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1.
MMWR Morb Mortal Wkly Rep ; 69(44): 1635-1640, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33151917

RESUMEN

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness and might be at risk for preterm birth (1-3). The full impact of infection with SARS-CoV-2, the virus that causes COVID-19, in pregnancy is unknown. Public health jurisdictions report information, including pregnancy status, on confirmed and probable COVID-19 cases to CDC through the National Notifiable Diseases Surveillance System.* Through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), 16 jurisdictions collected supplementary information on pregnancy and infant outcomes among 5,252 women with laboratory-confirmed SARS-CoV-2 infection reported during March 29-October 14, 2020. Among 3,912 live births with known gestational age, 12.9% were preterm (<37 weeks), higher than the reported 10.2% among the general U.S. population in 2019 (4). Among 610 infants (21.3%) with reported SARS-CoV-2 test results, perinatal infection was infrequent (2.6%) and occurred primarily among infants whose mother had SARS-CoV-2 infection identified within 1 week of delivery. Because the majority of pregnant women with COVID-19 reported thus far experienced infection in the third trimester, ongoing surveillance is needed to assess effects of infections in early pregnancy, as well the longer-term outcomes of exposed infants. These findings can inform neonatal testing recommendations, clinical practice, and public health action and can be used by health care providers to counsel pregnant women on the risks of SARS-CoV-2 infection, including preterm births. Pregnant women and their household members should follow recommended infection prevention measures, including wearing a mask, social distancing, and frequent handwashing when going out or interacting with others or if there is a person within the household who has had exposure to COVID-19.†.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo/epidemiología , Aborto Espontáneo/epidemiología , Adulto , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Laboratorios , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Medición de Riesgo , Estados Unidos/epidemiología , Adulto Joven
2.
MMWR Morb Mortal Wkly Rep ; 69(44): 1641-1647, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33151921

RESUMEN

Studies suggest that pregnant women might be at increased risk for severe illness associated with coronavirus disease 2019 (COVID-19) (1,2). This report provides updated information about symptomatic women of reproductive age (15-44 years) with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19. During January 22-October 3, CDC received reports through national COVID-19 case surveillance or through the National Notifiable Diseases Surveillance System (NNDSS) of 1,300,938 women aged 15-44 years with laboratory results indicative of acute infection with SARS-CoV-2. Data on pregnancy status were available for 461,825 (35.5%) women with laboratory-confirmed infection, 409,462 (88.7%) of whom were symptomatic. Among symptomatic women, 23,434 (5.7%) were reported to be pregnant. After adjusting for age, race/ethnicity, and underlying medical conditions, pregnant women were significantly more likely than were nonpregnant women to be admitted to an intensive care unit (ICU) (10.5 versus 3.9 per 1,000 cases; adjusted risk ratio [aRR] = 3.0; 95% confidence interval [CI] = 2.6-3.4), receive invasive ventilation (2.9 versus 1.1 per 1,000 cases; aRR = 2.9; 95% CI = 2.2-3.8), receive extracorporeal membrane oxygenation (ECMO) (0.7 versus 0.3 per 1,000 cases; aRR = 2.4; 95% CI = 1.5-4.0), and die (1.5 versus 1.2 per 1,000 cases; aRR = 1.7; 95% CI = 1.2-2.4). Stratifying these analyses by age and race/ethnicity highlighted disparities in risk by subgroup. Although the absolute risks for severe outcomes for women were low, pregnant women were at increased risk for severe COVID-19-associated illness. To reduce the risk for severe illness and death from COVID-19, pregnant women should be counseled about the importance of seeking prompt medical care if they have symptoms and measures to prevent SARS-CoV-2 infection should be strongly emphasized for pregnant women and their families during all medical encounters, including prenatal care visits. Understanding COVID-19-associated risks among pregnant women is important for prevention counseling and clinical care and treatment.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Evaluación de Síntomas , Adolescente , Adulto , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Laboratorios , Pandemias , Neumonía Viral/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , Adulto Joven
3.
J Perinat Med ; 48(9): 883-891, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-33151180

