Clinical characteristics and risk factors for SARS-CoV-2 infection in pregnant women attending a third level reference center in Mexico City.

BACKGROUND: COVID-19 symptoms vary widely among pregnant women. We aimed to assess the most frequent symptoms amongst pregnant women with SARS-CoV-2 infection in a tertiary hospital in Mexico City. METHODS: A cross-sectional study of pregnant women attending the National Institute of Perinatology in Mexico City was performed. All women who attended the hospital, despite their symptoms, were tested for SARS-CoV-2. A multivariate-age-adjusted logistic regression was used to assess the association between the main outcome and each characteristic of the clinical history. RESULTS: A total of 1880 women were included in the data analysis. Among all women, 30.74% (n = 578) had a positive PCR for SARS-CoV-2 from which 2.7 (n = 50) were symptomatic. Symptoms associated with a positive PCR result were headache (p=.01), dyspnea (p=.043), and myalgia (p=.043). CONCLUSIONS: At universal screening for SARS-CoV-2, one-third of the population had a positive result, while those symptoms associated with a positive PCR were headache, dyspnea, and myalgia.

COVID-19 Infection in Pregnancy: PCR Cycle Thresholds, Placental Pathology, and Perinatal Outcomes.

(1) This study aimed to evaluate characteristics, perinatal outcomes, and placental pathology of pregnant women with or without SARS-CoV-2 infection in the context of maternal PCR cycle threshold (CT) values. (2) This was a retrospective case-control study in a third-level health center in Mexico City with universal screening by RT-qPCR. The association of COVID-19 manifestations, preeclampsia, and preterm birth with maternal variables and CT values were assessed by logistic regression models and decision trees. (3) Accordingly, 828 and 298 women had a negative and positive test, respectively. Of those positive, only 2.6% of them presented mild to moderate symptoms. Clinical characteristics between both groups of women were similar. No associations between CT values were found for maternal features, such as pre-gestational BMI, age, and symptomatology. A significantly higher percentage of placental fibrinoid was seen with women with low CTs (<25; p < 0.01). Regarding perinatal outcomes, preeclampsia was found to be significantly associated with symptomatology but not with risk factors or CT values (p < 0.01, aOR = 14.72). Moreover, 88.9% of women diagnosed with COVID-19 at <35 gestational weeks and symptomatic developed preeclampsia. (4) The data support strong guidance for pregnancies with SARS-CoV-2 infection, in particular preeclampsia and placental pathology, which need further investigation.

Consecuencias oncológicas y perinatales del tratamiento conservador de la fertilidad en pacientes con cáncer endometrial tratadas con progestinas / Oncological and perinatal results of conservative treatment of fertility in patients with endometrial cancer treated with progestins

Resumen OBJETIVO: Estimar la tasa de respuesta completa y de embarazo en mujeres con cáncer endometrial en tratamiento conservador con progestinas. MATERIALES Y MÉTODOS: Estudio de cohorte, retrolectivo y transversal efectuado en el Instituto Nacional de Perinatología en mujeres con cáncer endometrial, en estadios tempranos, atendidas entre 2007 y diciembre de 2016. Criterios de inclusión: pacientes con límites de edad de 18 y 40 años, nulíparas, con deseo de fertilidad, haber sido tratadas con megestrol, DIU-levonorgestrel o progesterona micronizada durante seis meses. A todas las pacientes se les tomó una biopsia endometrial a los 6 y 12 meses. Se utilizó estadística descriptiva y comparaciones entre mediciones, χ2 o t de Student según la distribución de cada variable. RESULTADOS: Se incluyeron 11 pacientes con cáncer endometrial con edad promedio de 32 ± 2.4 años. La biopsia tomada a los seis meses fue: respuesta completa en 6/11, respuesta parcial en 2/11 y persistencia en 2/11; en una paciente no se tomó la biopsia a los seis meses por embarazo, no hubo casos de progresión. A los 12 meses de seguimiento hubo 5 respuestas completas, 2 parciales, 2 persistencias, 1 caso de progresión de la enfermedad y otro que suspendió el tratamiento. Se efectuaron 8 ciclos de FIV en 6 pacientes con tasa de embarazo de 25%. La duración del tratamiento fue de 19.3 ± 8 meses, el seguimiento total fue de 31.6 ± 13 meses. CONCLUSIONES: El tratamiento conservador de la fertilidad con progestinas en pacientes con cáncer endometrial, en etapas tempranas, es factible y seguro. El embarazo debe intentarse inmediatamente después de una respuesta completa.

