Comorbidity, poverty and social vulnerability as risk factors for mortality in pregnant women with confirmed SARS-CoV-2 infection: analysis of 13 062 positive pregnancies including 176 maternal deaths in Mexico.

OBJECTIVE: Mortality in pregnancy due to coronavirus disease 2019 (COVID-19) is a current health priority in developing countries. Identification of clinical and sociodemographic risk factors related to mortality in pregnant women with COVID-19 could guide public policy and encourage such women to accept vaccination. We aimed to evaluate the association of comorbidities and socioeconomic determinants with COVID-19-related mortality and severe disease in pregnant women in Mexico. METHODS: This is an ongoing nationwide prospective cohort study that includes all pregnant women with a positive reverse-transcription quantitative polymerase chain reaction result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the Mexican National Registry of Coronavirus. The primary outcome was maternal death due to COVID-19. The association of comorbidities and socioeconomic characteristics with maternal death was explored using a log-binomial regression model adjusted for possible confounders. RESULTS: There were 176 (1.35%) maternal deaths due to COVID-19 among 13 062 consecutive SARS-CoV-2-positive pregnant women. Maternal age, as a continuous (adjusted relative risk (aRR), 1.08 (95% CI, 1.05-1.10)) or categorical variable, was associated with maternal death due to COVID-19; women aged 35-39 years (aRR, 3.16 (95% CI, 2.34-4.26)) or 40 years or older (aRR, 4.07 (95% CI, 2.65-6.25)) had a higher risk for mortality, as compared with those aged < 35 years. Other clinical risk factors associated with maternal mortality were pre-existing diabetes (aRR, 2.66 (95% CI, 1.65-4.27)), chronic hypertension (aRR, 1.75 (95% CI, 1.02-3.00)) and obesity (aRR, 2.15 (95% CI, 1.46-3.17)). Very high social vulnerability (aRR, 1.88 (95% CI, 1.26-2.80)) and high social vulnerability (aRR, 1.49 (95% CI, 1.04-2.13)) were associated with an increased risk of maternal mortality, while very low social vulnerability was associated with a reduced risk (aRR, 0.47 (95% CI, 0.30-0.73)). Being poor or extremely poor were also risk factors for maternal mortality (aRR, 1.53 (95% CI, 1.09-2.15) and aRR, 1.83 (95% CI, 1.32-2.53), respectively). CONCLUSION: This study, which comprises the largest prospective consecutive cohort of pregnant women with COVID-19 to date, has confirmed that advanced maternal age, pre-existing diabetes, chronic hypertension, obesity, high social vulnerability and low socioeconomic status are risk factors for COVID-19-related maternal mortality. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx).

OBJECTIVE: There are limited, unmatched data reporting low complication rates in pregnant women with coronavirus disease 2019 (COVID-19). The aim of this study was to compare COVID-19-related outcomes between pregnant and non-pregnant women after adjusting for potential risk factors for severe outcomes. METHODS: Data were obtained from the COVID-19 National Data Registry of Mexico, which is an ongoing prospective cohort of people of any age with clinically suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and admitted to 475 monitoring hospitals. This study included pregnant and non-pregnant women of reproductive age (15-45 years) with COVID-19 confirmed by reverse transcription polymerase chain reaction. To adjust for underlying risk factors, propensity score matching was conducted for chronic obstructive pulmonary disease, asthma, smoking, hypertension, cardiovascular disease, obesity, diabetes, chronic renal disease, immunosuppression, age, language, nationality and level of health insurance. The primary outcome was death. Secondary outcomes were pneumonia, intubation and intensive care unit (ICU) admission. RESULTS: The cohort comprised 5183 pregnant and 175 905 non-pregnant women with COVID-19. The crude (unmatched) rates of death, pneumonia, intubation and ICU admission in pregnant compared with non-pregnant women were 1.5% vs 1.5%, 9.9% vs 6.5%, 8.1% vs 9.9% and 13.0% vs 6.9%, respectively. After propensity score matching (5183 pregnant and 5183 non-pregnant matched women), pregnant women had a higher odds of death (odds ratio (OR), 1.84; 95% CI, 1.26-2.69), pneumonia (OR, 1.86; 95% CI, 1.60-2.16) and ICU admission (OR, 1.86; 95% CI, 1.41-2.45) than non-pregnant women, but similar odds of intubation (OR, 0.93; 95% CI, 0.70-1.25). CONCLUSION: After adjusting for background demographic and medical factors, pregnancy is a risk factor for death, pneumonia and ICU admission in SARS-CoV-2-infected women of reproductive age. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Endometrioma con elevación inusual de CA-19.9. Reporte de un caso / Endometrioma with an unusual CA-19.9 elevation. A case report