RESUMEN

The outbreak of the SARS-CoV-2 elicited a surge in publications. Obstetric reports were with few exceptions characterized by small sample sizes with potentially limited generalizability. In this review, evidence suggests increased susceptibility to COVID-19 in pregnancy; common pregnancy comorbidities may help explain worse outcomes. While the risk of death is low, pregnancy may be associated with increased need for ventilation. Prematurity rates seem to be increased but may be accounted for in part by higher cesarean rates, to a large degree accounted for by elective decision to shorten the course of the labor. Though fetal/neonatal complication rates may be higher in the presence of COVID-19 infection, survival rates seem unaffected and vertical transmission is rare. As the outbreak continues in the USA with resurgence in many other western countries that achieved initial success in suppressing the virus, much remains to be learned. For example, the question related to the degree to pregnancy modifying symptomatology remains open. Currently, routine polymerase chain reaction testing remains limited by supply shortages possibly delaying diagnosis until later in the course of the disorder and thus altering the symptom complex at presentation. To add to the knowledge base, we initiated a regional COVID-19 in pregnancy collaborative observational study with a coordinating center, standardized data collection and a shared database. This was facilitated by a longstanding tradition of collaboration among regional obstetric services. Over an anticipated two-year study duration, we expect to study 400 documented and suspected COVID-19 pregnancies with time and site of services controls for cohort effect and high power to detect several adverse maternal/infant outcomes. We include a complete listing of variables in our database, which, along with our experience in setting up our regional collaborative, we hope and believe will be of use in other settings.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Colaboración Intersectorial , Neumonía Viral/complicaciones , Complicaciones Infecciosas del Embarazo/virología , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Susceptibilidad a Enfermedades , Femenino , Humanos , Metaanálisis como Asunto , Michigan/epidemiología , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Resultado del Embarazo , Nacimiento Prematuro/epidemiología , Sistema de Registros , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sensibilidad y Especificidad , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
4.
Biomedica ; 40(Supl. 2): 44-49, 2020 10 30.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33152187

RESUMEN

During the SARS COV-2 pandemic, the vast majority of infected patients are showing symptoms related to lung damage. At pediatric ages, especially newborns, symptoms from other organ systems without respiratory illness could make COVID-19 hard to diagnose. We are reporting three cases of newborns who were attended in the course of the mitigation phase in the emergency service of a maternal hospital in Barranquilla, Colombia, for high temperature and general compromised condition. During their clinical course, they developed gastrointestinal symptoms without showing any respiratory manifestations. They were not epidemiologically linked to a contact suspected to be a COVID-19 case and their mothers had had no respiratory symptoms since the public health emergency in our country was declared 45 days before. The absence of clinical respiratory manifestations in this group of patients with COVID-19 should draw clinicians' attention to the need to suspect SARS CoV-2 infection in febrile newborns.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/transmisión , Fiebre/etiología , Transmisión Vertical de Enfermedad Infecciosa , Sepsis Neonatal/etiología , Neumonía Viral/transmisión , Complicaciones Infecciosas del Embarazo , Adolescente , Adulto , Enfermedades Asintomáticas , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Diagnóstico Diferencial , Diarrea Infantil/etiología , Servicio de Urgencia en Hospital , Enterocolitis Necrotizante/diagnóstico , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Recién Nacido , Masculino , Sepsis Neonatal/virología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , Migrantes , Adulto Joven
5.
Acute Med ; 19(4): 230-234, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33215176

RESUMEN

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.