Abstract OBJECTIVE: To estimate the complete response rate and pregnancy in women with endometrial cancer who have received conservative treatment with progestins. MATERIALS AND METHODS: Cohort, retrolective and transversal study carried out in the National Institute of Perinatology, in women with endometrial cancer in early stages between 2007 and December 2016. Including patients between 18-40 years, nulliparous, with desire for fertility. The progestins used were megestrol, IUD-levonorgestrel and micronized progesterone for six months. Endometrial biopsy was performed at 6 and 12 months; The result was classified as a complete, partial response, persistence or progression of the disease. Descriptive statistics and comparisons between baseline measurements at six and 12 months are used using student grid and / or t tests according to the distribution of each variable. It is a statistical program SPSS version 23 for Windows (Chicago, USA). RESULTS: 11 women with endometrial cancer were included. The average age of the women was 32 ± 2.4 years. Morbidity associated with hypothyroidism and type 2 diabetes mellitus. Six-month biopsy was: complete response 6/11 partial response 2/11 and persistence 2/11, in one patient the biopsy was not performed at 6 months by pregnancy, there were no cases of progression. At 12 months of follow-up, there were 5 complete responses, 2 partial responses, 2 persistences, 1 case of disease progression and one case that discontinued treatment. Eight cycles of IVF were performed in 6 patients with a pregnancy rate of 25%, the duration of treatment was 19.3 ± 8 months, the total follow-up was 31.6 ± 13 months. CONCLUSIONS: Conservative fertility therapy with progestins in women younger than 40 years old with early-stage endometrial cancer is feasible and secure in our institution. Pregnancy must be sought immediately after a full response to the cancer treatment. Our findings are similar to the ones found in our systematic review of the international bibliography.

Cardiopatía congénita corregida en la mujer embarazada, experiencia en un hospital de tercer nivel / Correction congenital heart disease in pregnancy patients. Experience in a third level hospital

Resumen OBJETIVO: Describir los desenlaces cardiovasculares, obstétricos y perinatales durante el embarazo y puerperio de pacientes con cardiopatía congénita corregida. MATERIALES Y MÉTODOS: Estudio de cohorte simple, retrospectivo, descriptivo y transversal efectuado en pacientes embarazadas con cardiopatía congénita corregida, atendidas en el Instituto Nacional de Perinatología, entre enero de 2015 y febrero de 2017. Del expediente clínico se obtuvieron los datos demográficos, además de evaluar el riesgo de cardiopatía según la clasificación de la OMS, las comorbilidades y desenlaces obstétricos y perinatales. El análisis estadístico se realizó con el programa SPSS, versión 20. RESULTADOS: Se registraron 24 pacientes con cardiopatía congénita, principalmente comunicación interauricular e interventricular y coartación aórtica. La edad promedio fue de 24.6 años. En cuanto a la clasificación de riesgo de la OMS se encontraron 7 de 24 en OMS I, 8 de 24 en OMS II, 7 de 24 en OMS II-III y 2 de 24 en OMS III. Se observó que 13 de 24 pacientes tenían parche de pericardio bovino, 3 de 24 stent y 4 de 24 válvulas; 1 de 24 tuvo aborto espontáneo, 1 de 24 nacimiento pretérmino y 22 de 24 embarazo de término. El promedio de edad gestacional fue de 38.5 semanas y Apgar a los cinco minutos de 9. Ningún recién nacido ingresó a la unidad de cuidados intensivos, ni se registraron muertes maternas. CONCLUSIONES: El riesgo de alteraciones cardiovasculares durante el embarazo depende de la identificación de la cardiopatía específica y el estado clínico de la paciente. Es importante la asesoría individual, por un equipo multidisciplinario y en un centro especializado desde la etapa inicial del embarazo.

Abstract OBJECTIVE: To describe the cardiovascular, obstetric and perinatal outcomes during pregnancy and the puerperium of patients with corrected congenital heart disease; treated at the Instituto Nacional de Perinatología. MATERIALS AND METHODS: Simple, retrospective, descriptive and cross-sectional cohort study of pregnant patients with corrected congenital heart disease treated at the Instituto Nacional de Perinatología of January 2015 at February 2017. The cardiovascular risk according to WHO, comorbidities, obstetric outcomes and perinatal. Demographic data, WHO risk, comorbidities, obstetric outcomes and perinatal. The statistical analysis was carried out with the SPSS program in its version 20. RESULTS: We included 24 patients with congenital heart disease, the most frequent being interatrial and interventricular communication, aortic coarctation; average age of 24.6 years, the WHO risk distribution: 7/24 OMS I, 8/24 OMS II, 7/24 OMS II-III y 2/24 OMS III; 13/24 had a bovine pericardium patch, 3/24 stent, 4/24 valves;1/24 presented spontaneous abortion, 1/24 preterm birth, 22/24 achieved full-term gestation, average gestational age at the resolution of 38.5 SDG, Apgar at 5 minutes of 9, no newborn required admission to NICU, no maternal death occurred. CONCLUSION: The risk of pregnancy depends on the heart disease and clinical condition of the patient. Individual counseling is important, by a multidisciplinary team and in a specialized center from the early stage of pregnancy.