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1.
Rev Bras Ginecol Obstet ; 43(12): 949-960, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1585700

ABSTRACT

OBJECTIVE: To analyze the clinical and obstetric aspects of pregnant women with COVID-19. METHODS: A systematic literature review in the MEDLINE/PubMed, LILACS, SCIELO, and CNKI databases was performed from March to May 2020, with the descriptors: Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Of those chosen were original titles, without language and period restriction and that addressed pregnant women with a clinical and/or laboratory diagnosis of COVID-19. Revisions, editorials, and duplicate titles were excluded. The Newcastle-Ottawa (NOS) and Murad et al. scales were used to assess the quality of the studies. RESULTS: We included 34 articles with 412 pregnant women infected with severe acute respiratory syndrome (SARS-Cov-2), with an average age of 27.5 years of age and 36.0 gestational weeks. The most common symptom was fever (205 [49.7%]), and 89 (21.6%) pregnant women progressed to severe viral pneumonia. Laboratory tests showed an increase in C-reactive protein (154 [37.8%]), and radiological tests showed pneumonia with peripheral ground-glass pattern (172 [51.4%]). Emergency cesarean delivery was indicated for most pregnant women, and the most common gestational complication was premature rupture of ovarian membranes (14 [3.4%;]). We detected 2 (0.5%) neonatal deaths, 2 (0.5%) stillbirths, and 1 (0.2%) maternal death. CONCLUSION: Pregnant women with COVID-19 presented a clinical picture similar to that of non-infected pregnant women, with few obstetric or neonatal repercussions. There was a greater indication of cesarean deliveries before the disease aggravated, and there was no evidence of vertical transmission of the infection.


OBJETIVO: Analisar os aspectos clínicos e obstétricos de gestantes com COVID-19. MéTODOS: Revisão sistemática da literatura nas bases: MEDLINE/PubMed, LILACS, SCIELO e CNKI, realizada de março a maio de 2020, com os descritores Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Elegeram-se títulos originais, sem restrição de idioma e período e que abordassem gestantes com diagnóstico clínico e/ou laboratorial de COVID-19. Excluíram-se revisões, editoriais, títulos duplicados. As escalas de Newcastle-Ottawa (NOS, na sigla em inglês) e a de Murad et al. foram utilizadas para avaliar a qualidade dos estudos. RESULTADOS: Foram incluídos 34 artigos com 412 gestantes infectadas pela síndrome respiratória aguda grave (SARS-Cov, na sigla em inglês) com idade média de 27,5 anos e média de 36,0 semanas gestacionais. O sintoma mais incidente foi a febre (49,7%;205). e 89 (21,6%) gestantes evoluíram para pneumonia viral grave. Os exames laboratoriais demonstraram aumento da proteína C reativa (37,8%; 154) e os radiológicos mostraram pneumonia com padrão em vidro fosco periférico (51,4%; 172). O parto cesáreo de emergência foi indicado para a maior parte das gestantes, e a complicação gestacional mais comum foi a ruptura prematura de membranas ovulares (3,4%; 14). Foram detectados 2 (0,5%) mortes neonatais, 2 (0,5%) natimortos, e 1 (0,2%) morte materna. CONCLUSãO: Gestantes com doença coronavírus (COVID-19, na sigla em inglês apresentaram quadro clínico semelhante a gestantes não infectadas, com poucas repercussões obstétricas ou neonatais. Houve uma maior indicação de partos cesáreos antes do agravamento da doença e não se observaram evidências de transmissão vertical da infecção.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Premature Birth , Adult , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Pregnant Women , SARS-CoV-2
2.
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
3.
Eur J Obstet Gynecol Reprod Biol ; 263: 106-116, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1544979