Asunto(s)
Infecciones por Coronavirus , Disnea/virología , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo/virología , Betacoronavirus , Toma de Decisiones Conjunta , Disnea/diagnóstico , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico
6.
Rev Med Suisse ; 16(712): 2050-2054, 2020 Oct 28.
Artículo en Francés | MEDLINE | ID: mdl-33112519

RESUMEN

Mother-to-child transmission (MTCT) is almost inexistent in Switzerland nowadays. This success has been achieved with systematic screening of HIV in pregnant women, provision of antiretroviral treatment (ART), elective cesarean-section (CS), neonatal antiretroviral prophylaxis (ARP) and avoidance of breastfeeding. Elective CS and neonatal ARP are no longer recommended when the viral load (VL) is suppressed. Recent studies have shown that the risk of HIV MTCT through breastfeeding is extremely rare if not zero when the mother is treated, has a suppressed VL and is correctly followed-up. It is time to be open to discuss the risks and benefits of breastfeeding with HIV-infected pregnant women and to enter in a shared decision-making process, as recommended by the new Swiss guidelines. Close monitoring is mandatory in case of breastfeeding.


Asunto(s)
Lactancia Materna , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Lactancia Materna/efectos adversos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Madres/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Suiza/epidemiología
7.
J Pregnancy ; 2020: 4592450, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33062333

RESUMEN

With the emergence of SARS-CoV-2 and its rapid spread, concerns regarding its effects on pregnancy outcomes have been growing. We reviewed 245 pregnancies complicated by maternal SARS-CoV-2 infection across 48 studies listed on PubMed and MedRxiv. The most common clinical presentations were fever (55.9%), cough (36.3%), fatigue (11.4%), and dyspnea (12.7%). Only 4.1% of patients developed respiratory distress. Of all patients, 89.0% delivered via cesarean section (n = 201), with a 33.3% rate of gestational complications, a 35.3% rate of preterm delivery, and a concerning 2.5% rate of stillbirth delivery or neonatal death. Among those tested, 6.45% of newborns were reported positive for SARS-CoV-2 infection. Relative to known viral infections, the prognosis for pregnant women with SARS-CoV-2 is good, even in the absence of specific antiviral treatment. However, neonates and acute patients, especially those with gestational or preexisting comorbidities, must be actively managed to prevent the severe outcomes being increasingly reported in the literature.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Humanos , Recién Nacido , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Resultado del Embarazo
8.
J Perinat Med ; 48(9): 925-930, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-33035193

RESUMEN

Pregnant women may be at risk for more severe manifestations and sequelae of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At this time, there remain significant evidence gaps to allow for comprehensive counseling of pregnant women and their families, specifically regarding the risks of gestational-age specific maternal outcomes and potential risks of intrauterine or peripartum viral transmission to the fetus or newborn. As maternal fetal medicine providers and consultants, we are uniquely positioned to mitigate the risks associated with maternal infection and to guide the care for infected pregnant women by being able to provide the most current evidence-based recommendations. Such care requires incorporating the rapidly evolving data regarding this virus and its impact on pregnancy, as well as taking a stand to advocate for best scientific and clinical practices to optimize both women's health and public health during this pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Atención Perinatal/métodos , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Complicaciones Infecciosas del Embarazo/virología , Centers for Disease Control and Prevention, U.S. , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Cuidados Críticos/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Obstetricia/métodos , Pandemias , Neumonía Viral/diagnóstico , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Resultado del Embarazo , Embarazo de Alto Riesgo , Atención Prenatal/métodos , Estados Unidos
9.
J Perinat Med ; 48(9): 912-924, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-33068387

