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1.
BMC Pregnancy Childbirth ; 21(1): 658, 2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1770502

ABSTRACT

BACKGROUND: Whilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population. METHODS: A case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020. RESULTS: Although Pregnant women presented with fewer symptoms such as fever, cough, sore throat, and shortness of breath compared to non-pregnant women; yet they ran a much more severe course of illness. On admission, 12/79 (15.2%) Vs 2/85 (2.4%) had a chest radiograph score [on a scale 1-6] of ≥3 (p-value = 0.0039). On discharge, 6/79 (7.6%) Vs 1/85 (1.2%) had a score ≥3 (p-value = 0.0438). They also had much higher levels of laboratory indicators of severity with values above reference ranges for C-Reactive Protein [(28 (38.3%) Vs 13 (17.6%)] with p < 0.004; and for D-dimer [32 (50.8%) Vs 3(6%)]; with p < 0.001. They required more ICU admissions: 10/79 (12.6%) Vs 1/85 (1.2%) with p=0.0036; and suffered more complications: 9/79 (11.4%) Vs 1/85 (1.2%) with p=0.0066; of Covid-19 infection, particularly in late pregnancy. CONCLUSIONS: Pregnant women presented with fewer Covid-19 symptoms but ran a much more severe course of illness compared to non-pregnant women with the disease. They had worse chest radiograph scores and much higher levels of laboratory indicators of disease severity. They had more ICU admissions and suffered more complications of Covid-19 infection, such as risk for miscarriage and preterm deliveries. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy and requires management by an obstetric and medical multidisciplinary team.


Subject(s)
COVID-19 , Intensive Care Units/statistics & numerical data , Pregnancy Complications, Infectious , Premature Birth , Radiography, Thoracic , Symptom Assessment , Abortion, Spontaneous/epidemiology , Abortion, Spontaneous/etiology , C-Reactive Protein/analysis , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , COVID-19/transmission , Case-Control Studies , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Male , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome/epidemiology , Pregnancy, High-Risk , Premature Birth/epidemiology , Premature Birth/etiology , Radiography, Thoracic/methods , Radiography, Thoracic/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , United Arab Emirates/epidemiology
2.
BMC Pregnancy Childbirth ; 22(1): 191, 2022 Mar 08.
Article in English | MEDLINE | ID: covidwho-1736354

ABSTRACT

BACKGROUND: The COVID-19 social restrictions have increased the risk for depression compared to the previous period in Italian women with Low-Risk Pregnancy (LRP). lLess is known about the impact of COVID-19 restrictions on High-Risk Pregnancy (HRP). This study aimed: 1) to explore levels of depression in women who become pregnant before and during COVID-19 pandemic, distinguishing between LRP and HRP; 2) to analyze the impact of COVID-19 restrictions on pregnancy experience in LRP and HRP. METHODS: A before-during COVID-19 pandemic cross-sectional study was carried out on 155 pregnant women (Mean age = 34.18), between 23 and 32 weeks of gestation. 77 women were recruited before COVID-19 pandemic (51.9% LRP; 48.1% HRP) and 78 women were recruited during COVID-19 pandemic (51.3% LRP; 48.7% HRP). HRP group was enrolled during hospitalization for high-risk pregnancy. Participants filled out Edinburgh Postnatal Depression Scale. Moreover, only COVID-19 group answered an open-ended question about the impact of restriction on pregnancy experience. RESULTS: HRP women reported higher levels of depressive symptoms than LRP. No difference emerged for COVID (before/during) but an interaction effect between COVID-19 and obstetric condition was found. The qualitative results showed the impact of restrictions on emotions and concerns. CONCLUSION: Respect to the previous period, LRP women during COVID-19 presented an increased risk for depressive symptoms than HRP. The HRP women during COVID-19 seemed to use hospitalization as a resource to find a social support network with other pregnant women and to be reassured on the clinical ongoing of pregnancy.