ABSTRACT

The novel severe acute respiratory syndrome (SARS) coronavirus-2 which causes COVID-19 disease results in severe morbidity and mortality especially in vulnerable groups. Pregnancy by virtue of its physiological and anatomical adaptations increases the risk of severe infections especially those of the respiratory tract. This single stranded RNA virus is transmitted by droplets as well as soiled fomites. There are various degrees of disease severity- asymptomatic, mild, moderate severe and critical. Most infections in pregnancy are asymptomatic or mildly symptomatic. For these women, the consequences on the mother or pregnancy are minimal unless they have additional risk factors such as diabetes, hypertension, cardiorespiratory disease, obesity or are of ethnic minority background. Most women with symptoms will present with fever, unproductive cough, sore throat, myalgia, nasal congestion, loss of smell and taste with associated leukocytosis and lymphopenia. Diagnosis is by RT-PCR on nasopharyngeal flocked swabs or saliva and pathognomonic features of ground-glass appearance and pulmonary infiltrates on chest X-ray or CT scans. Management in pregnancy is same as that for non-pregnant women with COVID-19. It is not an indication for elective delivery but assisted delivery in the second stage for those with moderate, severe or critical disease may be required to shorten this stage. COVID-19 is not an indication for interrupting pregnancy or caesarean section but the latter may be performed to facilitate ventilation support or resuscitation in those with severe disease. Pain relief in labour should not be different but regional analgesia is preferred for operative deliveries. Postpartum thromboprophylaxis should be considered and breast feeding encouraged with appropriate precautions to minimize vertical transmission. Pregnant and lactating women should be encouraged to receive the mRNA based vaccines as there is no evidence of adverse outcomes with these.


Subject(s)
COVID-19 , Labor, Obstetric , Pregnancy Complications, Infectious , Venous Thromboembolism , Anticoagulants , Cesarean Section , Female , Humans , Infectious Disease Transmission, Vertical , Lactation , Minority Groups , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , SARS-CoV-2
5.
BMC Pregnancy Childbirth ; 21(1): 760, 2021 Nov 10.
Article in English | MEDLINE | ID: covidwho-1511731

ABSTRACT

BACKGROUND: Infection with SARS-CoV-2 during pregnancy can lead to a severe condition in the patient, which is challenging for obstetricians and anaesthesiologists. Upon severe COVID-19 and a lack of improvement after multidrug therapy and mechanical ventilation, extracorporeal membrane oxygenation (ECMO) is introduced as the last option. Such treatment is critical in women with very preterm pregnancy when each additional day of the intrauterine stay is vital for the survival of the newborn. CASE PRESENTATION: We report a case of a 38-year-old woman at 27 weeks of gestation treated with multidrug therapy and ECMO. The woman was admitted to the intensive care unit (ICU) with increasing fever, cough and dyspnoea. The course of the pregnancy was uncomplicated. She was otherwise healthy. At admission, she presented with severe dyspnoea, with oxygen saturation (SpO2) of 95% on passive oxygenation, heart rate of 145/min, and blood pressure of 145/90. After confirmation of SARS-CoV-2 infection, she received steroids, remdesivir and convalescent plasma therapy. The foetus was in good condition. No signs of an intrauterine infection were visible. Due to tachypnea of 40/min and SpO2 of 90%, the woman was intubated and mechanically ventilated. Due to circulatory failure, the prothrombotic activity of the coagulation system, further saturation worsening, and poor control of sedation, she was qualified for veno-venous ECMO. An elective caesarean section was performed at 29 weeks on ECMO treatment in the ICU. A preterm female newborn was delivered with an Apgar score of 7 and a birth weight of 1440 g. The newborn had no laboratory or clinical evidence of COVID-19. The placenta showed the following pathological changes: large subchorionic haematoma, maternal vascular malperfusion, marginal cord insertion, and chorangioma. CONCLUSIONS: This case presents the successful use of ECMO in a pregnant woman with acute respiratory distress syndrome in the course of severe COVID-19. Further research is required to explain the aetiology of placental disorders (e.g., maternal vascular malperfusion lesions or thrombotic influence of COVID-19). ECMO treatment in pregnant women remains challenging; thus, it should be used with caution. Long-term assessment may help to evaluate the safety of the ECMO procedure in pregnant women.


Subject(s)
COVID-19/therapy , Extracorporeal Membrane Oxygenation/methods , Placenta/pathology , Pregnancy Complications, Infectious/therapy , Adult , COVID-19/diagnosis , Cesarean Section , Female , Humans , Placenta/virology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Trimester, Second , Treatment Outcome
6.
Arch. argent. pediatr ; 119(5): e531-e535, oct. 2021. tab, ilus
Article in English, Spanish | LILACS (Americas) | ID: covidwho-1502724

ABSTRACT

La enfermedad por coronavirus de 2019 (COVID-19), causada por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), se convirtió en la primera pandemia del siglo XXI. La infección por SARS-CoV-2 se transmite principalmente a través de las gotículas. Si bien se han informado algunos casos de transmisión perinatal, no es claro si estas infecciones fueron resultado de la vía de contagio transplacentario o transcervical o de la exposición ambiental. En este artículo, presentamos el caso de un recién nacido que falleció por síndrome de dificultad respiratoria aguda neonatal con compromiso pulmonar grave. El bebé nació por cesárea de una madre con una PCR positiva para COVID-19 y se detectó que tenía una PCR positiva para COVID-19 mediante un hisopado nasofaríngeo en el transcurso de las 24 horas posteriores al parto debido a una sospecha de transmisión transplacentaria del SARS-CoV-2 de la madre al feto.


Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the first pandemic of the 21st century. SARS-CoV-2 infection is mainly transmitted via droplets. Although some cases of peri-natal transmission have been reported, it is unclear whether these infections occurred via transplacental or transcervical routes or via environmental exposure. Herein, we present the case of a newborn who died with neo-natal acute respiratory distress syndrome exhibiting severe pulmonary involvement. The baby was born to a COVID-19 PCR (+) mother by C-section and was found to be COVID-19 PCR (+) from a nasopharyngeal swab sample tested within 24 hours of birth due to the suspected transplacental transmission of SARS-CoV-2 from the mother to the fetus.


Subject(s)
Humans , Pregnancy , Infant, Newborn , Pregnancy Complications, Infectious/diagnosis , Respiratory Distress Syndrome, Newborn/diagnosis , Respiratory Distress Syndrome, Newborn/etiology , COVID-19 , Infectious Disease Transmission, Vertical , SARS-CoV-2
7.
Int J Mol Sci ; 22(21)2021 Oct 30.
Article in English | MEDLINE | ID: covidwho-1488617

ABSTRACT

Since the COVID-19 outbreak was acknowledged by the WHO on 30 January 2020, much research has been conducted to unveil various features of the responsible SARS-CoV-2 virus. Different rates of contagion in adults, children, and pregnant women may guide us to understand the underlying infection conditions of COVID-19. In this study, we first provide a review of recent reports of COVID-19 clinical outcomes in children and pregnant women. We then suggest a mechanism that explains the curious case of COVID-19 in children/pregnant women. The unique stem cell molecular signature, as well as the very low expression of angiotensin-converting enzyme 2 and the lower ACE/ACE2 ratio in stem cells of children/pregnant women compared to adults might be the cause of milder symptoms of COVID-19 in them. This study provides the main molecular keys on how stem cells can function properly and exert their immunomodulatory and regenerative effects in COVID-19-infected children/pregnant women, while failing to replicate their role in adults. This can lay the groundwork for both predicting the pattern of spread and severity of the symptoms in a population and designing novel stem cell-based treatment and prevention strategies for COVID-19.


Subject(s)
COVID-19/diagnosis , Pregnancy Complications, Infectious/diagnosis , SARS-CoV-2/immunology , Stem Cells/physiology , Adult , Age of Onset , COVID-19/epidemiology , COVID-19/immunology , COVID-19/pathology , Child , Female , Humans , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/immunology , Pregnancy Complications, Infectious/pathology , Prognosis , Severity of Illness Index
8.
Curr Opin Pediatr ; 33(2): 181-187, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1455408

ABSTRACT

PURPOSE OF REVIEW: To provide an update on the consequences of severe acute respiratory syndrome (SARS)-CoV-2 infection on the health and perinatal outcomes of pregnant women and their infants. RECENT FINDINGS: The severity of SARS-CoV-2 infection is greater in pregnant compared to nonpregnant women as measured by rates of admission to intensive care units, mechanical ventilation, mortality, and morbidities including myocardial infarction, venous thromboembolic and other thrombotic events, preeclampsia, preterm labor, and preterm birth. The risk of transmission from mother-to-infant is relatively low (1.5-5%) as quantitated by neonatal SARS-CoV-2 testing. Infants appear to be at higher risk of testing positive for SARS-CoV-2 if the mother has tested positive within 1 week of delivery or is herself symptomatic at the time of maternity admission. The rate of positivity is not higher in infants who room in with the mother compared to infants who are initially separated and cared for in a SARS-CoV-2-free environment. Infants who test positive in the hospital have no or mild signs of disease, most of which may be attributable to prematurity, and rarely require readmission for clinical signs consistent with COVID-19. SUMMARY: Pregnant women should take precautions to avoid infection with SARS-CoV-2. Infants born to mothers who test positive for SARS-CoV-2 can receive normal neonatal care in-hospital with their mothers if mother and staff adhere to recommended infection control practices.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Pandemics , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome , Premature Birth/epidemiology , SARS-CoV-2
10.
Arch Argent Pediatr ; 119(5): e531-e535, 2021 10.
Article in English, Spanish | MEDLINE | ID: covidwho-1441337

