Placental pathological findings in coronavirus disease 2019: Perinatal outcomes.

INTRODUCTION: Placental alterations caused by severe acute respiratory coronavirus-2 (SARS-CoV-2) infection have already been described, but most studies used small sample groups and the difference according to the severity of the disease has not been verified. Our objective was to describe placental alterations in patients with coronavirus disease 2019 (COVID-19) and analyze the association of pathological placental findings with the clinical parameters of COVID-19 and perinatal results. METHODS: This was a nested study within a prospective cohort study involving 109 symptomatic pregnant women with COVID-19. The prevalence of observed placental alterations was described, and the associations of pathological findings with the clinical parameters of COVID-19 severity and with perinatal outcomes were assessed. RESULTS: The frequency of types of placental features was poor maternal vascular perfusion in 45% of cases, poor fetal vascular perfusion in 33.9%, hematogenous origin infection in 32.1%, and morphological changes corresponding to ascending infection in 21.1%. Hematogenous infection differed significantly according to COVID-19 severity (p = 0.008), with a prevalence ratio (PR) of 1.74 (95% confidence interval, 1.02-2.98) in the moderate COVID-19 group compared to the mild COVID-19 group. Among the perinatal outcomes, there was an unexpected inverse association between prematurity and placental infection of hematogenous origin, with lower rates of prematurity among cases with inflammation of hematogenous origin (p = 0.029). DISCUSSION: Moderate SARS-Cov-2 infection presented a higher prevalence of placental pathological findings. There was no association of placental findings with adverse perinatal outcomes.

Impact of SARS-CoV-2 on pregnancy and neonatal outcomes: An open prospective study of pregnant women in Brazil.

OBJECTIVES: To determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARS-CoV-2 infection severity in pregnant women. METHOD: Open prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis. RESULTS: 734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87‒20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84‒8.75), preterm birth (aOR = 5.51; 95% CI 1.47‒20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36‒2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.86‒63.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93‒20.13) and preterm birth (aOR = 3.60; 95% CI 1.45‒9.27). Mild COVID-19 was associated with oligohydramnios (aOR = 3.77; 95% CI 1.56‒9.07). CONCLUSION: Adverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 status, and risk increased with disease severity.

Impact of SARS-CoV-2 on pregnancy and neonatal outcomes: An open prospective study of pregnant women in Brazil

Abstract Objectives: To determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARS-CoV-2 infection severity in pregnant women. Method: Open prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis. Results: 734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87‒20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84‒8.75), preterm birth (aOR = 5.51; 95% CI 1.47‒20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36‒2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.86‒63.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93‒20.13) and preterm birth (aOR = 3.60; 95% CI 1.45‒9.27). Mild COVID-19 was associated with oligohydramnios (aOR=3.77; 95% CI 1.56‒9.07). Conclusion: Adverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 status, and risk increased with disease severity. HIGHLIGHTS COVID-19 increases the rates of adverse pregnancy and neonatal outcomes. Serious cases are associated with oligohydramnios, fetal distress, prematurity, neonatal ICU admission, maternal and neonatal deaths. The maternal clinical status dictates obstetric and neonatal outcomes.

A importância do primeiro retorno pós-alta de recém-nascidos de baixo risco / The importance of the first visit to the outpatient pediatric clinic after discharge of low-risk full term newborn infants

Objetivos: analisar a importância de um ambulatório de retorno de recém-nascidos (RN) de baixo risco em relação à detecção e controle de intercorrências precoces, evolução ponderal, manutenção de aleitamento materno e ao cumprimento das orientações fornecidas na alta. Método: análise retrospectiva, incluindo todos os RN de baixo risco admitidos no berçário anexo à maternidade do HC-FM-USP, no período de 1º de janeiro de 2001 a 31 de março de 2003, que compareceram ao retorno ambulatorial pós-data. Os RN foram dividos em doi grupos: G1 - retorno < 14 dias, e G2 - retorno > 14 dias. Os grupos foram comparados entre si quanto às características do RN ao nascimento, à evolução na inidade neonatal e qunato às condições clínicas no retorno ambulatorial. Resultados: No G1 observou-se maior taxa de aleitamento materno, maior número de casos de icterícia e de patologia de coto umbilical. No G2 encontravam-se os RN que apresentaram maior tempo médio de internação, na maioria das vezes, por necessidade de fototerapia. O uso de fototerapia durante a internação relacionou-se à manutenção de icterícia no retorno (p = 0,0508). Todos os RN foram vacinados contra hepatite B e realizou-se triagem neonatal para hipotireoidismo e fenilcetonúria na inidade neonatal. Conclusões: o retorno ambulatorial em até 14 dias foi mais efetivo para a detecção de intercorrências precoces, reforço ao aleitamento materno e avaliação das orientações recebidas na alta. Os autores recomendam retorno ambulatorial para todos os RN de baixo risco durante a primeira semana de vida, a fim de melhorar a evolução dos mesmos pós-alta.

Evolução de recém-nascidos portadores de meningomielocele, segundo a idade da correção cirúrgica / Evoluation of newborn with myelomeningocele, in relation to their age for surgical correction

Objetivo: avaliar a evolução de recém-nascidos (RN) com meningomielocele (MMC) em relação à idade em que foi realizada a correção cirúrgica. Metodologia e Casuística: estudo retrospectivo, realizado no Berçário Anexo à Maternidade (BAM) do Instituto da Criança do Hospital das Clínicas, da Faculdade de Medicina da Universidade de São Paulo (ICHC-FMUSP), incluindo RN admitidos com MMC durante o período de janeiro de 1992 a dezembro de 1997. Foram excluídos RN com óbito em menos de 12 horas de vida ou transferidos para outro serviço. Resultados: 48 RN foram admitidos no serviço no período, com diagnóstico de MMC, sendo que 39 foram incluídos no estudo, distribuídos em dois grupos: Grupo I com correção cirúrgica antes de 48 horas de vida (27 RN), e Grupo II com correção cirúrgica após 48 horas de vida (12 RN). Foram comparadas as características de RN e das MMC, além de evolução no período neonatal destes RN. Houve maior incidência de complicações cirúrgicas no Grupo II em relação ao Grupo I (p=0,02): infecção local, deiscência de sutura e fístula liquórica. Conclusão: à correção cirúrgica precoce associou-se a menor incidência de complicações pós-operatórias.