Subject(s)
COVID-19/psychology , Depression/psychology , Pregnancy, High-Risk/psychology , Pregnant Women/psychology , Adult , Cross-Sectional Studies , Emotions , Female , Hospitalization , Humans , Italy , Middle Aged , Pregnancy/psychology , Psychiatric Status Rating Scales , Quality of Health Care , Quarantine/psychology , SARS-CoV-2
3.
S Afr Med J ; 111(12): 1174-1180, 2021 12 02.
Article in English | MEDLINE | ID: covidwho-1561763

ABSTRACT

BACKGROUND: The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously. OBJECTIVES: To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV. METHODS: We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m2) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV. RESULTS: One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 - 603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV. CONCLUSIONS: In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy.


Subject(s)
COVID-19/complications , HIV Infections/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Adult , CD4 Lymphocyte Count , Cohort Studies , Female , Humans , Infant, Newborn , Maternal Mortality , Pregnancy , Pregnancy Complications, Infectious/virology , Pregnancy, High-Risk , Prospective Studies , South Africa
5.
Am J Obstet Gynecol ; 224(4): B2-B15, 2021 04.
Article in English | MEDLINE | ID: covidwho-1184781

ABSTRACT

The rates of maternal morbidity and mortality in the United States demand a comprehensive approach to assessing pregnancy-related risks. Numerous medical and nonmedical factors contribute to maternal morbidity and mortality. Reducing the number of women who experience pregnancy morbidity requires identifying which women are at greatest risk and initiating appropriate interventions early in the reproductive life course. The purpose of this Consult is to educate all healthcare practitioners about factors contributing to a high-risk pregnancy, strategies to assess maternal health risks due to pregnancy, and the importance of risk assessment across the reproductive spectrum in reducing maternal morbidity and mortality.


Subject(s)
Maternal Mortality , Pregnancy Complications/prevention & control , Risk Assessment/methods , Algorithms , Congenital Abnormalities , Female , Humans , Maternal Health , Postpartum Period , Pregnancy , Pregnancy, High-Risk , Risk Factors
6.
Int J Gynaecol Obstet ; 152(2): 231-235, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1125309

ABSTRACT

OBJECTIVE: To assess the effects of the COVID-19 pandemic on obstetric care and outcomes. METHODS: A prospective observational single-center study was performed, including all antenatal and parturient women admitted from April to August, 2020. Data were collected regarding number of admissions, deliveries, antenatal visits, reason for inaccessibility of health care, and complications during pregnancy, and compared with data from the pre-COVID period of October 2019 to February 2020. RESULTS: There was a reduction of 45.1% in institutional deliveries (P < 0.001), a percentage point increase of 7.2 in high-risk pregnancy, and 2.5-fold rise in admission to the intensive care unit of pregnant women during the pandemic. One-third of women had inadequate antenatal visits. The main reason for delayed health-seeking was lockdown and fear of contracting infection, resulting in 44.7% of pregnancies with complications. Thirty-two symptomatic women who tested positive for COVID-19 were managed at the center with good maternal and fetal outcomes. CONCLUSION: Although COVID-19 does not directly affect pregnancy outcomes, it has indirect adverse effects on maternal and child health. Emergency obstetric and antenatal care are essential services to be continued with awareness of people while maintaining social distancing and personal hygiene.


Subject(s)
COVID-19 , Maternal Health , Pandemics , Patient Acceptance of Health Care , Prenatal Care , Time-to-Treatment , Communicable Disease Control , Female , Hospitalization , Humans , India , Infant, Newborn , Intensive Care Units , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Pregnancy, High-Risk , Prospective Studies , Tertiary Care Centers
7.
Am J Obstet Gynecol MFM ; 2(4): 100233, 2020 11.
Article in English | MEDLINE | ID: covidwho-1064758