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the first pandemic of the 21st century. SARS-CoV-2 infection is mainly transmitted via droplets. Although some cases of perinatal transmission have been reported, it is unclear whether these infections occurred via transplacental or transcervical routes or via environmental exposure. Herein, we present the case of a newborn who died with neonatal acute respiratory distress syndrome exhibiting severe pulmonary involvement. The baby was born to a COVID-19 PCR (+) mother by C-section and was found to be COVID-19 PCR (+) from a nasopharyngeal swab sample tested within 24 hours of birth due to the suspected transplacental transmission of SARS-CoV-2 from the mother to the fetus.


La enfermedad por coronavirus de 2019 (COVID-19), causada por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), se convirtió en la primera pandemia del siglo XXI. La infección por SARS-CoV-2 se transmite principalmente a través de las gotículas. Si bien se han informado algunos casos de transmisión perinatal, no es claro si estas infecciones fueron resultado de la vía de contagio transplacentario o transcervical o de la exposición ambiental. En este artículo, presentamos el caso de un recién nacido que falleció por síndrome de dificultad respiratoria aguda neonatal con compromiso pulmonar grave. El bebé nació por cesárea de una madre con una PCR positiva para COVID-19 y se detectó que tenía una PCR positiva para COVID-19 mediante un hisopado nasofaríngeo en el transcurso de las 24 horas posteriores al parto debido a una sospecha de transmisión transplacentaria del SARS-CoV-2 de la madre al feto.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Respiratory Distress Syndrome , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , SARS-CoV-2
11.
J Med Virol ; 93(10): 5864-5872, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1432419

ABSTRACT

The aim was to investigate the association of the delivery mode and vertical transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) through the samples of vaginal secretions, placenta, cord blood, or amniotic fluid as well as the neonatal outcomes. This cross-sectional study presents an analysis of prospectively gathered data collected at a single tertiary hospital. Sixty-three pregnant women with confirmed coronavirus disease 2019 (COVID-19) participated in the study. Vertical transmission of SARS-CoV-2 was analyzed with reverse transcriptase-polymerase chain reaction (RT-PCR) tests and blood tests for immunoglobulin G (IgG)-immunoglobulin M (IgM) antibodies. All patients were in the mild or moderate category for COVID-19. Only one placental sample and two of the vaginal secretion samples were positive for SARS-CoV-2. Except for one, all positive samples were obtained from patients who gave birth by cesarean. All cord blood and amniotic fluid samples were negative for SARS-CoV-2. Two newborns were screened positive for COVID-19 IgG-IgM within 24 h after delivery, but the RT-PCR tests were negative. A positive RT-PCR result was detected in a neof a mother whose placenta, cord blood, amniotic fluid, and vaginal secretions samples were negative. He died due to pulmonary hemorrhage on the 11th day of life. In conclusion, we demonstrated that SARS-CoV-2 can be detectable in the placenta or vaginal secretions of pregnant women. Detection of the virus in the placenta or vaginal secretions may not be associated with neonatal infection. Vaginal delivery may not increase the incidence of neonatal infection, and cesarean may not prevent vertical transmission. The decision regarding the mode of delivery should be based on obstetric indications and COVID-19 severity.


Subject(s)
COVID-19/transmission , SARS-CoV-2/isolation & purification , Adolescent , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Cesarean Section , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/epidemiology , Infant, Newborn, Diseases/virology , Infectious Disease Transmission, Vertical/statistics & numerical data , Male , Placenta/virology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Prospective Studies , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Tertiary Care Centers , Vagina/virology , Young Adult
12.
Ginekol Pol ; 92(10): 701-703, 2021.
Article in English | MEDLINE | ID: covidwho-1431059

ABSTRACT

OBJECTIVES: This study was carried out to visualize possible infection of the fetus during pregnancy through vertical transmission. MATERIAL AND METHODS: A descriptive observational study was conducted on a 39th week pregnant woman who was suspected COVID-19. Pregnancy was ended with a caesarean section due to epidemiological reasons. The mother and newborn were examined for COVID-19 infection using PCR swabs. RESULTS: At first there were discrepancies between SARS-CoV-2 test results from the nasopharyngeal swabs of the mother and the neonate. The mother tested positive, whereas the newborn tested negative. However, neonate's control swab was repeated within the following 48 hours and revealed a positive test result. CONCLUSIONS: The risk of vertical transmission with SARS-CoV2 is possible, therefore it is very important to isolate pregnant women from infected people to protect mothers and newborns.


