRACT

CONTEXTE: La nature exacte des répercussions de la maladie à coronavirus 2019 (COVID-19) sur la santé maternelle et néonatale reste à préciser. Nous avons cherché à évaluer l'association entre l'infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) pendant la grossesse et les issues défavorables de la grossesse. MÉTHODES: Nous avons réalisé une revue systématique et une méta-analyse d'études observationnelles fournissant des données comparatives sur l'infection par le SRAS-CoV-2 et la gravité de la COVID-19 pendant la grossesse. Nous avons sélectionné les études admissibles à partir des bases de données MEDLINE, Embase, ClinicalTrials.gov, medRxiv et Cochrane au 29 janvier 2021, en utilisant les Medical Subject Headings (vedettes matière en médecine) et les expressions clés « severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2 OR coronavirus disease 2019 OR COVID-19 ¼ (coronavirus du syndrome respiratoire aigu sévère 2 ou SRAS-CoV-2 ou maladie à coronavirus 2019 ou COVID-19) AND « pregnancy ¼ (grossesse). Nous avons ensuite évalué la qualité méthodologique de toutes les études retenues avec l'échelle de Newcastle­Ottawa. Les issues primaires étaient la prééclampsie et la naissance prématurée. Les issues secondaires incluaient la mortinaissance et le diabète gestationnel, ainsi que d'autres issues de grossesse. Nous avons calculé des rapports de cotes (RC) sommaires ou des différences moyennes pondérées avec des intervalles de confiance (IC) à 95 % par méta-analyse à effets aléatoires. RÉSULTATS: Nous avons retenu 42 études portant sur 438 548 personnes enceintes. Comparativement à une absence d'infection par le SRAS-CoV-2 pendant la grossesse, le diagnostic de COVID-19 a été associé à la prééclampsie (RC 1,33; IC à 95 % 1,03­1,73), à la naissance prématurée (RC 1,82; IC à 95 % 1,38­2,39) et à la mortinaissance (RC 2,11; IC à 95 % 1,14­3,90). Par rapport à la COVID-19 légère, la COVID-19 grave était fortement associée à la prééclampsie (RC 4,16; IC à 95 % 1,55­11,15), à la naissance prématurée (RC 4,29; IC à 95 % 2,41­7,63), au diabète gestationnel (RC 1,99; IC à 95 % 1,09­3,64) et au faible poids à la naissance (RC 1,89; IC à 95 % 1,14­3,12). INTERPRÉTATION: La COVID-19 pourrait être associée à un risque accru de prééclampsie, de naissance prématurée et d'autres issues défavorables de la grossesse.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Diabetes, Gestational/diagnosis , Diabetes, Gestational/virology , Female , Humans , Incidence , Infant, Low Birth Weight , Pre-Eclampsia/diagnosis , Pre-Eclampsia/virology , Pregnancy , Premature Birth/diagnosis , Premature Birth/virology , Severity of Illness Index , Stillbirth
11.
Am J Hematol ; 96(8): 1049-1055, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1227715

ABSTRACT

The metalloproteinase ADAMTS13 (a disintegrin with a thrombospondin type 1 motif, member 13), also known as VWF (von Willebrand factor) protease, may be assessed in a vast array of clinical conditions. Notably, a severe deficiency of ADAMTS13 characterizes TTP (thrombotic thrombocytopenic purpura), a rare but potentially fatal disorder associated with thrombosis due to accumulation of prothrombotic ultra-large VWF multimers. Although prompt identification/exclusion of TTP can be facilitated by rapid ADAMTS13 testing, the most commonly utilized assays are based on ELISA (enzyme linked immunosorbent assay) and require long turnaround time and have relatively limited throughput. Nevertheless, several rapid ADAMTS13 assays are now available, at least in select geographies. The current mini-review discusses these issues, as well as the potential utility of ADAMTS13 testing in a range of other conditions, including coronavirus disease 2019 (COVID-19).