ABSTRACT

Background: Telehealth has been successfully implemented for the delivery of obstetrical care. However, little is known regarding the attitudes and acceptability of patients and providers in high-risk obstetrics and whether the implementation of a telehealth model improves access to care in nonrural settings. Objective: This study aimed to describe patient and provider attitudes toward telehealth for the delivery of high-risk obstetrical care in a large healthcare system with both urban and suburban settings and to determine whether the implementation of a telehealth model improves patient adherence to scheduled appointments in this patient population. Study Design: Two self-administered surveys were designed. The first survey was sent to all high-risk obstetrical patients who received a telehealth visit between March 1, 2020, and May 30, 2020. The second survey was designed for providers who participated in these visits. We also compared the attended, cancelled, and no-show visit rates before (March 1 to May 30, 2019) and after (March 1 to May 30, 2020) the telehealth implementation and telehealth vs in-person visits in 2020. We reviewed scheduled high-risk prenatal care appointments, diabetes mellitus education sessions, and genetic counseling and Maternal-Fetal Medicine consultations. Results: A total of 91 patient surveys and 33 provider surveys were analyzed. Overall, 86.9% of patients were satisfied with the care they received and 78.3% would recommend telehealth visits to others. Notably, 87.8% of providers reported having a positive experience using telehealth, and 90.9% believed that telehealth improved patients' access to care. When comparing patient and provider preference regarding future obstetrical care after experiencing telehealth, 73.8% of patients desired a combination of in-person and telehealth visits during their pregnancy. However, a significantly higher rate of providers preferred in-person than telehealth visits (56% vs 23%, P=.024, respectively). When comparing visits between 2019 and 2020, there was a significantly lower rate of no-show appointments (8.49% vs 4.61%, P<.001), patient-cancelled appointments (7.06% vs 4.96%, P<.001), and patient same-day cancellations (2.30% vs 1.35%, P<.001) with the implementation of telehealth. There was also a significantly lower rate of patient-cancelled appointments (3.82% vs 5.44%, P=.021) and patient same-day cancellations (0.60% vs 1.65%, P=.002) with those receiving telehealth visits than in-person visits in 2020. Conclusion: The implementation of a telehealth model in high-risk obstetrics has the potential to improve access to high-risk obstetrical care, by reducing the rate of missed appointments. Both patients and providers surveyed expressed a high rate of satisfaction with telehealth visits and a desire to integrate telehealth into the traditional model of high-risk obstetrical care.


Subject(s)
COVID-19 , Obstetrics , Patient Acceptance of Health Care/statistics & numerical data , Pregnancy Complications , Pregnancy, High-Risk , Telemedicine , Adult , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Infection Control/methods , New York/epidemiology , Obstetrics/methods , Obstetrics/trends , Patient Preference/statistics & numerical data , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/epidemiology , Pregnancy Complications/therapy , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration
8.
Eur J Obstet Gynecol Reprod Biol ; 255: 190-196, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-928977

ABSTRACT

OBJECTIVE: We aimed to analyze the changing level of anxiety during COVID-19 pandemic in pregnant women, with and without high-risk indicators separately, in a tertiary care center serving also for COVID-19 patients, in the capital of Turkey. STUDY DESIGN: We designed a case-control and cross-sectional study using surveys. The Spielberger State-Trait Anxiety Scale questionnaire (STAI-T) and Beck Anxiety Inventory (BAI) which were validated in Turkish were given to outpatient women with high-risk pregnancies as study group and normal pregnancies as control group. A total of 446 women were recruited. RESULTS: There was a statistically significant difference between those with and without high-risk pregnancy in terms of Trait-State Anxiety scores with COVID-19 pandemic (p < 0.05). We found an increased prevalence of anxiety during COVID-19 pandemic in high-risk pregnant women comparing to pregnancies with no risk factors (p < 0.05). There was a statistically significant difference between the education level in high-risk pregnant women in terms of anxiety scores (p < 0.05), Beck Anxiety score was highest in high school graduates (42.75). While the level of Trait Anxiety was the highest with pandemic in those with high-risk pregnancy with threatened preterm labor and preterm ruptures of membranes (58.0), those with thrombophilia were the lowest (50.88). The State Anxiety level and Beck Anxiety Score of those with maternal systemic disease were the highest (53.32 and 45.53), while those with thrombophilia were the lowest (46.96 and 40.08). The scores of Trait Anxiety (56.38), State Anxiety (52.14), Beck Anxiety (43.94) were statistically higher during the pandemic in those hospitalized at least once (p < 0.05). CONCLUSION: High-risk pregnant women require routine anxiety and depression screening and psychosocial support during the COVID-19 pandemic. High-risk pregnancy patients have comorbid conditions most of the time, hence they not only at more risk for getting infected, but also have higher anxiety scores because of the stress caused by COVID-19 pandemic.