Subject(s)
COVID-19/transmission , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/diagnosis , COVID-19/diagnosis , Cesarean Section , Female , Humans , Infant, Newborn , Mothers , Pregnancy
13.
Viruses ; 13(9)2021 09 21.
Article in English | MEDLINE | ID: covidwho-1430983

ABSTRACT

(1) This study aimed to evaluate characteristics, perinatal outcomes, and placental pathology of pregnant women with or without SARS-CoV-2 infection in the context of maternal PCR cycle threshold (CT) values. (2) This was a retrospective case-control study in a third-level health center in Mexico City with universal screening by RT-qPCR. The association of COVID-19 manifestations, preeclampsia, and preterm birth with maternal variables and CT values were assessed by logistic regression models and decision trees. (3) Accordingly, 828 and 298 women had a negative and positive test, respectively. Of those positive, only 2.6% of them presented mild to moderate symptoms. Clinical characteristics between both groups of women were similar. No associations between CT values were found for maternal features, such as pre-gestational BMI, age, and symptomatology. A significantly higher percentage of placental fibrinoid was seen with women with low CTs (<25; p < 0.01). Regarding perinatal outcomes, preeclampsia was found to be significantly associated with symptomatology but not with risk factors or CT values (p < 0.01, aOR = 14.72). Moreover, 88.9% of women diagnosed with COVID-19 at <35 gestational weeks and symptomatic developed preeclampsia. (4) The data support strong guidance for pregnancies with SARS-CoV-2 infection, in particular preeclampsia and placental pathology, which need further investigation.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , SARS-CoV-2/physiology , Adult , Biopsy , COVID-19/diagnosis , Female , Humans , Immunohistochemistry , Infectious Disease Transmission, Vertical , Placenta/pathology , Placenta/virology , Polymerase Chain Reaction , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , Retrospective Studies , Young Adult
15.
Rev Bras Ginecol Obstet ; 43(8): 595-599, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1428974

ABSTRACT

OBJECTIVE: To describe the hematological changes, the platelet indices in particular, in pregnant women with coronavirus disease 2019 (COVID-19) compared to healthy pregnant women. METHODS: A retrospective case-control study conducted at the Al Yarmouk Teaching Hospital, in Baghdad, Iraq, involving 100 pregnant women, 50 with positive viral DNA for COVID-19 (case group), and 50 with negative results (control group); both groups were subjected to a thorough hematological evaluation. RESULTS: Among the main hematological variables analyzed, the platelet indices, namely the mean platelet volume (MPV) and the platelet distribution width (PDW), showed statistically significant differences (MPV: 10.87 ± 66.92 fL for the case group versus 9.84 ± 1.2 fL for the control group; PDW: 14.82 ± 3.18 fL for the case group versus 13.3 ± 2.16 fL for the controls). The criterion value of the receiver operating characteristic (ROC) curve for PDW at a cutoff point of > 11.8 fL showed a weak diagnostic marker, while the MPV at a cutoff value of > 10.17 fL showed a good diagnostic marker. CONCLUSION: The MPV and PDW are significantly affected by the this viral infection, even in asymptomatic confirmed cases, and we recommend that both parameters be included in the diagnostic panel of this infection.