Subject(s)
ADAMTS13 Protein/blood , COVID-19/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , SARS-CoV-2 , ADAMTS13 Protein/deficiency , ADAMTS13 Protein/immunology , Autoantibodies/blood , Autoantibodies/immunology , COVID-19/blood , Enzyme-Linked Immunosorbent Assay , Female , Fluorescence Resonance Energy Transfer , Humans , Luminescent Measurements , Male , Multicenter Studies as Topic , Pre-Eclampsia/diagnosis , Pre-Eclampsia/enzymology , Predictive Value of Tests , Pregnancy , Purpura, Thrombotic Thrombocytopenic/blood , Purpura, Thrombotic Thrombocytopenic/enzymology , Purpura, Thrombotic Thrombocytopenic/etiology , Recombinant Proteins/metabolism , Sensitivity and Specificity , von Willebrand Diseases/diagnosis , von Willebrand Diseases/enzymology , von Willebrand Factor/metabolism
12.
Semin Perinatol ; 44(7): 151280, 2020 11.
Article in English | MEDLINE | ID: covidwho-1027921

ABSTRACT

OBJECTIVE: To describe inpatient management strategies and considerations for pregnant patients with severe acute respiratory syndrome coronavirus 2 infection. FINDINGS: The novel coronavirus has posed challenges to both obstetric patients and the staff caring for them, due to its variable presentation and current limited knowledge about the disease. Inpatient antepartum, intrapartum and postpartum management can be informed by risk stratification, severity of disease, and gestational age. Careful planning and anticipation of emergent situations can prevent unnecessary exposures to patients and clinical staff. CONCLUSION: As new data arises, management recommendations will evolve, thus practitioners must maintain a low threshold for adaptation of their clinical practice during obstetric care for patients with severe acute respiratory syndrome coronavirus 2 infection.


Subject(s)
COVID-19/therapy , Delivery, Obstetric , Fetal Monitoring , Hospitalization , Pregnancy Complications, Infectious/therapy , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19 Nucleic Acid Testing , Cesarean Section , Chorioamnionitis/diagnosis , Delivery Rooms , Diagnosis, Differential , Disease Management , Endometritis/diagnosis , Female , Fetal Organ Maturity , Gestational Age , HELLP Syndrome/diagnosis , Humans , Immunization, Passive , Influenza, Human/diagnosis , Intensive Care Units , Labor, Induced , Obstetric Labor, Premature/drug therapy , Patient Discharge , Patient Isolators , Personal Protective Equipment , Postnatal Care , Practice Guidelines as Topic , Pre-Eclampsia/diagnosis , Pregnancy , Pyelonephritis/diagnosis , Rooming-in Care , SARS-CoV-2 , Severity of Illness Index , Thrombosis/prevention & control , Time Factors , Tocolytic Agents/therapeutic use
13.
Am J Emerg Med ; 39: 252.e3-252.e5, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1023404

ABSTRACT

The evolving coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a rapid expansion of knowledge on the disease's clinical manifestations, laboratory and radiographic abnormalities, and patient trajectories. One area of particular focus is the effect that this illness may have on pregnancy and maternal-fetal disease. As of April 24, 2020, we identified 55 English language reports in the scientific literature summarizing data for 339 women and 258 fetuses and neonates. The majority of these data have focused on maternal-fetal transmission and neonatal outcomes. One systematic review and meta-analysis including the spectrum of coronaviruses [Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and COVID-19] in pregnancy noted increased rates of adverse outcomes associated with this group of infections. Here, we report the case of a COVID-19 positive woman presenting to our emergency department (ED) at 34 weeks gestation with preeclampsia. This case highlights the unique diagnostic and therapeutic challenges associated with treating patients with these concomitant diseases.