Subject(s)
Anxiety/epidemiology , COVID-19/epidemiology , Pregnancy Complications/epidemiology , Pregnancy, High-Risk , Pregnant Women/psychology , Adult , Anxiety/virology , COVID-19/psychology , Case-Control Studies , Comorbidity , Cross-Sectional Studies , Female , Humans , Inpatients/psychology , Pregnancy , Pregnancy Complications/psychology , Pregnancy Complications/virology , Prevalence , Psychiatric Status Rating Scales , SARS-CoV-2 , Turkey/epidemiology , Young Adult
9.
Am J Obstet Gynecol MFM ; 2(4): 100234, 2020 11.
Article in English | MEDLINE | ID: covidwho-856409

ABSTRACT

Background: In response to the coronavirus disease 2019 pandemic, hospitals nationwide have implemented modifications to labor and delivery unit practices designed to protect delivering patients and healthcare providers from infection with severe acute respiratory syndrome coronavirus 2. Beginning in March 2020, our hospital instituted labor, and delivery unit modifications targeting visitor policy, use of personal protective equipment, designation of rooms for triage and delivery of persons suspected or infected with coronavirus disease 2019, delivery management, and newborn care. Little is known about the ramifications of these modifications in terms of maternal and neonatal outcomes. Objective: The objective of this study was to determine whether labor and delivery unit policy modifications we made during the coronavirus disease 2019 pandemic were associated with differences in outcomes for mothers and newborns. Study Design: We conducted a retrospective cohort study of all deliveries occurring in our hospital between January 1, 2020, and April 30, 2020. Patients who delivered in January and February 2020 before labor and delivery unit modifications were instituted were designated as the preimplementation group, and those who delivered in March and April 2020 were designated as the postimplementation group. Maternal and neonatal outcomes between the pre- and postimplementation groups were compared. Differences between the 2 groups were then compared with the same time period in 2019 and 2018 to assess whether any apparent differences were unique to the pandemic year. We hypothesized that maternal and newborn lengths of stay would be shorter in the postimplementation group. Statistical analysis methods included Student's t-tests and Wilcoxon tests for continuous variables and chi-square or Fisher exact tests for categorical variables. Results: Postpartum length of stay was significantly shorter after implementation of labor unit changes related to coronavirus disease 2019. A postpartum stay of 1 night after vaginal delivery occurred in 48.5% of patients in the postimplementation group compared with 24.9% of the preimplementation group (P<.0001). Postoperative length of stay after cesarean delivery of ≤2 nights occurred in 40.9% of patients in the postimplementation group compared with 11.8% in the preimplementation group (P<.0001). Similarly, after vaginal delivery, 49.0% of newborns were discharged home after 1 night in the postimplementation group compared with 24.9% in the preimplementation group (P<.0001). After cesarean delivery, 42.5% of newborns were discharged after ≤2 nights in the postimplementation group compared with 12.5% in the preimplementation group (P<.0001). Slight differences in the proportions of earlier discharge between mothers and newborns were due to multiple gestations. There were no differences in cesarean delivery rate, induction of labor, or adverse maternal or neonatal outcomes between the 2 groups. Conclusion: Labor and delivery unit policy modifications to protect pregnant patients and healthcare providers from coronavirus disease 2019 indicate that maternal and newborn length of stay in the hospital were significantly shorter after delivery without increases in the rate of adverse maternal or neonatal outcomes. In the absence of long-term adverse outcomes occurring after discharge that are tied to earlier release, our study results may support a review of our discharge protocols once the pandemic subsides to move toward safely shortening maternal and newborn lengths of stay.


