Factors Related to Low COVID-19 Vaccination Rate in Pregnant and Postpartum Women with and without COVID-19.

OBJECTIVE: This study focused on pregnant and postpartum women during the COVID-19 pandemic, aiming to determine the attitudes and behaviors of vaccinated and unvaccinated groups, and the vaccination behaviors in the groups with and without the disease. The reasons for refusing the vaccine were also questioned. METHODS: This cross-sectional study was performed from September 2021 to October 2021. The study data were collected using a face-to-face questionnaire. The participants were pregnant women who applied to the hospital for routine antenatal care and were hospitalized, and women in the postpartum period. Additionally, pregnant and postpartum patients who were diagnosed with COVID-19 at the time of admission and were hospitalized and admitted to the intensive care unit due to this disease were also included in the study. RESULTS: A total of 1,146 pregnant and postpartum women who completed the questionnaire were included in our study. Only 43 (3.8%) of the participants were vaccinated; 154 (13.4%) of the participants had comorbidities. The number of COVID-19-positive patients was 153. The lack of sufficient information about the safety of the COVID-19 vaccine is the most common reason for the refusal. CONCLUSION: Vaccine refusal can significantly delay or hinder herd immunity, resulting in higher morbidity and mortality. Considering the adverse effects of COVID-19 on pregnancy, it is essential to understand pregnant and postpartum women's perceptions toward vaccination to end the pandemic.

Umbilical artery half peak systolic velocity deceleration time: a novel Doppler parameter for prediction of neonatal outcomes in pregnant women with preeclampsia.

PURPOSE: To assess the effectiveness of half peak systolic velocity deceleration time (hPSV-DT) in predicting neonatal outcomes in pregnant women with preeclampsia and to compare its usefulness with the conventional umbilical artery (UA) pulsatility index (PI) approach. METHODS: A prospective cohort study was conducted among pregnant women with preeclampsia who were admitted to the Department of Perinatology, Ministry of Health Ankara City Hospital between 01 September 2022 and 01 January 2023 at 28-41 weeks gestational age. 55 patients were divided into two groups: the study group with UA hPSV-DT value < 5th percentile (n = 22) and the control group with UA hPSV-DT value ≥ 5th percentile (n = 33). UA hPSV-DT calculates the time in milliseconds needed to halve the maximal velocity of the UA waveform using Doppler ultrasonography. RESULTS: Birth weight, gestational age at birth, 1st minute APGAR, 5th minute APGAR, and umbilical cord pH values were significantly lower in the anormal hPSV-DT group (p < 0.05). Additionally, the rates of admission to NICU, respiratory distress syndrome (RDS), delivery time < 34 weeks, and birth weight < 2500 g were significantly more frequent in the anormal hPSV-DT group compared to the normal hPSV-DT group (p < 0.05). UA-PI > 95th percentile was detected in only 2 (8%) of 23 patients whose newborns were admitted to the NICU (p = 0.149), while hPSV-DT < 5th percentile was detected in 16 (69%) of 23 patients (p < 0.001). According to ROC analysis, the area under the curve was 0.82 (95% CI 0.06-0.28) for admission to the NICU. The best balance of sensitivity/specificity in ROC curves was 221.5 (82.6% sensitivity, 69.1% specificity, p < 0.001). CONCLUSION: UA hPSV-DT was successful in predicting composite adverse perinatal outcomes in pregnant women with preeclampsia. It is a promising novel method that is accurate, quantitative, reproducible, and easily applicable. With further studies, this method may be a primary diagnostic tool in the management of high-risk pregnancies and in determining the optimal timing of delivery.

Cervical sliding sign at second trimester in the prediction of early preterm birth in twin pregnancy.

OBJECTIVE: To examine the cervical sliding sign (CSS) alongside cervical length (CL) in twin pregnancies to predict preterm birth (PB). METHODS: Twin pregnancies (n = 37) with no known risk factor for PB were included in this prospective study. CSS was defined as the ultrasonographic finding in which the anterior lip of the cervix slides over the posterior lip with gentle and continuous pressure application. The CSS and CL measurements were held in the second trimester. Early PB was defined as the birth of the fetus before 32 weeks of gestation. The patients were divided into two groups as CSS-positive and CSS-negative. RESULTS: Whereas 11 (29.7%) of the twin pregnancies were CSS-positive, 26 (70.3%) were CSS-negative. CSS positivity had a sensitivity of 75.0%, a specificity of 82.2%, a positive predictive value of 54.5%, and a negative predictive value of 92.3% to predict early PB. Multivariate logistic regression analysis revealed that CSS positivity was the only significant independent factor related to early PB. CONCLUSION: CSS was shown to be superior to CL in providing a better insight to predict early PB. CSS evaluation should be performed in twin pregnancies.