RESUMEN

Objectives To assess perinatal outcomes of COVID-19 infections during pregnancy and the possibility of vertical transmission. Methods An analysis was performed using Stata 15.0, and Q-test was used to evaluate the heterogeneity of the included studies. Results The most common symptoms were found to be fever (64.78%), cough (59.81%) and shortness of breath or dyspnea (23.86%). Of this 88.73% patients demonstrated typical COVID-19 signs on chest CT or X-ray. Intubation was carried out in 35.87% of patients, and 4.95% of mothers were admitted to the intensive care unit, where the rate of maternal death was <0.01% and that of premature delivery was 25.32%. The rate of the birth weight being <2,500 g was 30.65% and that of Neonatal intensive care unit (NICU) admission was 24.41%. Positive nasopharynx swabs or sputum from newborns was <0.01%. Conclusions Pregnant patients with COVID-19 most commonly presented with fever, cough, shortness of breath and dyspnea, most of which possessed imaging manifestations. The risk of intubation and admission to intensive care unit were high. The risk of premature delivery was higher, leading to a high risk of NICU admission and low neonatal birthweight. Vertical transmission of SARS-CoV-2 from mother to child was found to be unlikely.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo/epidemiología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/terapia , Cuidados Críticos/estadística & datos numéricos , Parto Obstétrico/métodos , Femenino , Edad Gestacional , Humanos , Recién Nacido , Cuidado Intensivo Neonatal/estadística & datos numéricos , Intubación Intratraqueal/estadística & datos numéricos , Pandemias , Neumonía Viral/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Nacimiento Prematuro/epidemiología
10.
J Perinat Med ; 48(9): 977-980, 2020 Nov 26.
Artículo en Inglés | MEDLINE | ID: mdl-33085639

RESUMEN

Objectives The burden of undocumented SARS-Cov-2 infections in Portuguese pregnant women is unknown. At our institution, routine COVID-19 testing was implemented from 19th of March on to all pregnant women who were admitted for delivery. The purpose of the study was to estimate the SARS-CoV-2 infection rate in our obstetric population admitted for delivery. Mathods Between 19th March and May 4th, 184 pregnant women were screened for SARS-CoV-2 infection upon admission. Results Eleven women were positive for SARS-CoV-2, corresponding to a global prevalence of 6.0%. Of these, only two reported symptoms at admission. The prevalence of asymptomatic infection was 4.9%. We report a lower rate of positive cass than other studies. Eighty-two percent of our cases had no symptoms at admission. Conclusions The proportion of asymptomatic infection highlights the importance of universal laboratory screening for all women admitted for delivery as opposed to symptom-based screening.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Parto Obstétrico , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Adulto , Infecciones Asintomáticas/epidemiología , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Femenino , Hospitalización , Humanos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Portugal/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
11.
Nat Commun ; 11(1): 5128, 2020 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-33046695

RESUMEN

The impact of SARS-CoV-2 infection during gestation remains unclear. Here, we analyse the viral genome on maternal and newborns nasopharyngeal swabs, vaginal swabs, maternal and umbilical cord plasma, placenta and umbilical cord biopsies, amniotic fluids and milk from 31 mothers with SARS-CoV-2 infection. In addition, we also test specific anti-SARS-CoV-2 antibodies and expression of genes involved in inflammatory responses in placentas, and in maternal and umbilical cord plasma. We detect SARS-CoV-2 genome in one umbilical cord blood and in two at-term placentas, in one vaginal mucosa and in one milk specimen. Furthermore, we report the presence of specific anti-SARS-CoV-2 IgM and IgG antibodies in one umbilical cord blood and in one milk specimen. Finally, in the three documented cases of vertical transmission, SARS-CoV-2 infection was accompanied by a strong inflammatory response. Together, these data support the hypothesis that in utero SARS-CoV-2 vertical transmission, while low, is possible. These results might help defining proper obstetric management of COVID-19 pregnant women, or putative indications for mode and timing of delivery.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Transmisión Vertical de Enfermedad Infecciosa , Neumonía Viral/transmisión , Neumonía Viral/virología , Complicaciones Infecciosas del Embarazo/virología , Adolescente , Adulto , Anticuerpos Antivirales/análisis , Betacoronavirus/genética , Betacoronavirus/inmunología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/patología , Femenino , Genoma Viral , Humanos , Recién Nacido , Inflamación , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/patología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/patología , Adulto Joven
12.
Eur Rev Med Pharmacol Sci ; 24(18): 9748-9752, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33015821

