Co-Infection of Dengue in a Pregnant Woman With COVID-19 Disease.

The pandemic due to severe respiratory syndrome coronavirus 2 (SARS-Cov-2) was one of the most damaging healthcare emergencies the world has ever seen. Co-infection with dengue virus in COVID-19-positive patients is an additional challenge especially in dengue-endemic areas. Both dengue and COVID-19 infection cause increased morbidity and adverse outcomes in pregnant women, and simultaneous infection of these two illnesses can be further detrimental and sometimes fatal in pregnant women. Here, we present a case of a pregnant woman in her early second trimester with co-infection of dengue and moderate COVID-19 disease who was managed successfully and had a favorable outcome.

Study of the Vertical Transmission of COVID-19 by Using the World Health Organisation Protocol in a Tertiary Care Hospital in Eastern India.

BACKGROUND: The World Health Organisation (WHO) has established criteria to diagnose vertical transmission in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the incidence of vertical transmission of SARS-CoV-2 using WHO criteria in a tertiary care centre in eastern India. METHODS: A hospital-based prospective observational study was conducted from June 2021 to February 2022 on women admitted for delivery with a positive nasopharyngeal (NP) swab and a SARS-CoV-2 real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test. Following the delivery, the amniotic fluid (AF) and swab from the placenta were tested for SARS-CoV-2 by the Truenat test. The umbilical cord and maternal blood were analyzed to detect immunoglobulin M (IgM) and immunoglobulin G (IgG). The nasopharyngeal swabs of the newborns were tested for SARS-CoV-2 by RT-PCR. RESULTS: Forty-eight SARS-CoV-2-positive asymptomatic women were included in the study. Twenty-eight (58.3%) were delivered via cesarean section. Preterm delivery occurred in 13 (27.1%) cases. In only one case, vertical transmission was confirmed as the neonate had a positive nasopharyngeal SARS-CoV-2 RT-PCR test and the cord blood was IgM positive (suggesting an immune response in the neonate). The placenta was positive in three cases, and amniotic fluid was positive in two. However, vertical transmission was deemed unlikely in these cases as there was no evidence of immune response or viral persistence according to the WHO criteria. There was one stillbirth, and it tested negative for SARS-CoV-2. CONCLUSION: This study strengthens the evidence of vertical transmission in COVID-19-positive asymptomatic mothers. The data suggest a low transmission rate.

Maternal and Neonatal Outcomes in Pregnant Women With SARS-CoV-2 Infection Complicated by Hepatic Dysfunction.

Background and objective The coronavirus disease 2019 (COVID-19) pandemic has caused one of the most devastating healthcare crises in recent times and presented many diagnostic challenges and uncertainties. COVID-19 complicated by acute hepatic dysfunction is a well-described phenomenon, but its impact on maternal and perinatal outcomes is not well documented. In this study, we aimed to evaluate the maternal and neonatal outcomes in pregnant women with COVID-19 complicated by liver dysfunction and compare those with pregnant women with COVID-19 and normal liver function. Methodology This was a retrospective observational cohort study conducted at the Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. All COVID-19-positive pregnant women (n=249) admitted to the hospital from May 15, 2020, to August 15, 2021, were included in this study. Retrospective data collection was done using the medical records of these COVID-19-positive pregnant women and included the baseline characteristics, past medical history, obstetric history, clinical presentation, laboratory results, management modalities, and maternal and neonatal outcomes. Of note, 107 women were found to have acute liver function abnormality on admission and 142 women had normal liver function tests (LFTs). Pregnant women with normal LFTs were classified as group one and those with deranged LFTs as group two. Characteristics such as age, period of gestation, symptoms, associated comorbidities, laboratory results, management, and outcomes were compared across both groups. Results Out of the total 249 pregnant women with COVID-19 admitted during the study period, 42.97% (n=107) women had laboratory findings consistent with liver dysfunction and 142 women (57.03%) had a normal liver function. Significantly higher levels of lactate dehydrogenase (LDH), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), alanine transaminase (ALT), aspartate aminotransferase (AST), and total bilirubin levels were seen in pregnant women with hepatic dysfunction when compared to those with normal liver function. Among the 249 patients, the majority were asymptomatic or had mild disease, 12 women had moderate disease, and six women had severe COVID-19. All women with severe COVID-19 had deranged LFTs. There was no statistical difference in terms of obstetric management between pregnant patients with and without liver dysfunction. Out of the 107 women with deranged liver function, 18 women had a preterm birth, four had intrauterine fetal death, and one had neonatal death. Complications such as postpartum hemorrhage, the need for blood transfusions, sepsis and multiorgan failure, and mortality were more commonly seen in the group of pregnant women with hepatic dysfunction associated with COVID-19. Conclusion COVID-19 in pregnancy may cause deranged LFTs in these women. Pregnant women with COVID-19 complicated by liver dysfunction have been reported to have worse inflammation, higher disease severity, and more morbidity and mortality when compared to those without liver dysfunction. They are also at a higher risk of complications such as postpartum hemorrhage, the need for blood transfusion, sepsis, and multiorgan dysfunction.