Correlation of systemic inflammation biomarkers and disease severity in pregnant women with COVID-19.

OBJECTIVE: The aim of this study was to evaluate the prognostic value of whole blood parameters, systemic inflammatory indices, and systemic inflammatory markers in pregnant women with COVID-19. METHODS: In this cross-sectional study, the demographic, clinical, and laboratory data (i.e., whole blood parameters, C-reactive protein, procalcitonin, ferritin, and D-dimer) of 464 pregnant women with COVID-19 who attended a tertiary hospital between January and April 2021 were reviewed. Systemic inflammatory indices (i.e., neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet/neutrophil ratio, and systemic immune inflammation index) were calculated. Asymptomatic and mildly symptomatic pregnant women were classified as Group 1 (n=413), and those with severe disease were classified as Group 2 (n=51). RESULTS: Lymphocyte count and lymphocyte percentage in whole blood parameters were significantly lower (p<0.05), and C-reactive protein, ferritin, and procalcitonin values were higher in Group 2 (p<0.05). Systemic inflammatory indices [neutrophil/lymphocyte ratio (4.7±2.9 (1.1-21.2) vs 7.5±4.7 (2.13-23.2)), platelet/lymphocyte ratio (191.1±104.3 (53.0-807.1) vs 269.5±118.9 (105.0-756.0)), systemic immune inflammation index (1,000±663 (209-5,231) vs 1,630±1,314 (345-7,006))] were found statistically significantly higher in severe disease group (p<0.001). CONCLUSION: Evidence in this study indicates that neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune inflammation index at first admission are simple, rapid, and inexpensive indices in predicting the prognosis of COVID-19 in pregnant women.

The role of systemic immune-inflammation index in the severity of hyperemesis gravidarum.

BACKGROUND: Hyperemesis gravidarum(HEG) is one of the severe health problems in early pregnancy. Obstetricians should be aware of systemic inflammation in HEG patients to provide better preventive strategies. AIM: Hyperemesis gravidarum(HEG) is one of the most common causes of hospitalization in early pregnancy. Complete blood count parameters can be used as inflammatory markers in patients with HEG. We aimed to investigate the Systemic Immune-Inflammation Index (SII)in predicting the severity of HEG. METHODS: This cross-sectional study was performed with 469 pregnant women diagnosed and hospitalized with HEG. The study parameters were calculated from complete blood count tests and urine analysis. Demographic characteristics, the Pregnancy Unique Quantification of Emesis (PUQE) scale values, and ketonuria levels at hospital admission were recorded. The neutrophil­to­lymphocyte ratio (NLR), platelet­to­lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and SII, calculated by the formula (neutrophil × platelet/lymphocyte), were evaluated for predicting the severity of HEG. RESULTS: There was a positive correlation between the increased degree of ketonuria and SII. The cut-off value of SII for predicting the severity of HEG was 1071.8 (AUC 0.637, 95% CI (0.582-0.693), p<0.001), and sensitivity and specificity were 59% and 59%, respectively. The cut-off value of SII to predict the length of hospitalization was 1073.6(AUC: 0.565, 95% CI: (0.501-0.628), p = 0.039); sensitivity and specificity were 56.3% and 55.5%, respectively. CONCLUSIONS: The clinical utility of SII in predicting HEG severity is limited due to relatively low sensitivity and specificity. Further research is needed to determine the importance of inflammatory indices in HEG patients.

Comparison of cord blood pro-BNP levels in newborns of SARS-COV-2-positive and -negative women, and its association with adverse perinatal outcomes.

OBJECTIVE: To compare umbilical cord blood pro-B-type natriuretic peptide (BNP) levels in newborns of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) positive pregnancies to those of SARS-COV-2 negative pregnancies. METHODS: Prospectively cord blood samples from newborns of 42 SARS-COV-2 positive women, and 42 negative pregnant were collected at birth and analyzed for pro-BNP levels. RESULTS: The mean cord blood pro-BNP level was significantly higher in newborns of SARS-COV-2 positive women than in controls. Furthermore, the pro-BNP level was an independent predictor of NICU admission in both SARS-COV-2 positive and control patients. CONCLUSION: Cord blood pro-BNP level may be a parameter that can predict the under-stress fetus and adverse perinatal outcomes especially, in cases where placental involvement is present as in SARS-COV-2 infection.

