ABSTRACT
BACKGROUND: Risk factors for severe SARS-CoV2 infection in pregnancy have not been extensively studied. This information can help guide the management of pregnant women with COVID-19. OBJECTIVE: Examine risk factors for severe COVID-19 in pregnant women. METHODS: We reviewed the records of all pregnant women with positive SARS-CoV2 tests (qRT-PCR) managed at a single tertiary private maternity in Sao Paulo, Brazil. We categorized women as having non-severe (mild or moderate) or severe (severe or critical) COVID-19. We conducted multivariable analyses to identify differences in sociodemographic and clinical characteristics of the two groups as risk factors for severe COVID-19. RESULTS: Between March 13 and June 7 2020, 114 women tested positive for SARS-CoV-2; 80.7% (n = 92) had non-severe disease (69 mild, 23 moderate), 15.7% (n = 18) had severe, and 3.5% (n = 4) had critical COVID-19. Women with severe/critical COVID-19 (n = 22) were significantly older (35.0 ± 5.9 × 31.8 ± 5.1 years, p = 0.011), more likely to have at least one medical comorbidity (81.8% × 52.2%, p = .011) or a history of asthma (18.2% × 3.3%, p = .025), and tended to have a higher median body mass index (30.1 kg/m2, IQR 28.1-33.9 × 28.6, IQR 26.2-32.0, p = .056) than women with non-severe disease. Multivariate logistic regression analysis identified four factors as independent predictors of severe/critical COVID-19: asthma (OR 34.469, 95% CI 1.151-78.030, p = .026), non-white ethnicity (OR 7.932, 95% CI 1.311-47.973, p = .024), maternal age with a best cutoff of ≥ 34 years (OR 1.195, 95% CI 1.001-1.427, p = .048) and gestational age at diagnosis with a best cut-off of ≥ 35 weeks (OR 0.876, 95% CI 0.780-0.983, p = .025). The predictive value of the model including all variables was 0.823 (p < .001). CONCLUSION: A history of asthma, non-white ethnicity, and older maternal age were risk factors for, while higher gestational age was protective against severe/critical COVID-19 in pregnant Brazilian women.
Subject(s)
Asthma , COVID-19 , Pregnancy Complications, Infectious , Female , Pregnancy , Humans , Adult , Infant , COVID-19/epidemiology , SARS-CoV-2 , Brazil/epidemiology , Pregnant Women , RNA, Viral , Risk Factors , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/diagnosis , Asthma/epidemiology , Pregnancy OutcomeABSTRACT
BACKGROUND: Limited data are available on the management of pregnant women with severe or critical forms of COVID-19, such as the optimal timing of provider-initiated delivery, and post-partum care, including antithrombotic prophylaxis. We present the clinical course, pre- and post-partum management, and outcomes of two pregnant women critically ill with COVID-19. CASES: Both women had confirmed SARS-CoV-2 pneumonia with rapid clinical decompensation that required admission to the intensive care unit, intubation, and delivery by emergency cesarean section at 32 and 29 weeks. Both patients clinically improved in the first two postoperative days, but this was followed by clinical, laboratory and radiological deterioration on the third postoperative day; however, they both improved again after full anticoagulation. This pattern suggests the possible formation of pulmonary microthrombi in the early puerperium. We discuss the challenges faced by the multiprofessional team in the management of these patients. CONCLUSIONS: There are few resources to guide health professionals caring for pregnant women with critical COVID-19. These two cases contribute to the rapidly evolving knowledge on the management and outcomes of pregnant women with COVID-19.
ABSTRACT
Este artigo, de caráter descritivo, tem como objetivo apresentar o perfil de mulheres atendidas em um centro de atendimento à mulher em Londrina, Paraná, e caracterizar os casos quanto aos tipos de violência sofrida, queixa principal, ambiente em que ocorreu a violência e tipo de vínculo do agressor com a mulher. Utilizando-se o Programa Epi Info 6,04 montou-se um banco de dados com as informações extraídas das fichas das mulheres atendidas pelo Serviço, no ano de 2001. Do total de 470 fichas analisadas, verificou-se que a média de idade das mulheres é de 34 anos. A maioria, 47,2 por cento, declarou-se casada e 54 por cento possuem um ou dois filhos. Declararam-se chefes de família 38,7 por cento das mulheres. A violência emocional prevaleceu, representando 56,4 por cento dos casos, seguida pela violência física (32,1 por cento). Os principais agressores são os atuais maridos ou companheiros das mulheres (73,4 por cento) e o lar é o espaço onde a maioria das agressões ocorre. Considerando-se a complexidade do problema, que está associado à questão da construção social dos papéis masculinos e femininos e da desigualdade existente nas relações entre os gêneros, conclui-se que os serviços de atendimento às mulheres em situação de violência são de fundamental importância e que estes devem estar articulados com os serviços e saúde no desenvolvimento de ações preventivas e na perspectiva da ação integral à mulher.