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Background: The recent pandemic prompted a number of clinical trials to assess the efficacy and safety of medication use for the treatment for COVID-19. As pregnant women are excluded or vastly underrepresented in clinical research, there is a paucity of data on how pregnancy and perinatal outcomes are impacted by such medications. Considering that pregnant women are at increased risk for COVID-19 infection and that pregnancy is also associated with an increased risk of developing severe COVID-19, it is of utmost importance to assess the effect of gestational medications use for COVID-19 on pregnancy outcomes. Objective(s): The aims of this systematic review were to (1) determine and quantify COVID-19-specific and repurposed medication use during pregnancy, and (2) provide an overview of the pregnancy and neonatal outcomes that have occurred in COVID-19-positive pregnant women exposed to COVID-19-specific or repurposed medications compared to use in pregnant women without COVID-19;neonatal outcomes compared between COVID-19 positive pregnant women treated and untreated with these medications. Method(s): A systematic literature search was conducted in Ovid and executed in the following databases: MEDLINE, Embase, and Global Health. Search strategies applied combined database-specific subject headings and keywords relevant to the topic. Some subject headings used in databases were pregnancy outcome, COVID-19, SARS-CoV-2, pharmaceutical preparations, drugs, and prescription. Some keywords used for the searches were pregnancy outcome, neonatal outcome, coronavirus disease 2019, drug, medication, and treatment. For each database, keywords were searched within the , keyword heading word or heading words, and title fields. Restrictions were applied regarding the date of publication and searches were limited to English publications. Study selection was accomplished by two independent investigators (NSK, NAB). Only original research articles were considered for inclusion. Included studies investigated pregnancy or neonatal outcomes in women with COVID-19 receiving medication to treat COVID-19. A standardized extraction form was used to independently extract relevant information. Result(s): The literature search yielded a total of 344 records. After deduplication, 69 records were removed. The title and of 275 publications were screened.
RESUMEN
Introduction &Objective: In 2019, the airborne SARS-CoV-2 virus caused a global pandemic. This presented new challenges to safe operating for patients and staff. Patients requiring pneumoperitoneum had the increased risk of aerosol transmission of the virus. New recommendations were introduced to reduce surgical plume and pressure of pneumoperitoneum. We analysed the clinical outcomes of cases performed at a lower pressure of pneumoperitoneum of 8mmHg during the COVID 19 pandemic. The results were compared to cases performed prior to the pandemic at a pressure of 12mmmHg to assess if surgery at a lower pressure impacted outcomes. Method(s): Using the online Medsafe database at The London Clinic, we retrospectively collected data of patients undergoing RARP performed by a single surgeon between March 2019 and October 2021. A total of 34 patients had RARP under the standard pressure (SPP) of 12mmHg in the year prior to introduction of new recommendations. 27 patients had RARP at a lower pressure (LPP) of 8mmHg during the pandemic. Patient demographics, co-morbidities, gleeson score and PSA were recorded. Data on intra-operative and post-operative parameters was collected. Result(s): Mean weight was 87kg in both groups with a range of 71-111.5kg in the LPP group and 59-108kg in the SPP group. BMI was 27 (23-36.5) in the LPP group and 26 (21.8-40.2) in the SPP group. Gleeson score was 7 and ASA was 2 in both groups. Mean operative time was 104minutes (60-180mins) in the LPP group and 102 minutes (70-180mins) in the SPP group. Blood loss was 130mls (100-500mls) in the LPP group and 106mls (0-200mls) in the SPP group. Pain score at rest and movement was not statistically significant between groups. Length of stay was equivalent at 2.07 days (2-3days) for the LPP group and 2.17 days (1-3 days) for the SPP group. Post-operatively peripheral oedema was noted in 1 patient in the LPP group and 4 patients in the SPP group. The rate of ileus, positive surgical margins and readmission rates were similar in both groups. Conclusion(s): Lower pressure pneumoperitoneum in RARP during the COVID 19 pandemic did not show inferior results to the standard pressure pneumoperitoneum used prior to the pandemic. Post-operative peripheral oedema and complications were lower in the LPP group. Therefore, we recommend continuing the use of LPP as a safer alternative to using SPP.
RESUMEN
Background: The coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health emergency. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory and heart failure in the gravida. Case description: We present a case report of 30-year-old primigravidae with 36.5 weeks by date and 37 week by scan with diagnosed preeclampsia 2 weeks back on medication with 11 × 10.4 × 10.9 cm single intramural anterior wall fibroid with breech presentation. COVID nasopharyngeal sample reported as SARS-CoV-2 real-time PCR positive. The patient was started on medication defining the Stage 1 Group A Asymptomatic Category. Chest X-ray showed mild bilateral pulmonary infiltrates. On Day 6 of admission, the patient went in labor, and hence was taken for emergency LSCS in view of primigravidae with breech with preeclampsia with fibroid with PROM under spinal anesthesia with all precautions. Intraoperatively, the LSCS was uneventful. Postoperatively 6 hours postpartum, the patient developed sudden onset breathlessness NYHA Grade 4, with saturation of 56%, and patient was intubated and shifted to ICU. Chest X-ray revealed viral pneumonia, and further 2D ECHO was suggestive of cardiomyopathy. Conclusion: We suggest an echocardiogram in pregnant women with coronavirus disease 2019 pneumonia, in particular those necessitating oxygen or those who are critically ill. Clinical significance: Viral myocarditis and cardiomyopathy have been reported in nonpregnant COVID-19 patients. Information on COVID-19 in pregnancy is currently limited. No specific literature is available of viral cardiomyopathy reported in pregnant women with COVID-19 infection. © The Author(s). 2020.