Impact of COVID-19 during pregnancy on placental pathology, maternal and neonatal outcome - A cross-sectional study on anemic term pregnant women from a tertiary care hospital in southern India.

Background: SARS-CoV-2 infection during pregnancy may cause adverse maternal, neonatal and placental outcomes. While tissue hypoxia is often reported in COVID-19 patients, pregnant women with anemia are suspected to be more prone to placental hypoxia-related injuries. Methods: This hospital-based cross-sectional study was conducted between August-November 2021, during COVID-19 second wave in India. Term pregnant women (N=212) admitted to hospital for delivery were enrolled consecutively. Since hospital admission mandated negative RT-PCR test for SARS-CoV-2 virus, none had active infection. Data on socio-demography, COVID-19 history, maternal, obstetric, and neonatal outcomes were recorded. Pre-delivery maternal and post-delivery cord blood samples were tested for hematological parameters and SARS-CoV-2 IgG. Placentae were studied for histology. Results: Of 212 women, 122 (58%) were seropositive for SARS-CoV-2 IgG, but none reported COVID-19 history; 134 (63.2%) were anemic. In seropositive women, hemoglobin (p=0.04), total WBC (p=0.009), lymphocytes (p=0.005) and neutrophils (p=0.02) were significantly higher, while ferritin was high, but not significant and neutrophils to lymphocytes (p=0.12) and platelets to lymphocytes ratios (p=0.03) were lower. Neonatal outcomes were similar. All RBC parameters and serum ferritin were significantly lower in anemic mothers but not in cord blood, except RDW that was significantly higher in both, maternal (p=0.007) and cord (p=0.008) blood from seropositive anemic group compared to other groups. Placental histology showed significant increase in villous hypervascularity (p=0.000), dilated villous capillaries (p=0.000), and syncytiotrophoblasts (p=0.02) in seropositive group, typically suggesting placental hypoxia. Maternal anemia was not associated with any histological parameters. Univariate and multivariate logistic regression analyses of placental histopathological adverse outcomes showed strong association with SARS-CoV-2 seropositivity but not with maternal anemia. When adjusted for several covariates, including anemia, SARS-CoV-2 seropositivity emerged as independent risk factor for severe chorangiosis (AOR 8.74, 95% CI 3.51-21.76, p<0.000), dilated blood vessels (AOR 12.74, 95% CI 5.46-29.75, p<0.000), syncytiotrophoblasts (AOR 2.86, 95% CI 1.36-5.99, p=0.005) and villus agglutination (AOR 9.27, 95% CI 3.68-23.32, p<0.000). Conclusion: Asymptomatic COVID-19 during pregnancy seemed to be associated with various abnormal placental histopathologic changes related to placental hypoxia independent of maternal anemia status. Our data supports an independent role of SARS-CoV-2 in causing placental hypoxia in pregnant women.

Knowledge and attitude regarding the covid-19 pandemic among healthcare workers at a medical college and hospital in south india

Background: The ongoing COVID-19 pandemic has provided multiple challenges within the health-care sector. There is an urgency to rapidly update and prepare all staff members not only for effective patient care but also decrease risk of occupational exposure. Earlier studies conducted indicate that non-physicians, non-nursing staff may possess significant lacunae within the required knowledge base. Aims and Objectives: We decided to study knowledge and associated attitude among healthcare workers at our hospital to enable further policies regarding awareness programs. Materials and Methods: We provided 104 employees (front desk, housekeeping, pharmacists, security, and technical staff) with a validated questionnaire to assess knowledge and attitude regarding the COVID-19 pandemic. Descriptive statistics, Chi-square test for association, and logistic regression analysis were conducted to analyze the results. Results: About 69.2% of respondents demonstrated a good knowledge level while positive attitude was obtained in 74% respondents. Higher education and profession (technical staff) showed a trend in determining a good level of knowledge. Less than 80% score in the attitude section was associated with the source of information being newspaper (P = 0.02) and peers/family (P = 0.014). Logistic regression analysis with multiple independent factors indicated increased age (>33 years), security, housekeeping, and pharmacy-related work as risk factors for a poor level of COVID-19 related knowledge. Conclusions: The knowledge score and attitude regarding COVID-19 is satisfactory within the hospital staff. Increased educational input involving the housekeeping, security, and pharmacy staff may improve COVID-19 related knowledge.