SARS-CoV-2 infection during pregnancy - single-center retrospective study.

OBJECTIVES: The SARS-CoV-2 virus infection has spread to almost all countries in the last two years. Pregnancy complicated with COVID-19 is a unique situation and challenge for doctors. The study aimed to evaluate obstetric results, and biochemical test results and to analyze the treatment used in pregnant patients complicated with COVID-19 infection. MATERIAL AND METHODS: A retrospective analysis of 146 pregnant patients hospitalized at the Department of Obstetrics and Perinatology Jagiellonian University Medical College (JUMC) in Krakow was conducted from July 2020 to August 2021. RESULTS: In the analyzed group respiratory failure occurred in 19.19% of cases and intravascular coagulation syndrome (DIC) in 1.37%. One patient died (0.68%). 16.6% of cases were transferred to the Intensive Care Unit (ICU) and required intubation. The remaining cases were mild: 39.04% were asymptomatic, 41.78% reported cough, 30.82% dyspnoea and 23.97% myalgia. In the laboratory tests increased values of CRP and IL-6 were observed with normal levels of leukocytes. Additionally, a decreased level of total protein and an increased level of d-dimers were detected. 98.63% of patients received a prophylactic dose of low molecular weight heparin. 46.58% of cases needed additional antibiotic therapy. Cesarean sections were performed in 59.59% of cases. The children were born in good general condition. Vertical transmission of SARS-CoV-2 to the newborn has not been confirmed. CONCLUSIONS: Data from the above study show a significant effect of COVID-19 on pregnant patients. Almost one in five pregnant women occurred respiratory failure and most of them had to be transferred to the ICU department and had to be intubated.

Postoperative gynecologic oncology admissions to intensive care unit in the tertiary care center: an eight-year retrospective study.

OBJECTIVES: The purpose of the study was to analyze the cohort of gynecologic oncology patients admitted to intensive care unit (ICU). MATERIAL AND METHODS: We conducted a retrospective study including all ICU postoperative admissions related to adult female patients with gynecological malignancies diagnosis treated in the tertiary care center between Jan 1, 2007, and Dec 31, 2014. RESULTS: A total of 666 women were admitted to ICU. It accounted for 2 % of all tertiary care center gynecology admissions. The mean age was 62.4 ± 12.7 years, and the mean length of stay was 8.9 ± 9.6 days. One hundred seventeen women (17.5%) required mechanical ventilation, and 220 women (33%) vasoactive drug infusion. The most common malignancy in the observed cohort of patients was ovarian cancer 326 (48.9%), followed by endometrial cancer 206 (30.9%). The patients with respiratory or circulatory insufficiency were older (mean age 64.9 ± 11.8 vs 60.8 ± 13; p < 0.001) and had longer mean ICU stay (13.1 ± 13.9 vs 6.3 ± 3.5 days; p < 0.001). We found a decrease in ICU admissions of patients without respiratory and circulatory failure after elective major surgery (Spearman: r = -1, p = 0.017). We report 21 patients' deaths (3.1% in the cohort; 0.06% of all admissions). CONCLUSIONS: Ovarian cancer patients were the largest group in the study, representing almost half of ICU admissions in the gynecology oncologic population. Older age was the risk factor of respiratory and circulatory insufficiency. Availability of intermediate care facilities could reduce ICU admissions after major surgery.

Anesthesia for gynecological cancer surgery.

Malignant neoplasms are currently a severe medical challenge and the second leading cause of death worldwide. The modern anesthesia applied may improve the patient outcome. This paper presents a review of anesthesia management related to patients with gynaecologic malignancies. It includes the influence of the type of anesthesia on cancer recurrence, application of regional anesthesia in gynaecologic oncologic surgery, and selected aspects of anesthesia for robotic surgery. We performed a literature search on MEDLINE, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, and Clinical Trials. The database search focused on the topics related to anesthesia in gynecological oncology. The authors also contributed through individual, independent literature searches.

COVID-19 Infection Complicated by Disseminated Intravascular Coagulation during Pregnancy-Two Cases Report.

Coagulopathies are one of the obstetric complications affecting the period of pregnancy, childbirth, and puerperium. One of the more severe and complex disorders of the haemostatic system is the disseminated intravascular coagulation syndrome (DIC), in which generalised activation of the coagulation system and activation of inflammatory cells occurs. DIC syndrome was observed in patients whose pregnancy was complicated by SARS-CoV-2 infection. Both the course of these cases and literature review indicate that particular notice should be paid to laboratory parameters of the coagulation system, closely monitoring the well-being of the foetus and, in the situation of acute DIC development, it is advised to deliver a baby and initiate intensive therapy.

Validation of APACHE II and SAPS II scales at the intensive care unit along with assessment of SOFA scale at the admission as an isolated risk of death predictor.

BACKGROUND: Disease's severity classification systems are applied to measure the risk of death and to choose the best therapy for patients admitted to intensive care unit (ICU). The aim of the study was to verify risk of death calculated with APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score II), SOFA (Sequential Organ Failure Assessment) and evaluate correlation between these scores. The usefulness of SOFA score as a sole scale also was assessed. METHODS: This was a retrospective study conducted in 30-beds ICU in Kraków, Poland. Every male and female patient over 18 years old who was admitted to the ICU between 18.04.2016 and 12.08.2016 was included in the analysis. Patients who were transferred from another ICU were excluded from the research. APACHE II, SAPS II, SOFA were calculated after admission using laboratory results and clinical examination. Discrimination and calibration were used to validate these scoring system. RESULTS: Analysis included 86 patients. The outcomes were compared within survivors and non-survivors groups. The prediction of death was statistically significant only for APACHE II and SAPS II. The best AUROC was for APACHE II 0.737 and SAPS II 0.737; discrimination for SOFA was not statistically significant. There was high correlation only between SAPS II and APACHE II results (r ≥ 0.7, P < 0.01). The calibration was excellent for SAPS II, P = 0.991, and slightly worse for APACHE II, P = 0.685, and SOFA, P = 0.540. Patients who survived spent more days on ICU (P < 0.01), mean Length of Stay (LOS) in this group was 38.25 ± 16.80 days. CONCLUSIONS: APACHE II and SAPS II scales have better discrimination, calibration and power to predict deaths on ICU than SOFA. Among these scales SOFA did not achieve expected results.