Factors Related to Low COVID-19 Vaccination Rate in Pregnant and Postpartum Women with and without COVID-19 / Fatores relacionados à baixa taxa de vacinação contra COVID-19 em gestantes e puérperas com e sem COVID-19

Abstract Objective This study focused on pregnant and postpartum women during the COVID-19 pandemic, aiming to determine the attitudes and behaviors of vaccinated and unvaccinated groups, and the vaccination behaviors in the groups with and without the disease. The reasons for refusing the vaccine were also questioned. Methods This cross-sectional study was performed from September 2021 to October 2021. The study data were collected using a face-to-face questionnaire. The participants were pregnant women who applied to the hospital for routine antenatal care and were hospitalized, and women in the postpartum period. Additionally, pregnant and postpartum patients who were diagnosed with COVID-19 at the time of admission and were hospitalized and admitted to the intensive care unit due to this disease were also included in the study. Results A total of 1,146 pregnant and postpartum women who completed the questionnaire were included in our study. Only 43 (3.8%) of the participants were vaccinated; 154 (13.4%) of the participants had comorbidities. The number of COVID-19-positive patients was 153. The lack of sufficient information about the safety of the COVID-19 vaccine is the most common reason for the refusal. Conclusion Vaccine refusal can significantly delay or hinder herd immunity, resulting in higher morbidity and mortality. Considering the adverse effects of COVID-19 on pregnancy, it is essential to understand pregnant and postpartum women's perceptions toward vaccination to end the pandemic.

Correlation of systemic inflammation biomarkers and disease severity in pregnant women with COVID-19

SUMMARY OBJECTIVE: The aim of this study was to evaluate the prognostic value of whole blood parameters, systemic inflammatory indices, and systemic inflammatory markers in pregnant women with COVID-19. METHODS: In this cross-sectional study, the demographic, clinical, and laboratory data (i.e., whole blood parameters, C-reactive protein, procalcitonin, ferritin, and D-dimer) of 464 pregnant women with COVID-19 who attended a tertiary hospital between January and April 2021 were reviewed. Systemic inflammatory indices (i.e., neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet/neutrophil ratio, and systemic immune inflammation index) were calculated. Asymptomatic and mildly symptomatic pregnant women were classified as Group 1 (n=413), and those with severe disease were classified as Group 2 (n=51). RESULTS: Lymphocyte count and lymphocyte percentage in whole blood parameters were significantly lower (p<0.05), and C-reactive protein, ferritin, and procalcitonin values were higher in Group 2 (p<0.05). Systemic inflammatory indices [neutrophil/lymphocyte ratio (4.7±2.9 (1.1-21.2) vs 7.5±4.7 (2.13-23.2)), platelet/lymphocyte ratio (191.1±104.3 (53.0-807.1) vs 269.5±118.9 (105.0-756.0)), systemic immune inflammation index (1,000±663 (209-5,231) vs 1,630±1,314 (345-7,006))] were found statistically significantly higher in severe disease group (p<0.001). CONCLUSION: Evidence in this study indicates that neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune inflammation index at first admission are simple, rapid, and inexpensive indices in predicting the prognosis of COVID-19 in pregnant women.

An evaluation of the results of convalescent plasma therapy applied to pregnant women diagnosed as COVID-19- positive in a pandemic center: A prospective cohort study.