Subject(s)
COVID-19/diagnosis , Pre-Eclampsia/diagnosis , Pregnancy Complications, Infectious/virology , Adult , Female , Gestational Age , Humans , Pre-Eclampsia/virology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Radiography, Thoracic , Tomography, X-Ray Computed
15.
Pregnancy Hypertens ; 23: 136-139, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-894167

ABSTRACT

The early postpartum period is crucial for mothers who have a complicated delivery due to preeclampsia. In mothers with symptoms of COVID-19, there may be severe and sometimes fatal consequences. We report the first maternal death in Balouchestan (Iran) due to complicated delivery with preeclampsia concomitant with COVID-19 postpartum. The patient was asymptomatic for COVID-19 during the delivery and rapidly progressed to severe respiratory distress and coagulopathy in the early postpartum period. Mothers with preeclampsia features may be at risk for severe COVID-19, and detailed assessments are essential for these patients during the COVID-19 pandemic.


Subject(s)
COVID-19/diagnosis , Pre-Eclampsia/diagnosis , Pregnancy Complications, Infectious/diagnosis , Prenatal Care , Puerperal Disorders/diagnosis , SARS-CoV-2 , Diagnosis, Differential , Female , Humans , Pre-Eclampsia/diagnostic imaging , Pregnancy , Young Adult
16.
BMJ Case Rep ; 13(8)2020 Aug 11.
Article in English | MEDLINE | ID: covidwho-712861

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.


Subject(s)
Acute Kidney Injury/complications , Betacoronavirus , Coronavirus Infections/complications , Fatty Liver/complications , HELLP Syndrome/diagnosis , Pneumonia, Viral/complications , Pre-Eclampsia/diagnosis , Pregnancy Complications, Infectious/diagnosis , Acute Kidney Injury/blood , Acute Kidney Injury/diagnosis , Adult , COVID-19 , Coronavirus Infections/blood , Fatty Liver/blood , Fatty Liver/diagnosis , Female , HELLP Syndrome/blood , Humans , Kidney Function Tests , Pandemics , Pneumonia, Viral/blood , Pre-Eclampsia/blood , Pregnancy , Pregnancy Complications/blood , Pregnancy Complications/diagnosis , Pregnancy Complications, Infectious/blood , SARS-CoV-2
17.
Adv Chronic Kidney Dis ; 27(5): 397-403, 2020 09.
Article in English | MEDLINE | ID: covidwho-695253

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a rapidly spreading pandemic. Owing to changes in the immune system and respiratory physiology, pregnant women are vulnerable to severe viral pneumonia. We review the clinical course, pregnancy outcomes, and management of women with COVID-19 in pregnancy with a focus on those with kidney involvement. Current evidence does not show an increased risk of acquiring SARS-CoV-2 during pregnancy and the maternal course appears to be similar to nonpregnant patients. However, severe maternal disease can lead to complex management challenges and has shown to be associated with higher incidence of preterm and caesarean births. The risk of congenital infection with SARS-CoV-2 is not known. All neonates must be considered as high-risk contacts and should be screened at birth and isolated. Pregnant women should follow all measures to prevent SARS-CoV-2 exposure and this fear should not compromise antenatal care. Use of telemedicine, videoconferencing, and noninvasive fetal and maternal home monitoring devices should be encouraged. High-risk pregnant patients with comorbidities and COVID-19 require hospitalization and close monitoring. Pregnant women with COVID-19 and kidney disease are a high-risk group and should be managed by a multidisciplinary team approach including a nephrologist and neonatologist.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/therapy , Kidney Transplantation , Pregnancy Complications, Infectious/therapy , Pregnancy Complications/therapy , Renal Insufficiency, Chronic/therapy , Acute Kidney Injury/etiology , COVID-19/complications , COVID-19/prevention & control , COVID-19/transmission , Cesarean Section/statistics & numerical data , Diagnosis, Differential , Disease Management , Female , Humans , Infectious Disease Transmission, Vertical , Kidney Cortex Necrosis/complications , Kidney Cortex Necrosis/diagnosis , Patient Care Team , Pre-Eclampsia/diagnosis , Pregnancy , Premature Birth/epidemiology , Prenatal Care/methods , Pyelonephritis/complications , Pyelonephritis/diagnosis , Renal Insufficiency, Chronic/complications , SARS-CoV-2 , Telemedicine/methods , Thrombotic Microangiopathies/complications , Thrombotic Microangiopathies/diagnosis
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