Resumen Antecedentes: la prueba diagnóstica de referencia para endometriosis es la visualización de focos endometriósicos en un procedimiento quirúrgico. Los valores de CA-125 > 35 UI/mL y de CA-19.9 > 37 UI/mL sugieren endometriosis o tumores de ovario (teratomas, endometriomas y mucinosos). Los valores de CA-19.9 > 300 UI/mL tienen un valor predictivo positivo mayor de 90% para cáncer de páncreas. Caso clínico: paciente de 32 años de edad, con infertilidad primaria de 10 años, tumoración compleja en el ovario derecho de 209 cc y en el ovario izquierdo de 14.81 cc, con CA-19.9 de 2,920 UI/mL y CA-125 de 142.37 UI/mL. Por tomografía y panendoscopia se descartó la posibilidad de malignidad en el aparato gastrointestinal. En la laparotomía exploradora, protocolizada para tumor de ovario, se encontró un tumor de 10 x 8.0 cm en el ovario derecho y uno de 3.0 x 2.0 cm en el izquierdo. El reporte de patología fue de quistes endometriósicos, sin malignidad coexistente. En el seguimiento a los 40 días se encontró un CA-19.9 de 41.38 U/mL y a los 60 días logró un embarazo espontáneo. Conclusiones: los marcadores tumorales se utilizan para descartar algún proceso maligno en el ovario. Se carece de pruebas suficientes para recomendarlos rutinariamente para diagnosticar endometriosis. Cuando inusualmente sus valores se encuentran por encima del punto de corte, es importante descartar cualquier malignidad en el aparato gastrointestinal. Se recomienda asumir el tratamiento de estas pacientes con un equipo multidisciplinario.

Abstract Background: Endometriosis is the presence of ectopic non-neoplastic endometrial tissue. The gold standard diagnosis is a visual inspection by laparoscopy. A CA-125 >35 IU/mL and a CA-19.9 >37 IU/mL have been present in endometriosis and ovarian tumors (teratomas, endometriomas or mucinous). However, an elevation >300 IU/mL have a positive predictive value >90% for pancreatic cancer. Case report: 32-year-old female, with 10-year primary infertility. With a complex tumor in the right ovary of 209cc and in the left one of 14.81cc. The CA-19.9 was at 2,920 IU/mL and the CA-125 at 142.37 IU/mL. In which have ruled out gastrointestinal malignancy with tomography and panendoscopy. A laparotomy exploratory was performed, finding a tumor of 10x8.0cm in the right ovary and 3.0x2.0cm in the left one. The pathology report was of endometriosis cysts, with no coexisting malignancy. At follow-up at 40 days a CA-19.9 of 41.38 IU/mL was found and at 60 days achieved a spontaneous pregnancy. Conclusions: Tumor biomarkers are generally used to rule out malignant ovary pathology. There is insufficient evidence to recommend its routine use to diagnose endometriosis. However, when they are unusually above the cut-off point, it is important to specifically rule out gastrointestinal malignancy, working in a multidisciplinary way.

Neoplasia intraepitelial cervical durante el embarazo, experiencia institucional / Cervical intraepithelial neoplasia during pregnancy, Institutional Experience

Resumen OBJETIVO: describir el tipo de atención médica, tratamiento y seguimiento de pacientes con neoplasia intraepitelial cervical (NIC 3) y carcinoma in situ durante el embarazo, su evolución y condiciones del recién nacido. MATERIALES Y MÉTODOS: estudio retrospectivo de pacientes atendidas en el Instituto Nacional de Perinatología entre los meses de enero de 2009 y diciembre de 2014. Se incluyeron pacientes con diagnóstico de NIC 3 durante el embarazo, con expediente completo y atendidas en el servicio de Obstetricia desde su ingreso para control prenatal hasta la terminación del embarazo y tratamiento oncológico definitivo. RESULTADOS: se identificaron 6 casos de pacientes embarazadas con diagnóstico de NIC 3 posterior a la toma de citología cervical. A todas se les realizó colposcopia y biopsia cervical, sin complicaciones secundarias al procedimiento. El diagnóstico histopatológico fue: carcinoma epidermoide in situ en 3 pacientes y en otras 3 neoplasia intraepitelial cervical. Todas las pacientes recibieron atención multidisciplinaria, sin complicaciones obstétricas ni neonatales. El seguimiento promedio fue de 2 años. CONCLUSIONES: el diagnóstico oportuno de las lesiones precursoras de cáncer cervicouterino es indispensable y no se relaciona con inconvenientes perinatales derivados del tipo de acceso.

Abstract OBJECTIVE: Describe the approach, management and monitoring of patients with cervical intraepithelial neoplasia (NIC) 3 and in situ carcinoma during pregnancy, its evolution and perinatal outcomes. MATERIALS AND METHODS: We made a retrospective study of cases from January 2009 to December 2014 in women of the National Institute of Perinatology . We included patients who were diagnosed with cervical intraepithelial neoplasia 3 during pregnancy, with complete file and that received medical consultation of the oncology and obstetrics service since their admission to the hospital for prenatal control until de resolution of pregnancy and oncological definitive treatment. RESULTS: During the study period, 6 cases of pregnant patients where diagnosed with CIN 3, after cervical cytology was taken, a cervical biopsy was performed without complications secondary to this procedure; the histopathological diagnosis was: In situ epidermoid carcinoma in 3 patients and Cervical Intraepithelial Neoplasia in the other 3. All patients were treated with a Multidisciplinary approach. None of the patients presented obstetric or neonatal complications; At the end of the puerperium, follow-up was continued,the mean follow-up after the definitive treatment was 2 years. CONCLUSIONS: The timely diagnosis of precursor lesions of CACU is indispensable, in turn, is not related to adverse perinatal outcomes derived from the approach and timely screening.