Maternal and Neonatal Outcome of Pregnant Women With SARS-CoV-2 Infection During the First and Second Wave of COVID-19 in a Tertiary Care Institute in Eastern India.

Background The ongoing coronavirus 2019 (COVID-19) pandemic is the most devastating health care crisis of our times. Pregnant women with COVID-19 infection belong to a vulnerable group with concerns about the effect of the disease on maternal and neonatal health. As we are dealing with a new disease, we must study the changing trend of disease presentation, diagnosis, and treatment to successfully manage such pregnancies. Objective The purpose of the present study was to evaluate the differences in presenting features, comorbidities, the fetal and maternal outcomes in COVID-19 positive pregnant women in the first and second wave of the pandemic in a tertiary care institute in eastern India. Methodology This study was a retrospective observational cohort study conducted at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. All COVID-19 positive by reverse transcription-polymerase chain reaction or rapid antigen (RTPCR) test pregnant women (249 women) admitted to the hospital from May 2020 to August 2021 were included in this study. Out of the total, 139 women were admitted during the first wave (May 2020 to February 2021), and 110 women were admitted during the second wave (March 2021 to August 2021) of the pandemic. Data like baseline characteristics, clinical presentation, associated co-morbidities, management modalities, the maternal and neonatal outcomes were analyzed and compared. Results The peak of the first wave of COVID-19 was found during the months of August-October 2020, while the second wave was in April-May 2021. The majority of women had the asymptomatic or mild disease during both waves, but 14 women had moderate to severe disease during the second wave as compared to two women during the first wave. There was a significant increase in maternal deaths in the second wave (3.64%) as compared to the first wave (0.00%). During the second wave, out of 85 women who delivered, 78.8% (n=67) women had a cesarean section which was significantly higher than the first wave (64.6%). Hypertensive disorders (pre-eclampsia, gestational hypertension, and chronic hypertension) were the most common associated comorbidity, followed by diabetes (gestational diabetes, diabetes mellitus type 2) and anemia during both waves of the pandemic. The rate of preterm delivery was 27.78% (n=35) and 24.71% (n=21) during the first and second waves, respectively. Two babies tested positive within 24 hours of delivery during the first wave and one during the second wave.  Conclusion A significantly higher number of moderate to severe disease and maternal deaths were reported during the second wave of the pandemic. A higher incidence of severe oligohydramnios and cesarean section was seen during the second wave. The frequency of preterm deliveries and low birth weight remained high during both waves. Neonatal COVID-19 infection was seen during both waves, but the incidence remained low.

Analysis of Pregnant Women Recovered From Antenatal SARS-CoV-2 Infection: An Observational Study.

Background and objective The global health care system is facing the challenge of diagnosing and treating the ongoing coronavirus disease 2019 (COVID-19) pandemic. Pregnant women belong to a vulnerable group, and the effect of the virus on the mother and fetus is not well established. The aim of the study was to understand the maternal and fetal outcomes after recovery from antenatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods  This was a retrospective observational study conducted at Tata Main Hospital, Jamshedpur, India. It included all COVID-19-negative pregnant women who had delivered between 1st January 2021 and 31st August 2021 and had tested positive in the antenatal period (by reverse transcription-polymerase chain reaction (RT-PCR)), the details of which are available in the hospital database. Results A total of 53 women were included in our study who had tested positive in the antenatal period and had turned negative during delivery. Out of the 53 women, 5.7% were infected in the first trimester, 34% in the second trimester, and 60.3% were positive in the third trimester. We found an asymptomatic subgroup in 52.8% of women and mild symptoms in 41.5% of women. Two women were admitted in their antenatal period with moderate COVID-19 disease and one with severe. Preterm births between 34 weeks and 37 weeks were seen in 26.4% of women. Vaginal delivery accounted for 30.2% of cases. The most common indications for cesarean section were fetal distress (17%), previous cesarean section (17%), and unwillingness for vaginal delivery. Out of the 53 pregnant women included in the study, acute respiratory distress syndrome (ARDS) was seen in two women- one diagnosed intraoperatively during cesarean section and the other was diagnosed on the first postoperative day. Conclusion The study showed that pregnant women infected with SARS-CoV-2 usually have no/mild symptoms, and they recover well and have favorable maternal and neonatal outcomes. However, perinatal vigilance is advisable in these cases, as there is a risk of developing respiratory morbidity.