Subject(s)
COVID-19 , Delivery Rooms/organization & administration , Delivery, Obstetric , Infection Control , Safety Management , Adult , COVID-19/epidemiology , COVID-19/prevention & control , California/epidemiology , Delivery, Obstetric/methods , Delivery, Obstetric/trends , Female , Humans , Infant, Newborn , Infection Control/methods , Infection Control/organization & administration , Organizational Innovation , Organizational Policy , Pregnancy , Pregnancy Outcome/epidemiology , Pregnancy, High-Risk , SARS-CoV-2 , Safety Management/methods , Safety Management/trends
10.
J Perinat Med ; 48(9): 925-930, 2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-841764

ABSTRACT

Pregnant women may be at risk for more severe manifestations and sequelae of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At this time, there remain significant evidence gaps to allow for comprehensive counseling of pregnant women and their families, specifically regarding the risks of gestational-age specific maternal outcomes and potential risks of intrauterine or peripartum viral transmission to the fetus or newborn. As maternal fetal medicine providers and consultants, we are uniquely positioned to mitigate the risks associated with maternal infection and to guide the care for infected pregnant women by being able to provide the most current evidence-based recommendations. Such care requires incorporating the rapidly evolving data regarding this virus and its impact on pregnancy, as well as taking a stand to advocate for best scientific and clinical practices to optimize both women's health and public health during this pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/therapy , Perinatal Care/methods , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Pregnancy Complications, Infectious/virology , COVID-19 , COVID-19 Testing , Centers for Disease Control and Prevention, U.S. , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Critical Care/statistics & numerical data , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Obstetrics/methods , Pandemics , Pneumonia, Viral/diagnosis , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/therapy , Pregnancy Outcome , Pregnancy, High-Risk , Prenatal Care/methods , SARS-CoV-2 , United States
13.
Am J Perinatol ; 37(14): 1411-1416, 2020 12.
Article in English | MEDLINE | ID: covidwho-811504

ABSTRACT

OBJECTIVE: The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis. STUDY DESIGN: This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables. RESULTS: Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17-1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50-1.93) when compared with those without a diagnosis of COVID-19. CONCLUSION: Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes. KEY POINTS: · Information about blood loss associated with peripartum COVID-19 is limited.. · COVID-19 diagnosis is not associated with increase in obstetric hemorrhage.. · COVID-19 diagnosis is not associated with increase in blood loss..


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Postpartum Hemorrhage/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Adult , COVID-19 , Comorbidity , Female , Humans , Infant, Newborn , Pandemics , Pregnancy , Pregnancy, High-Risk , Prenatal Care/methods , Retrospective Studies , Risk Factors , SARS-CoV-2 , United States
15.
Am J Perinatol ; 37(10): 1015-1021, 2020 08.
Article in English | MEDLINE | ID: covidwho-621819