BACKGROUND: Convalescent plasma (CP) might be an additional treatment modality in COVID-19. The aim of this study was to compare CP-related clinical characteristics and perinatal outcomes in pregnant women with mild or moderate-severe COVID-19. METHODS: This prospective cohort study included 36 pregnant women (12 mild and 24 moderate-severe), who underwent CP therapy. The CP obtained from recently recovered donors was transfused to patients together with maximum supportive care and antiviral agents. The groups were then compared in respect of clinical characteristics, laboratory parameters, obstetric complications, and neonatal outcomes. RESULTS: Significant differences were determined between the groups in respect of systemic corticosteroids in COVID-19 treatment (41.7%, 87.5%, p = 0.004), oxygen (O2) support (0%, 91.7%, p < 0.001), chest imaging (41.7%, 58.3%, p = 0.02), intensive care unit admission (0%, 20.8%, p = 0.03) and length of hospitalization (5.5 versus 9.5 days, p < 0.001). The O2 saturation levels before and after administration of CP were significantly lower in the moderate-severe COVID-19 group (p < 0.05). The O2 therapy time before and after administration of CP and total O2 therapy time were significantly lower in the mild COVID-19 group (p < 0.05). Platelet, plateletcrit and lymphocyte counts were significantly higher in both the mild and moderate-severe COVID-19 groups after treatment compared to the pretreatment values (p < 0.05). DISCUSSION: Although data on the results of CP treatment in pregnant women are somewhat limited, it has been suggested that early CP treatment may be associated with improvements in laboratory and ventilatory parameters in pregnant women with mild and moderate-severe COVID-19. Nevertheless, there is a need for further, randomized controlled studies on this subject with the inclusion of greater numbers of patients.

Point shear wave velocity(pSWV) evaluation of the placenta of pregnant women who had recovered from COVID-19: A prospective cohort study from a tertiary pandemic center.

INTRODUCTION: To assess the placental elasticity using point shear wave velocity (pSWV) in pregnant women who had recovered from coronavirus COVID-19. METHODS: A total of 40 pregnant women who had recovered from moderate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 40 healthy pregnant women were included in this study. We evaluated placental elasticity by using transabdominal pSWV method. Three measurements were made, and their average was accepted as the mean placental velocity value in each case. The results were compared between the post-COVID-19 and control groups. RESULTS: The mean pSWV values were significantly higher in the post-COVID-19 group compared to the control group, indicating that the women with a history of COVID-19 had stiffer placentas. Furthermore, the pSWV values were significantly and positively correlated with the uterine artery pulsatility index. We also found that the NICU requirement was statistically higher in the post-COVID 19 group. DISCUSSION: The pregnant women who had recovered from COVID-19 had rigid placentas than the healthy controls. The use of pSWV for the assessment of placental velocity may provide valuable information in the diagnosis and management of post-COVID-19 patients as a complementary tool to the existing ultrasonography methods.

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases.

PURPOSE: To compare the clinical features and perinatal outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-variant and post-variant periods. METHODS: This prospective cohort study includes pregnant women with SARS-CoV-2 who were followed-up at Ankara City Hospital between 11, March 2020 and 15, September 2021. Demographic features, clinical characteristics and pregnancy outcomes were compared between the pre-variant (n = 1416) and post-variant (n = 519) groups. RESULTS: The rates of severe and critical cases significantly increased in the post-variant group (9.7% vs 2%, p < 0.001). The rates of respiratory support (26.8% vs 7.3%, p < 0.001), ICU admission (12.9% vs 1.8%, p < 0.001) and maternal mortality (2.9% vs 0.4%, p < 0.001) were significantly higher in the post-variant group. A significant increase was observed for pregnancy complications in the post-variant group (45.6% vs 18.8%, p = 0.007). The rates of preterm delivery (26.4% vs 4.4%, p < 0.001) and NICU admission (34% vs 18.8%, p < 0.001) were significantly higher in the post-variant group. Positive, weak, statistically significant correlations were observed between the post-variant period, disease severity and maternal mortality (r = 0.19, r = 0.12 and p < 0.001). CONCLUSION: Post-variant COVID-19 period was associated with a severe course of the disease and increased rates of adverse obstetric outcomes in pregnant patients.

Fetal pulmonary artery Doppler evaluation in pregnant women after recovery from COVID-19.

OBJECTIVE: To evaluate fetal lung development using pulmonary artery Doppler in pregnant women who had recovered from COVID-19. METHODS: The prospective case-control study included 41 pregnant women who had recovered from COVID-19 and 43 healthy pregnant women (control group). All the women in the study group had been diagnosed with COVID-19 and had completed a quarantine period. RESULTS: The demographic data of patients were similar in the groups (P > 0.05). Main pulmonary artery peak systolic velocity was higher and pulsatility indices were lower in pregnant women who recovered from COVID-19 compared to the controls (P < 0.001, P = 0.001). Acceleration time, ejection time, and acceleration/ejection time ratio (PATET) of the fetal MPA Doppler were significantly decreased in pregnant women who recovered from COVID-19 (P < 0.001, P = 0.036, and P = 0.002, respectively). The patients who had recovered from COVID-19 were divided into two groups: those treated with expectant management and those treated in hospital. The pulmonary artery acceleration time and PATET ratio were significantly lower in the group treated in the hospital (P = 0.023 and P = 0.045, respectively). CONCLUSION: Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID-19 disease.