Descrever as alterações hematológicas, em particular os índices plaquetários em gestantes com doença coronavírus 2019 (COVID-19) em comparação com gestantes saudáveis. MéTODOS: Estudo caso-controle retrospectivo realizado no Hospital Universitário Al Yarmouk, em Bagdá, Iraque envolvendo 100 gestantes, 50 com DNA viral positivo para COVID-19 (grupo caso) e 50 com resultados negativos (grupo controle); ambos os grupos foram submetidos a uma avaliação hematológica completa. Entre as principais variáveis hematológicas analisadas, os índices plaquetários, nomeadamente o volume plaquetário médio (VPM) e a largura de distribuição plaquetária (PDW), apresentaram diferenças estatisticamente significativas (VPM: 10,87 ± 66,92 fL para o grupo caso versus 9,84 ± 1.2 fL para o o grupo controle; PDW: 14,82 ± 3,18 fL para o grupo caso versus 13,3 ± 2,16 fL para os controles). O valor de critério da curva de característica de operação do receptor (ROC) para PDW em um ponto de corte de> 11,8 fL mostrou um marcador diagnóstico fraco, enquanto o do VPM em um valor de corte de> 10,17 fL mostrou um bom marcador de diagnóstico. CONCLUSãO: O MPV e PDW são significativamente afetados por esta infecção viral, mesmo em casos confirmados assintomáticos, e recomendamos que ambos os parâmetros sejam incluídos no painel de diagnóstico desta infecção.


Subject(s)
Blood Platelets/virology , COVID-19/blood , Pregnancy Complications, Infectious/blood , Adult , Asymptomatic Diseases , Biomarkers/blood , Blood Platelets/physiology , COVID-19/diagnosis , COVID-19 Testing , Case-Control Studies , Female , Humans , Mean Platelet Volume , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Retrospective Studies
16.
Placenta ; 115: 78-86, 2021 11.
Article in English | MEDLINE | ID: covidwho-1415712

ABSTRACT

The risk of potential vertical transmission in SARS-CoV-2 infected pregnant women is currently a topic of debate. To explore the correlation between the two, we searched PubMed, Embase®, and Web of Science for studies on vertical transmission of COVID-19. The quality of the studies was evaluated by the Cochrane risk of bias tool. Detailed information of each included case including methods of delivery, protection measures for mothers and neonates at birth, types of specimens, inspection time, results of testing and feeding patterns was collected to assess the possibility of vertical transmission. The results showed that of the 390 neonates reported in 36 studies, 23 were infected with SARS-CoV-2 by potential vertical transmission. From the perspective of virology and pathology, vertical transmission of SARS-CoV-2 was possible via uterus or breastmilk. Some reported potential vertically transmitted neonates could be attributed to horizontal transmission. It is extremely vital to fully elucidate the potential routes of transmission of SARS-CoV-2, implicating clinical practice and nursing to reduce the risk of not only horizontal transmission but also vertical transmission, thus protecting neonates from COVID-19 infection.


Subject(s)
COVID-19/transmission , Infectious Disease Transmission, Vertical/prevention & control , SARS-CoV-2/physiology , Biomedical Research/methods , COVID-19/diagnosis , COVID-19/therapy , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/therapy , SARS-CoV-2/metabolism
17.
Ital J Pediatr ; 47(1): 191, 2021 Sep 18.
Article in English | MEDLINE | ID: covidwho-1413462

ABSTRACT

BACKGROUND: Presently, it is known that, even if less frequently than in adults, children can develop a severe new coronavirus disease 2019 (COVID-19). Children with the SARS-CoV-2 infection can have neurological signs and symptoms of disease more frequently than previously thought, revealing the involvement of the central nervous system, the peripheral nervous system, or both. Aim of this manuscript is to highlight the neurologic complications associated with SARS-CoV-2 among pediatric patients with COVID-19, suggesting when to monitor carefully neurologic development. MAIN FINDINGS: Children with a severe chronic underlying disease, infants and toddlers and those who develop the so-called multisystem inflammatory syndrome (MIS-C) are those with the highest incidence of neurological complications. Fortunately, in most of the cases, neurological manifestations, mainly represented by headache and anosmia, are mild and transient and do not significantly complicate the COVID-19 course. However, in some cases, very severe clinical problems associated with relevant alterations of neuroimaging, electroencephalography, nerve conduction studies and electromyography findings can develop. Generally, almost all the children with COVID-19 and neurological manifestations till now described have made a complete recovery, although in some cases this has occurred after several weeks of treatment. Moreover, COVID-19 infection during pregnancy has been found associated with an increased risk of obstetric complications that can lead to neurological acute and long-term manifestations in neonates. CONCLUSIONS: Based on data showing the neurologic impact of COVID-19 in pediatric age, we suggest monitoring neurological development a few months after healing in pediatric patients who have presented MIS-C, seizures or other neurological manifestations and in children of pregnant women with COVID-19 in order to detect overt and subtle deficits.