ABSTRACT

OBJECTIVE: Antenatal corticosteroids given prior to preterm deliveries reduce the risk of adverse neonatal outcomes. However, steroid administration in the setting of a viral respiratory infection can worsen maternal outcomes. Therefore, the decision to administer corticosteroids must balance the neonatal benefits with the potential harm to the mother if she is infected with the novel coronavirus disease 2019 (COVID-19). This study aimed to determine the gestational ages for which administering antenatal corticosteroids to women at high risk of preterm labor with concurrent COVID-19 infection results in improved combined maternal and infant outcomes. STUDY DESIGN: A decision-analytic model using TreeAge (2020) software was constructed for a theoretical cohort of hospitalized women with COVID-19 in the United States. All model inputs were derived from the literature. Outcomes included maternal intensive care unit (ICU) admission and death, along with infant outcomes of death, respiratory distress syndrome, intraventricular hemorrhage, and neurodevelopmental delay. Quality-adjusted life years (QALYs) were assessed from the maternal and infant perspectives. Sensitivity analyses were performed to determine if the results were robust over a range of assumptions. RESULTS: In our theoretical cohort of 10,000 women delivering between 24 and 33 weeks of gestation with COVID-19, corticosteroid administration resulted in 2,200 women admitted to the ICU and 110 maternal deaths. No antenatal corticosteroid use resulted in 1,500 ICU admissions and 75 maternal deaths. Overall, we found that corticosteroid administration resulted in higher combined QALYs up to 31 weeks of gestation in all hospitalized patients, and up to 29 weeks of gestation in ICU patients. CONCLUSION: Administration of antenatal corticosteroids at less than 32 weeks of gestation for hospitalized patients and less than 30 weeks of gestation for patients admitted to the ICU resulted in higher combined maternal and infant outcomes compared with expectant management for women at high risk of preterm birth with COVID-19 infection. These results can guide clinicians in their counseling and management of these pregnant women. KEY POINTS: · Antenatal steroids reduce adverse neonatal outcomes.. · Steroids worsen maternal outcomes in COVID-19.. · Steroids given < 32 weeks result in improved outcomes..


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Coronavirus Infections/prevention & control , Maternal Death/statistics & numerical data , Obstetric Labor, Premature/drug therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pregnancy Outcome , Premature Birth/prevention & control , Adrenal Cortex Hormones/adverse effects , COVID-19 , Cohort Studies , Coronavirus Infections/epidemiology , Decision Support Techniques , Female , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Intensive Care Units , Male , Monte Carlo Method , Obstetric Labor, Premature/prevention & control , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy, High-Risk , Prenatal Care/methods , Risk Assessment , United States
16.
Am J Perinatol ; 37(10): 1044-1051, 2020 08.
Article in English | MEDLINE | ID: covidwho-612524

ABSTRACT

Pregnant patients with severe acute respiratory syndrome coronavirus 2, the virus responsible for the clinical condition newly described in 2019 as coronavirus disease 2019 (COVID-19) and illness severity to warrant intensive care have a complex disease process that must involve multiple disciplines. Guidelines from various clinical societies, along with direction from local health authorities, must be considered when approaching the care of an obstetric patient with known or suspected COVID-19. With a rapidly changing landscape, a simplified and cohesive perspective using guidance from different clinical society recommendations regarding the critically-ill obstetric patient with COVID-19 is needed. In this article, we synthesize various high-level guidelines of clinical relevance in the management of pregnant patients with severe disease or critical illness due to COVID-19. KEY POINTS: · When caring for severely ill obstetric patients with COVID-19, one must be well versed in the complications that may need to be managed including, but not limited to adult respiratory distress syndrome with need for mechanical ventilation, approach to refractory hypoxemia, hemodynamic shock, and multiorgan system failure.. · Prone positioning can be done safely in gravid patients but requires key areas of support to avoid abdominal compression.. · For the critically ill obstetric patient with COVID-19, the focus should be on supportive care as a bridge to recovery rather than delivery as a solution to recovery..


Subject(s)
Coronavirus Infections/epidemiology , Critical Care/methods , Delivery, Obstetric/methods , Infectious Disease Transmission, Vertical/prevention & control , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/epidemiology , Respiratory Distress Syndrome/epidemiology , COVID-19 , Comorbidity , Coronavirus Infections/prevention & control , Delivery, Obstetric/adverse effects , Female , Humans , Intensive Care Units , Pandemics/prevention & control , Patient Positioning/methods , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome , Pregnancy, High-Risk , Risk Assessment , Thromboembolism/prevention & control , Young Adult
17.
Am J Perinatol ; 37(10): 1066-1069, 2020 08.
Article in English | MEDLINE | ID: covidwho-601347

