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1.
Acta Obstet Gynecol Scand ; 102(5): 567-576, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36958983

RESUMEN

INTRODUCTION: SARS-CoV-2 infection during pregnancy may cause viral inflammation of the placenta, resulting in fetal demise even without fetal or newborn infection. The impact of timing of the infection and the mechanisms that cause fetal morbidity and mortality are not well understood. MATERIAL AND METHODS: To describe placental pathology from women with confirmed SARS-CoV-2 infection during pregnancy, a SARS-CoV-2 immunohistochemistry-positive placenta and late miscarriage, stillbirth, neonatal death, or medically indicated birth due to fetal distress. RESULTS: The triad of trophoblastic necrosis, inflammatory intervillous infiltrates, and increased perivillous fibrinoid deposition was present in all 17 placentas; the pregnancies resulted in eight stillbirths, two late miscarriages (19 and 21 weeks' gestation), and seven liveborn children, two of which died shortly after delivery. The severity of maternal COVID-19 was not reflected by the extent of the placental lesions. In only one case, SARS-CoV-2 was detected in lung tissue samples from the fetus. The majority events (miscarriage, stillbirth, fetal distress resulting in indicated birth, or livebirth, but neonatal death) happened shortly after maternal SARS-CoV-2 infection was diagnosed. Seven of eight sequenced cases were infected with the Delta (B.1.617.2) virus strain. CONCLUSION: We consolidate findings from previous case series describing extensive SARS-CoV-2 placentitis and placental insufficiency leading to fetal hypoxia. We found sparse evidence to support the notion that SARS-CoV-2 virus had infected the fetus or newborn.


Asunto(s)
Aborto Espontáneo , COVID-19 , Placenta , Complicaciones Infecciosas del Embarazo , Humanos , Femenino , Embarazo , Recién Nacido , Placenta/patología , Placenta/virología , COVID-19/diagnóstico , SARS-CoV-2 , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Transmisión Vertical de Enfermedad Infecciosa , Sufrimiento Fetal , Aborto Espontáneo/epidemiología , Aborto Espontáneo/virología , Dinamarca/epidemiología , Muerte Perinatal , Corioamnionitis , Adulto
2.
Acta Obstet Gynecol Scand ; 102(3): 282-293, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36695168

RESUMEN

INTRODUCTION: We identified risk factors and outcomes associated with SARS-CoV-2 infection in pregnancy in a universally tested population according to disease severity and validated information on SARS-CoV-2 during pregnancy in national health registers in Denmark. MATERIAL AND METHODS: Cohort study using data from national registers and medical records including all pregnancies between March 1, 2020 and February 28, 2021. We compared women with a validated positive SARS-CoV-2 test during pregnancy with non-infected pregnant women. Risk factors and pregnancy outcomes were assessed by Poisson and Cox regression models and stratified according to disease severity defined by hospital admission status and admission reason (COVID-19 symptoms or other). Using medical record data on actual period of pregnancy, we calculated predictive values of the SARS-CoV-2 diagnosis in pregnancy in the registers. RESULTS: SARS-CoV-2 infection was detected in 1819 (1.6%) of 111 185 pregnancies. Asthma was associated with infection (relative risk [RR] 1.63, 95% confidence interval [CI] 1.28-2.07). Risk factors for severe COVID-19 disease requiring hospital admission were high body mass index (median ratio 1.06, 95% CI 1.04-1.09), asthma (RR 7.47, 95% CI 3.51-15.90) and gestational age at the time of infection (gestational age 28-36 vs < 22: RR 3.53, 95% CI 1.75-7.10). SARS-CoV-2-infected women more frequently had hypertensive disorders in pregnancy (adjusted hazard ratio [aHR] 1.31, 95% CI 1.04-1.64), early pregnancy loss (aHR 1.37, 95% CI 1.00-1.88), preterm delivery before gestational age 28 (aHR 2.31, 95% CI 1.01-5.26), iatrogenically preterm delivery before gestational age 37 (aHR 1.49, 95% CI 1.01-2.19) and small-for-gestational age children (aHR 1.28, 95% CI 1.05-1.54). The associations were stronger among women admitted to hospital for any reason. The validity of the SARS-CoV-2 diagnosis in relation to pregnancy in the registers compared with medical records showed a negative predictive value of 99.9 (95% CI 99.9-100.0) and a positive predictive value of 82.1 (95% CI 80.4-83.7). CONCLUSIONS: Women infected with SARS-CoV-2 during pregnancy were at increased risk of hypertensive disorders in pregnancy, early pregnancy loss, preterm delivery and having children small for gestational age. The validity of Danish national registers was acceptable for identification of SARS-CoV-2 infection during pregnancy.