Subject(s)
COVID-19/complications , Nervous System Diseases/virology , Pregnancy Complications, Infectious/virology , Systemic Inflammatory Response Syndrome/virology , COVID-19/diagnosis , COVID-19/virology , Child , Child, Preschool , Comorbidity , Female , Humans , Infant , Infant, Newborn , Male , Nervous System Diseases/diagnosis , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Risk Factors , SARS-CoV-2 , Seizures/virology , Systemic Inflammatory Response Syndrome/diagnosis
18.
BMC Pediatr ; 21(1): 400, 2021 09 13.
Article in English | MEDLINE | ID: covidwho-1412878

ABSTRACT

OBJECTIVE: We report here on the management and outcomes of neonates born to mothers with active perinatal SARS-CoV-2 infection. STUDY DESIGN: In this prospective study, eligible neonates were enrolled in a database to track in-hospital outcomes and followed up outpatient periodically till 2 months of age to assess for late onset symptoms of infection. RESULTS: From April 2020 to February 2021, 67 mothers with perinatal SARS-CoV-2 infection and 70 at-risk neonates were included. Two neonates (3%) tested positive for SARS-CoV-2 within 48 h of life but remained asymptomatic during hospitalization and at all follow-up periods. Three infants were reported to have a febrile illness in 2 months follow up period, none of which was attributable to SARS-CoV-2. CONCLUSION: Our data supports the emerging evidence which describes a probable low risk of vertical transmission of SARS-CoV-2. We also demonstrate a low risk of post-natal transmission or late-onset symptomatic infection with SARS-CoV-2.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Female , Humans , Infant, Newborn , Mothers , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Prospective Studies , SARS-CoV-2
20.
BMC Pregnancy Childbirth ; 21(1): 636, 2021 Sep 18.
Article in English | MEDLINE | ID: covidwho-1411707

ABSTRACT

BACKGROUND: Few reports have presented an overall view of pregnant women with coronavirus disease 2019 (COVID-19) across an entire country and throughout the entire gestation period. Furthermore, no such reports are available for Japan. We examined the clinical characteristics and outcomes of pregnant women with COVID­19 on a national scale in Japan. METHODS: A nationwide questionnaire-based survey for all 2,185 maternity services in Japan was conducted between July and August 2020. Information regarding maternal characteristics and epidemiological, clinical, treatment, and perinatal outcomes of pregnant women diagnosed with COVID-19 between 16 January and 30 June 2020 were collected. Main outcome measures were incidence of pregnant women with COVID-19 and infant infection, positive rate of the universal screening test for asymptomatic pregnant women, identification of infection route and rates of maternal death, and severe cases. RESULTS: Responses from 1,418 institutions were assessed (65% of all delivery institutions in Japan). Seventy-two pregnant women were reported to have been diagnosed with COVID-19. The positive rate of the universal screening test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic pregnant women was 0.03% (2/7428). The most common route of infection was familial (57%). Fifty-eight pregnant women with COVID-19 were symptomatic, of whom five (8.6%) had a severe infection and one died (a tourist). Severe respiratory symptoms, oxygen administration, and pneumonia were frequently reported in the third trimester and postpartum period compared with in early pregnancy (22.2% vs 2.5% [P = 0.03], 38.9% vs 7.5% [P = 0.01], and 50.0% vs 7.5% [P < 0.001], respectively). All pregnant women with COVID-19 underwent caesarean sections, regardless of symptoms. There were no SARS-CoV-2 transmissions to newborns. CONCLUSIONS: In Japan, the number of cases of COVID-19 infection in pregnant women is very low. Compared with early pregnancy, late pregnancy may be a risk factor for exacerbation of symptoms and familial transmission is the most common route of infection. The importance of infection prevention should be emphasised, especially in women in late pregnancy, their families, and any cohabitants.


Subject(s)
COVID-19/diagnosis , Pregnancy Complications, Infectious/diagnosis , Adult , Asymptomatic Infections , COVID-19/epidemiology , COVID-19/therapy , COVID-19/transmission , COVID-19 Testing , Female , Health Surveys , Humans , Incidence , Infant, Newborn , Infectious Disease Transmission, Vertical , Japan/epidemiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome , Severity of Illness Index , Treatment Outcome
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