ABSTRACT

We describe our experience with three pregnant women with novel coronavirus disease 2019 (COVID-19) who required mechanical ventilation. Recent data suggest a mortality of 88% in nonpregnant patients with COVID-19 who require intubation and mechanical ventilation. The three women we report were intubated and mechanically ventilated during pregnancy due to respiratory failure and pneumonia resulting from COVID-19. After several days of ventilation, all three were successfully weaned off mechanical ventilation and extubated, and are continuing their pregnancies with no demonstrable adverse effects. Our experience suggests that the mortality in pregnant women with COVID-19 requiring mechanical ventilation is not necessarily as high as in nonpregnant patients with COVID-19. KEY POINTS: · Coronavirus disease 2019 (COVID-19) is now a pandemic.. · COVID-19 may cause pneumonia or respiratory failure in pregnant women.. · Approximately 5% of women with COVID-19 will develop severe or critical disease.. · Mechanical ventilation in pregnant women may not necessarily result in high mortality rates..


Subject(s)
Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Pregnancy, High-Risk , Respiratory Insufficiency/therapy , Adult , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/therapy , Emergency Service, Hospital , Female , Gestational Age , Humans , Middle Aged , Monitoring, Physiologic/methods , Pandemics , Pneumonia, Viral/therapy , Pregnancy , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Risk Assessment , Sampling Studies
18.
Am J Perinatol ; 37(10): 1038-1043, 2020 08.
Article in English | MEDLINE | ID: covidwho-555470

ABSTRACT

With the coronavirus disease 2019 (COVID-19) pandemic in the United States, a majority of states have instituted "shelter-in-place" policies effectively quarantining individuals-including pregnant persons-in their homes. Given the concern for COVID-19 acquisition in health care settings, pregnant persons with high-risk pregnancies-such as persons living with HIV (PLHIV)-are increasingly investigating the option of a home birth. Although we strongly recommend hospital birth for PLHIV, we discuss our experience and recommendations for counseling and preparation of pregnant PLHIV who may be considering home birth or at risk for unintentional home birth due to the pandemic. We also discuss issues associated with implementing a risk mitigation strategy involving high-risk births occurring at home during a pandemic. KEY POINTS: · Coronavirus disease 2019 pandemic has increased interest in home birth.. · Women living with HIV are pursuing home birth.. · Safe planning is paramount for women living with HIV desiring home birth, despite recommending against the practice..


Subject(s)
Coronavirus Infections/epidemiology , HIV Infections/epidemiology , Home Childbirth/methods , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pregnancy Outcome , Pregnancy, High-Risk , Adult , COVID-19 , Comorbidity , Coronavirus Infections/prevention & control , Counseling , Delivery, Obstetric/methods , Female , Home Childbirth/statistics & numerical data , Humans , Infectious Disease Transmission, Vertical/prevention & control , Pandemics/statistics & numerical data , Patient Safety/statistics & numerical data , Pneumonia, Viral/prevention & control , Pregnancy , Risk Assessment , United States
19.
Am J Perinatol ; 37(8): 800-808, 2020 06.
Article in English | MEDLINE | ID: covidwho-245788

ABSTRACT

As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services. KEY POINTS: · Telehealth for prenatal care is feasible.. · Telehealth may reduce coronavirus exposure during prenatal care.. · Telehealth should be tailored for high risk prenatal patients..


Subject(s)
Coronavirus Infections , Infection Control/organization & administration , Pandemics , Pneumonia, Viral , Pregnancy Complications , Pregnancy, High-Risk , Prenatal Care , Telemedicine , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Genetic Counseling/methods , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , New York City/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/prevention & control , Prenatal Care/methods , Prenatal Care/organization & administration , Prenatal Care/trends , Prenatal Diagnosis/methods , Remote Consultation/methods , SARS-CoV-2 , Telemedicine/instrumentation , Telemedicine/methods , Telemedicine/organization & administration
20.
Anaesth Crit Care Pain Med ; 39(3): 345-349, 2020 06.
Article in English | MEDLINE | ID: covidwho-245466
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