RESUMEN

OBJECTIVE: Coronavirus infections, including SARS, MERS and COVID-19 have significant impact on global health as well as on pregnancies. The aim of this review was to enlighten and summarize the cumulative knowledge regarding the relationship between Coronavirus outbreaks and pregnancy. MATERIALS AND METHODS: Literature search was commenced in order to analyze the maternofetal effects of Coronavirus outbreaks. RESULTS: Fever and cough are the most common presenting symptoms of COVID-19 which mostly affects pregnant women in their 3rd trimester with a maternal mortality rate of  0-77%  and fetal and neonatal mortality rates of 1.2%. Fetal demise is common in critically ill pregnant. Pregnancy seems as a worsening factor for SARS and MERS epidemics and both infections affect prominently 3rd trimester pregnancies, although abortion (57%) is a significant risk for cases of early pregnancy. Clinical course of COVID-19, SARS and MERS may be rapid and worse in pregnant women than non-pregnant individuals. Cesarean section is the choice of delivery in most reported women due to mostly obstetrical reasons, although vaginal delivery seems not a worsening factor for the disease. CONCLUSIONS: COVID-19, SARS and MERS have significant detrimental effect on pregnancy. Rapid intervention, treatment, and intensive care support are essential for infected pregnant. Timely delivery is important in order to avoid intrauterine fetal death.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Mortalidad Fetal , Coronavirus del Síndrome Respiratorio de Oriente Medio , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/mortalidad , Síndrome Respiratorio Agudo Grave/diagnóstico , Betacoronavirus , Femenino , Humanos , Pandemias , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico
13.
Biomed Res Int ; 2020: 1708267, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029489

RESUMEN

We aimed to summarize reliable medical evidence by the meta-analysis of all published retrospective studies that examined data based on the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by clinical symptoms, molecular (RT-PCR) diagnosis, and characteristic CT imaging features in pregnant women. The MEDLINE, PubMed, Scopus, ISI Web of Science, ClinicalKey, and CINAHL databases were used to select the studies. Then, 384 articles were received, including the studies until 01/May/2020. As a result of the full-text evaluation, 12 retrospective articles covering all the data related were selected. A total of 181 pregnant cases with SARS-CoV-2 infections were included in the meta-analysis within the scope of these articles. According to the results, the incidence of fever was 38.1% (95% CI: 14.2-65%) and cough was 22% (95% CI: 10.8-35.2%) among all clinical features of pregnant cases with SARS-CoV-2 infection. So, fever and cough are the most common symptoms in pregnant cases with SARS-CoV-2 infection, and 91.8% (95% CI: 76.7-99.9%) of RT-PCR results are positive. Moreover, abnormal CT incidence is 97.9% (95% CI: 94.2-99.9%) positive. No case was death. However, as this virus spreads globally, it should not be overlooked that the incidence will increase in pregnant women and maybe in the risky group. RT-PCR and CT can be used together in an accurate and safe diagnosis. In conclusion, these findings will provide important guidance for current studies regarding the clinical features and correct detection of SARS-CoV-2 infection in pregnant women, as well as whether it will create emergency tables that will require the use of a viral drug.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Pandemias , Neumonía Viral/epidemiología , Embarazo , ARN Viral/análisis , ARN Viral/genética , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X
14.
BMC Pregnancy Childbirth ; 20(1): 580, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008308

RESUMEN

BACKGROUND: During the ongoing global outbreak of COVID-19, pregnant women who are susceptible to COVID-19 should be highly concerned. The issue of vertical transmission and the possibility of neonatal infection is a major concern. CASE PRESENTATION: Case 1: A 35-year-old pregnant woman with a gestational age of 37 weeks and 6 days was admitted to our hospital at the point of giving birth. Except for the abnormalities in her chest CT image, she was asymptomatic. She had an uncomplicated spontaneous vaginal delivery, and her infant was discharged home for isolation. Because of the positive result of the maternal swabs for SARS-CoV-2 obtained on the 2nd day after sampling, we transferred the mother to the designated hospital and followed up with her by telephone interviews. Luckily, it was confirmed on February 23 that the newborn did not develop any COVID-19 symptoms after observation for 14 days after birth. Case 2: Another pregnant woman, with a gestational age of 38 weeks and 2 days, was also admitted to our hospital because of spontaneous labor with cervical dilation of 5 cm. Since she had the typical manifestations of COVID-19, including cough, lymphopenia, and abnormal chest CT images, she was highly suspected of having COVID-19. Based on the experience from case 1, we helped the mother deliver a healthy baby by vaginal delivery. On the 2nd day after delivery, the maternal nasopharyngeal swab result was positive, while the infant's result was negative. CONCLUSION: There is still insufficient evidence supporting maternal-fetal vertical transmission for COVID-19-infected mothers in late pregnancy, and vaginal delivery may not increase the possibility of neonatal infection.