Assessment of fetal Doppler parameters in pregnant women with COVID-19 infection: a prospective case-control study.

OBJECTIVES: To investigate the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on fetal Doppler parameters. METHODS: This was a prospective case-control study conducted in Ankara City Hospital with confirmed SARS-CoV-2 infected pregnants between August 1, 2020 and October 1, 2020. There were 54 COVID-19 confirmed pregnant women and 97 age-matched pregnant women as a control group between 28 and 39 weeks. Infection was confirmed based on positive real-time polymerase-chain reaction results. Demographic features, uterine artery (right, left), umblical artery, middle cerebral artery, ductus venosus, cerebro-placental ratio, and cerebral-placental-uterine ratio Doppler parameters were investigated in both groups. RESULTS: Two groups were similar in terms of demographic features and no difference was found for fetal Doppler parameters. CONCLUSIONS: COVID-19 seems to have no adverse effect on fetoplacental circulation in mild and moderate patients during the acute phase of the infection.

Investigating the risk of maternal-fetal transmission of SARS-CoV-2 in early pregnancy.

INTRODUCTION: The possibility of vertical transmission of SARS-CoV-2 from the mother to the fetus is one of the most crucial issues regarding the COVID-19 effects on pregnancy. In this study, we aimed to explore the risk of maternal-fetal transmission before 24 weeks of gestation, through analysis of abortion materials collected from PCR-positive women with pregnancy loss. To the best of our knowledge, apart from case reports, this study is the first prospective work on the vertical transmission of SARS-CoV-2 in early pregnancy. METHODS: The patients who had attended our clinic with the diagnosis of pregnancy loss before 24 weeks of gestation were screened for COVID-19. Vertical transmission in PCR-positive women was assessed through the presence of SARS-CoV-2 RNA in fetal-placental tissues by rt-PCR test. RESULTS: 24 of 210 (%11,4) pregnant women participating in the study had positive rt-PCR results. Placenta and curettage material samples of these PCR-positive patients were analyzed and all valid test results (21 samples) were negative for SARS CoV-2 RNA. In three cases, the rt-PCR results were invalid due to failed internal controls. DISCUSSION: In the literature, the possibility of intrauterine vertical transmission of SARS-CoV-2 is still controversial. The findings of the present study did not reveal any evidence of vertical transmission of SARS-CoV-2 in early pregnancy.

Is it Possible to Predict Massive Bleeding in Nulliparous Women with Placenta Previa?

OBJECTIVE: We evaluated risk factors to determine if there were specific risk factors that could predict massive bleeding in nulliparous women with placenta previa. METHODS: The participants were classified into two groups. Women with a calculated blood loss ≥ 1,000 mL were included in the massive bleeding group. Women without any signs or symptoms related with hypovolemia or with a calculated bleeding volume < 1,000 mL were categorized into the non-massive bleeding group. RESULTS: There were 28 patients (40.6%) with massive bleeding and 41 cases (59.4%) with non-massive bleeding. The calculated blood loss and number of cases that required red cell transfusions were statistically different between the groups (< 0.005 and 0.002, respectively). There were no statistically significant differences in terms of maternal or fetal factors, placental location, or delivery characteristics between the two groups. CONCLUSION: We could not determine the predictive features for massive hemorrhage based on clinical features, delivery features, or placental location.

Is it possible to predict massive bleeding in nulliparous women with placenta previa?

Abstract Objective We evaluated risk factors to determine if there were specific risk factors that could predict massive bleeding in nulliparous women with placenta previa. Methods The participants were classified into two groups. Women with a calculated blood loss ≥ 1,000mL were included in the massive bleeding group. Women without any signs or symptoms related with hypovolemia or with a calculated bleeding volume < 1,000 mL were categorized into the non-massive bleeding group. Results There were 28 patients (40.6%) with massive bleeding and 41 cases (59.4%) with non-massive bleeding. The calculated blood loss and number of cases that required red cell transfusions were statistically different between the groups (< 0.005 and 0.002, respectively). There were no statistically significant differences in terms of maternal or fetal factors, placental location, or delivery characteristics between the two groups. Conclusion We could not determine the predictive features for massive hemorrhage based on clinical features, delivery features, or placental location.