Approach to dyspnoea in pregnancy in the COVID-19 era.

IMPORTANCE: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. OBJECTIVE: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. DESIGN, SETTING AND PARTICIPANTS: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. RESULTS: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

Abstracts and papers published in the International Journal of Obstetric Anesthesia since inception.

BACKGROUND: Since the International Journal of Obstetric Anesthesia (IJOA) was first published in 1991, barriers to conducting and publishing research in the UK have increased, as has the pressure to improve practitioners' curricula vitae. We speculated that the type and geographical origin of abstracts and papers published in IJOA might reflect these changes. METHODS: We analysed all substantive papers and Obstetric Anaesthetists' Association abstracts published in IJOA, using online access. Full articles and abstracts were categorised and the location of the submitting hospital recorded. Those published in the period 1991-99 inclusive were compared with those in 2000-08. RESULTS: A total of 890 substantive papers were reviewed, 387 in 1991-99 and 503 in 2000-08. We found non-significant changes (P = 0.065) in the type of paper between the two time periods; the number (proportion) of observational studies increased from 178 (46%) to 256 (51%), respectively, while randomised and non-randomised interventional trials remained similar. Changes in geographical origin were also not significant (P = 0.17), with most coming from the UK and outside Europe. Non-UK European papers accounted for only 54 (14%) and 65 (13%), respectively. Abstract numbers have increased greatly, from 190 in 1991-99 to 702 in 2000-08, with increases in all categories but a doubling of the proportion of observational studies and a reduced proportion of interventional trials: observational 17% and 34% respectively; randomised 23% and 13% respectively; and non-randomised interventional 29% and 26% respectively (P < 0.0001). Most abstracts were from the UK although this proportion fell from 92% in 1991-99 to 86% in 2000-08, whilst those from non-UK European countries and the rest of the world increased (respectively 2% and 6% in 1991-99; 7% and 8% in 2000-08; P = 0.001). CONCLUSION: Substantive papers and abstracts show different trends but observational studies are the most frequent type in both forms of presentation. Trends in abstracts suggest a decrease in the proportion of randomised controlled trials, although the absolute numbers of interventional trials has increased. Non-UK European papers and abstracts are relatively few compared with those from the UK and rest of the world.