Asunto(s)
Infecciones Asintomáticas , Infecciones por Coronavirus/diagnóstico , Parto Obstétrico/métodos , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Lactancia Materna , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/terapia , Tos , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Edad Gestacional , Humanos , Linfopenia , Máscaras , Terapia por Inhalación de Oxígeno , Pandemias , Aislamiento de Pacientes , Equipo de Protección Personal , Neumonía Viral/terapia , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Pruebas Serológicas , Tomografía Computarizada por Rayos X
15.
BMC Pregnancy Childbirth ; 20(1): 587, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023500

RESUMEN

BACKGROUND: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION: A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION: The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.


Asunto(s)
Antihipertensivos/administración & dosificación , Betacoronavirus/aislamiento & purificación , Ceguera Cortical , Cesárea/métodos , Infecciones por Coronavirus , Eclampsia , Fibrinolíticos/administración & dosificación , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Convulsiones , Adulto , Ceguera Cortical/diagnóstico , Ceguera Cortical/virología , Encéfalo/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Eclampsia/diagnóstico , Eclampsia/terapia , Eclampsia/virología , Femenino , Humanos , Examen Neurológico/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Resultado del Embarazo , Convulsiones/diagnóstico , Convulsiones/etiología , Convulsiones/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
16.
J Med Case Rep ; 14(1): 186, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33023635

RESUMEN

INTRODUCTION: A novel coronavirus named severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019. The virus, known as COVID-19, is recognized as a potentially life-threatening disease by causing severe respiratory disease. Since this virus has not previously been detected in humans, there is a paucity of information regarding its effects on humans. In addition, only limited or no information exists about its impact during pregnancy. CASE PRESENTATION: In the present case study, we report the death of a neonate born to a 32-year-old mother with coronavirus disease 2019 in Ilam, Iran, with Kurdish ethnicity. We report the infection and death of a neonate in Iran with a chest X-ray (CXR) marked abnormality 2 hours after birth demonstrating coronavirus disease 2019 disease. The neonate was born by elective cesarean section, the fetal health was assessed using fetal heart rate and a non-stress test before the birth, and there was no evidence of fetal distress. All the above-mentioned facts and radiographic abnormalities suggested that coronavirus disease 2019 is involved. CONCLUSIONS: In this case study, we report the death of a neonate born to a mother with coronavirus disease 2019, 11 hours after birth. There is a paucity of data on the vertical transmission and the adverse maternal-fetal consequences of this disease, so vertical transmission from mother to child remains to be confirmed.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Cuidados Críticos/métodos , Enfermedades del Recién Nacido , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Adulto , Cesárea/métodos , Deterioro Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Resultado Fatal , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/fisiopatología , Enfermedades del Recién Nacido/terapia , Transmisión Vertical de Enfermedad Infecciosa , Irán , Tamizaje Neonatal/métodos , Muerte Perinatal , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Respiración Artificial/métodos
17.
Rev Bras Ginecol Obstet ; 42(10): 669-671, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33129222