Asunto(s)
Aborto Espontáneo , Asma , COVID-19 , Hipertensión Inducida en el Embarazo , Complicaciones Infecciosas del Embarazo , Nacimiento Prematuro , Recién Nacido , Niño , Femenino , Embarazo , Humanos , Adulto , SARS-CoV-2 , Resultado del Embarazo/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , Estudios de Cohortes , Nacimiento Prematuro/epidemiología , Prueba de COVID-19 , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Factores de Riesgo , Gravedad del Paciente
3.
Acta Obstet Gynecol Scand ; 100(11): 2097-2110, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34467518

RESUMEN

INTRODUCTION: Assessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy is essential to guide clinical care. Previous studies on SARS-CoV-2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS-CoV-2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS-CoV-2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission. MATERIAL AND METHODS: This was a prospective population-based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Cases of SARS-CoV-2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID-19) symptoms. RESULTS: Among 82 682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41-3.41) and being foreign born (OR 2.12, 95% CI 1.70-2.64). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74, 95% CI 1.00-7.51), smoking (OR 4.69, 95% CI 1.58-13.90), infection after gestational age (GA) 22 weeks (GA 22-27 weeks: OR 3.77, 95% CI 1.16-12.29; GA 28-36 weeks: OR 4.76, 95% CI 1.60-14.12), and having asthma (OR 4.53, 95% CI 1.39-14.79). We found no difference in any obstetrical or neonatal outcomes. CONCLUSIONS: Only 1 in 20 women with SARS-CoV-2 infection during pregnancy required admission to hospital due to COVID-19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS-CoV-2 infection in pregnancy were rare.


Asunto(s)
COVID-19/diagnóstico , COVID-19/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Adulto , COVID-19/terapia , Estudios de Cohortes , Dinamarca , Femenino , Hospitalización , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Resultado del Embarazo , Factores de Riesgo , Adulto Joven
4.
Ugeskr Laeger ; 184(21)2022 05 23.
Artículo en Danés | MEDLINE | ID: mdl-35656614

RESUMEN

A case of puerperal uterine inversion is, in this case report, presented in a low risk 29-year-old para 2. After a difficult manual removal of placenta, the patient became disproportionally hypovolaemic shocked compared to blood loss. When the diagnosis was recognized, uterus was reverted, and bleeding ceased momentarily. The precise aetiology of uterine inversion is not known, but factors such as prolonged duration of labour, abnormal placentation and manipulation of third stage of labour have been proposed. The severity and unpredictable nature emphasize the importance of every birth attendant being aware of this condition.


Asunto(s)
Trabajo de Parto , Complicaciones del Trabajo de Parto , Choque , Inversión Uterina , Adulto , Femenino , Humanos , Embarazo , Inversión Uterina/diagnóstico , Inversión Uterina/etiología , Útero/diagnóstico por imagen
5.
Ugeskr Laeger ; 176(38)2014 Sep 15.
Artículo en Danés | MEDLINE | ID: mdl-25294197

RESUMEN

A retrospective sample of 180 records from four regional hospitals and five university hospitals in Denmark was collected and the documentation for use of oxytocin in augmentation of labour and ventouse deliveries according to the national guidelines was registered. Only approximately half of the elements in the national guidelines were documented. This shows that there is a potential for improvement in the ongoing Danish national quality improvement project Safe Deliveries (Sikre Fødsler).


Asunto(s)
Documentación , Trabajo de Parto , Oxitócicos/administración & dosificación , Oxitocina/administración & dosificación , Extracción Obstétrica por Aspiración/estadística & datos numéricos , Dinamarca , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Registros Médicos/normas , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Guías de Práctica Clínica como Asunto , Embarazo , Estudios Retrospectivos
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