Moderate to Severe Thrombocytopenia in Four Pregnant Women With Asymptomatic COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) pandemic is one of the biggest healthcare crises faced globally. Since its emergence, uncertainty about its progress and treatment options has challenged clinicians around the world. Pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection pose a higher challenge due to the concerns of an already altered immune system during pregnancy and the disease's effect on the fetus. Thrombocytopenia is associated frequently with moderate to severe coronavirus disease and is also an established marker of worsening of the disease. However, it is infrequently seen in mild or asymptomatic cases. Neuraxial anesthesia is the preferred choice of anesthesia in COVID-19 positive patients but thrombocytopenia in a parturient with coronavirus disease can cause a dilemma for the obstetric anesthesiologist. Here we describe the management of four pregnant women with asymptomatic COVID-19 disease who had moderate to severe thrombocytopenia. These cases highlight the importance of careful monitoring of the platelet count of pregnant women with COVID-19 infection even if asymptomatic.

Central Placenta Previa With Coexisting Central Cervical Fibroid in Pregnancy: An Obstetrician's Nightmare.

Pregnancy with central placenta praevia and a coexistent cervical fibroid is infrequently encountered in clinical practice. A patient with this unusual combination is a nightmare for any clinician, especially if she presents with obstetric emergencies. In this scenario, there is a high chance of catastrophic obstetric hemorrhage during the peripartum period leading to a fatal outcome. We report a case of a 27-year-old lady at term pregnancy, who was brought to emergency in labor pain with antepartum hemorrhage. Subsequently, she was diagnosed to have central placenta praevia along with a large central cervical fibroid. An emergency cesarean section was performed to deliver the child. Intraoperatively, she had a major postpartum hemorrhage which was successfully managed with intrauterine balloon tamponade, hemostatic sutures, and uterine artery ligation. We could avoid cesarean hysterectomy by precise anticipation, meticulous planning, and step-wise protocol-driven management.

Pregnancy With SARS-CoV-2 Infection Complicated by Preeclampsia and Acute Fatty Liver of Pregnancy.

The coronavirus disease 2019 (COVID-19) pandemic has spread across the world in a relentless and merciless way. As the pandemic escalates, varied presentations and complications of the disease have been reported from all over the world. Pregnant women fall into a vulnerable group who have been reported to have more severe disease and need of intensive care when compared to non-pregnant women of the same age group. Preeclampsia is one of the most common co-morbidity seen in pregnant women with COVID-19 infection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to worsening of pre-existing co-morbidities and extra vigilance is required in such cases. Here we present a case of a pregnant woman with COVID-19 infection with preeclampsia complicated by acute fatty liver of pregnancy and acute kidney injury. Although a rare diagnosis, a prompt multidisciplinary approach helped in achieving a favorable maternal and neonatal outcome.

Treatment With Remdesivir in Two Pregnant Patients With COVID-19 Pneumonia.

The current coronavirus disease 2019 (COVID-19) pandemic has resulted in an unprecedented global healthcare crisis. Pregnant women belong to a vulnerable group with a higher chance of severe disease and need of intensive care. However, there is limited data on treatment options for severe coronavirus disease in pregnancy. Here, we describe two cases of severe COVID-19 infection in pregnancy with radiological diagnosis of COVID-19 pneumonia, who required intensive care treatment. Both were treated with remdesivir and recovered well without any major side effects, with a favorable maternal and fetal outcome.

Maternal and Neonatal Outcomes of COVID-19 in Pregnancy: A Single-Centre Observational Study.

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic is one of the most challenging healthcare crises faced globally. Adequate information and understanding of the clinical presentation and impact of the disease on maternal and neonatal outcomes is the key to successfully manage a pregnancy with COVID-19. OBJECTIVE: The purpose of the present study was to evaluate the clinical presentation of COVID-19 in pregnancy, its course during pregnancy and its effects on maternal and neonatal outcomes. STUDY DESIGN AND SETTING: This study was a retrospective observational study conducted at Tata Main Hospital, Jamshedpur, a tertiary care hospital in Eastern India. Population and study period: All COVID-19-positive (by reverse transcription polymerase chain reaction or rapid antigen test) pregnant women admitted to the hospital from 15th May 2020 to 15th November 2020.  Results: A total of 132 COVID-19-positive pregnant women were included in the study. Eighty-six women (65.15%) were asymptomatic, 45 women (34.09%) had mild symptoms and one woman had severe disease. Major co-morbidities seen were hypertensive disorders (pre-eclampsia, gestational hypertension and chronic hypertension) in 18 (13.64%) and diabetes (gestational diabetes, diabetes mellitus type 2) in 14women (10.60%). The rate of preterm delivery was 28.69% (n=35). Caesarean section was done for 78 women (63.93%) and 44 (36.07%) delivered vaginally. Average birth weight reported was 2.59 kilograms. Forty babies (33.06%) were admitted to the neonatal intensive care unit. Two babies (1.65%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 24 hours of delivery.  Conclusion: COVID-19 in pregnancy commonly presents as an asymptomatic or mild disease. It is associated with high rates of preterm births and neonatal admissions to the intensive care unit. Intrauterine and neonatal death rates remain low. Vertical transmission is possible; however, the incidence is low, and the majority of these neonates are asymptomatic.