RESUMEN

The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks. She presented with history of myalgia, jaundice, and abdominal discomfort. No flu-like symptoms as fever or cough. She was not aware of exposure to COVID-19. Normal blood pressure and O2 saturation. Laboratory tests showed platelet count of 218,000 mm3, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl. Doppler ultrasound in one twin was compatible with brain sparing. Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed. On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress. Tomography revealed both lungs with ground-glass opacities. Swab for COVID-19 polymerase chain reaction (PCR) was positive. Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome. We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Síndrome HELLP/diagnóstico , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo , Adulto , Cesárea/métodos , Técnicas de Laboratorio Clínico , Diagnóstico Diferencial , Femenino , Edad Gestacional , Humanos , Pandemias , Embarazo , Embarazo Gemelar , Trombocitopenia/diagnóstico , Ultrasonografía Prenatal
18.
Am J Perinatol ; 37(13): 1310-1316, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32882743

RESUMEN

OBJECTIVE: The novel virus known as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has led to a terrifying pandemic. The range of illness severity among children is variable. This study aims to assess the characteristics of newborns born to SARS-CoV-2-positive women compared with those mothers who tested negative. STUDY DESIGN: This was a retrospective cohort study performed at Brookdale Hospital Medical Center in New York City from March to May 2020. Electronic medical records of mother-baby dyads were reviewed. RESULTS: Seventy-nine mothers tested for SARS-CoV-2 were included, out of which 18.98% of mothers tested SARS-CoV-2 positive. We found a significant association between symptoms and SARS-CoV-2 status. We observed a significant association between newborns of SARS-CoV-2 positive and SARS-CoV-2 negative mothers regarding skin-to-skin contact (p < 0.001). Both groups showed significant differences regarding isolation (p < 0.001). Interestingly, regarding SARS-CoV-2 infection in newborns, only one newborn tested SARS-CoV-2 positive and was unstable in the neonatal intensive care unit (NICU). With the multivariable logistic regression model, babies of SARS-CoV-2 positive mothers were three times as likely to have desaturations in comparison to newborns from negative mothers. Also, newborns of SARS-CoV-2-positive mothers were four times more likely to have poor feeding, compared with newborns of SARS-CoV-2-negative mothers. Finally, babies of SARS-CoV-2-positive mothers were ten times more likely to be symptomatic at the 2-week follow-up. CONCLUSION: SARS-CoV-2 has caused major morbidity and mortality worldwide. Neonates born to mothers with confirmed or suspected SARS-CoV-2 are most of the time asymptomatic. However, neonatal critical illness due to SARS-CoV-2 is still a possibility; thus, isolation precautions (such as avoiding skin-to-skin contact and direct breastfeeding) and vertical transmission should be studied thoroughly. In addition, testing these newborns by nasopharyngeal swab at least at 24 hours after birth and monitoring them for the development of symptoms for 14 days after birth is needed. KEY POINTS: · For SARS-CoV-2-positive mothers, reducing transmission of infection to newborns is crucial.. · Newborns of SARS-CoV-2-positive mothers are usually asymptomatic and may not be easily infected.. · Critical illness in the newborn may still happen, so monitoring is needed..


Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus , Transmisión Vertical de Enfermedad Infecciosa , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Enfermedades Asintomáticas/epidemiología , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Cuidado Intensivo Neonatal/estadística & datos numéricos , Masculino , Conducta Materna , Monitoreo Fisiológico/métodos , Tamizaje Neonatal/métodos , Ciudad de Nueva York/epidemiología , Oximetría/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo
19.
Am J Perinatol ; 37(13): 1317-1323, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32892325

RESUMEN

OBJECTIVE: The perinatal consequences of neonates born to severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) infected mothers are uncertain. This study aimed to compare the differences in clinical manifestation, laboratory results, and outcomes of neonates born to mothers with or without coronavirus disease 2019 (COVID-19). STUDY DESIGN: A total of 48 neonates were admitted to Tongji Hospital and HuangShi Maternal and Child Healthcare Hospital from January 17 to March 4, 2020. The neonates were divided into three groups according to the mothers' conditions: neonates born to mothers with confirmed COVID-19, neonates born to mothers with clinically diagnosed COVID-19, and neonates born to mothers without COVID-19. The clinical data of mothers and infants in the three groups were collected, compared, and analyzed. RESULTS: The deliveries occurred in a negative pressure isolation room, and the neonates were separated from their mothers immediately after birth for further observation and treatment. None of the neonates showed any signs of fever, cough, dyspnea, or diarrhea. SARS-CoV-2 reverse transcriptase-polymerase chain reaction of the throat swab and feces samples from the neonates in all three groups was negative. No differences were detected in the whole blood cell, lymphocytes, platelet, and liver and renal function among the three groups. All mothers and their infants showed satisfactory outcomes, including a 28-week preterm infant. CONCLUSION: The clinical manifestations, radiological, and biochemical results did not show any difference between the three groups. No evidence of vertical transmission was found in this study whether the pregnant women developed coronavirus infection in the third (14 cases) or second trimester (1 case). KEY POINTS: · Characteristics of neonates born to mothers with and without COVID-19 have been compared.. · All the 48 cases presented in the study had good outcomes.. · A 28-week preterm born to COVID-19 mother presented to be clear of SARS-COV-2 infection..


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Tamizaje Neonatal/métodos , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Evaluación de Síntomas , Adulto , China/epidemiología , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Resultado del Embarazo , Trimestres del Embarazo , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
20.
Am J Perinatol ; 37(13): 1301-1309, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32892329

RESUMEN

OBJECTIVE: This study aimed to describe the response of labor and delivery (L&D) units in the United States to the novel coronavirus disease 2019 (COVID-19) pandemic and determine how institutional characteristics and regional disease prevalence affect viral testing and personal protective equipment (PPE). STUDY DESIGN: A cross-sectional survey was distributed electronically through the Society for Maternal-Fetal Medicine e-mail database (n = 584 distinct practices) and social media between April 14 and 23, 2020. Participants were recruited through "snowballing." A single representative was asked to respond on behalf of each L&D unit. Data were analyzed using Chi-square and Fisher's exact tests. Multivariable regression was performed to explore characteristics associated with universal testing and PPE usage. RESULTS: A total of 301 surveys (estimated 51.5% response rate) was analyzed representing 48 states and two territories. Obstetrical units included academic (31%), community teaching (45%) and nonteaching hospitals (24%). Sixteen percent of respondents were from states with high prevalence, defined as higher "deaths per million" rates compared with the national average. Universal laboratory testing for admissions was reported for 40% (119/297) of units. After adjusting for covariates, universal testing was more common in academic institutions (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.23-2.42) and high prevalence states (aOR = 2.68, 95% CI: 1.37-5.28). When delivering asymptomatic patients, full PPE (including N95 mask) was recommended for vaginal deliveries in 33% and for cesarean delivery in 38% of responding institutions. N95 mask use during asymptomatic vaginal deliveries remained more likely in high prevalence states (aOR = 2.56, 95% CI: 1.29-5.09) and less likely in hospitals with universal testing (aOR = 0.42, 95% CI: 0.24-0.73). CONCLUSION: Universal laboratory testing for COVID-19 is more common at academic institutions and in states with high disease prevalence. Centers with universal testing were less likely to recommend N95 masks for asymptomatic vaginal deliveries, suggesting that viral testing can play a role in guiding efficient PPE use. KEY POINTS: · Heterogeneity is seen in institutional recommendations for viral testing and PPE.. · Universal laboratory testing for COVID-19 is more common at academic centers.. · N95 mask use during vaginal deliveries is less likely in places with universal testing..


Asunto(s)
Infecciones por Coronavirus , Parto Obstétrico , Control de Infecciones , Servicio de Ginecología y Obstetricia en Hospital , Pandemias , Equipo de Protección Personal/estadística & datos numéricos , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Adulto , Betacoronavirus , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Estudios Transversales , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Femenino , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Masculino , Máscaras/estadística & datos numéricos , Servicio de Ginecología y Obstetricia en Hospital/organización & administración , Servicio de Ginecología y Obstetricia en Hospital/normas , Servicio de Ginecología y Obstetricia en Hospital/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Prevalencia , Estados Unidos/epidemiología
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