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1.
BMC Pregnancy Childbirth ; 21(1): 273, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794829

RESUMEN

BACKGROUND: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS: We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES: Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS: Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p <  0.001) was also observed in positive mothers. CONCLUSION: This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.


Asunto(s)
/epidemiología , Rotura Prematura de Membranas Fetales/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Cesárea/estadística & datos numéricos , Femenino , Edad Gestacional , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Trabajo de Parto Inducido/estadística & datos numéricos , Modelos Logísticos , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Embarazo , Estudios Prospectivos , España/epidemiología , Adulto Joven
2.
Medicina (Kaunas) ; 57(3)2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33807607

RESUMEN

Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.


Asunto(s)
/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Cesárea , Tos/fisiopatología , Femenino , Retardo del Crecimiento Fetal/epidemiología , Rotura Prematura de Membranas Fetales/epidemiología , Cefalea/fisiopatología , Hospitalización , Maternidades , Humanos , Trabajo de Parto Inducido , Trabajo de Parto Prematuro/epidemiología , Portugal/epidemiología , Hemorragia Posparto/epidemiología , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Mortinato/epidemiología , Extracción Obstétrica por Aspiración
3.
BMC Pregnancy Childbirth ; 21(1): 247, 2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761892

RESUMEN

BACKGROUND: Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women. METHODS: A PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively. RESULTS: One thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed. CONCLUSIONS: Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.


Asunto(s)
Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , /terapia , Hidroxicloroquina/uso terapéutico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Respiración Artificial , Adulto , Asia/epidemiología , Cesárea , Europa (Continente)/epidemiología , Femenino , Humanos , Inmunización Pasiva , Recién Nacido , América Latina/epidemiología , Tiempo de Internación , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Nacimiento Prematuro , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
4.
Biomed Environ Sci ; 34(2): 130-138, 2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33685572

RESUMEN

Objective: Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer (IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET. Method: We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups. Results: The untreated PTB group had significantly lower clinical pregnancy (31.7% vs. 38.1%) and live birth (23.8% vs. 30.6%) rates than the non-PTB group (both P < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio ( OR), 0.80; 95% confidence interval ( CI), 0.66-0.98; P = 0.028] in all patients and for increased miscarriage ( OR, 4.19; 95% CI, 1.69-10.39; P = 0.002) and decreased live birth ( OR, 0.45; 95% CI, 0.24-0.83; P = 0.011) rates in patients with unexplained infertility. Conclusions: Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.


Asunto(s)
Transferencia de Embrión/estadística & datos numéricos , Fertilización In Vitro/estadística & datos numéricos , Infertilidad Femenina/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Tuberculosis Pulmonar/epidemiología , Aborto Espontáneo/epidemiología , Adulto , China/epidemiología , Femenino , Humanos , Infertilidad Femenina/diagnóstico por imagen , Infertilidad Femenina/etiología , Nacimiento Vivo/epidemiología , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Radiografía Torácica , Estudios Retrospectivos , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagen , Adulto Joven
5.
BMC Pregnancy Childbirth ; 21(1): 212, 2021 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-33731037

RESUMEN

BACKGROUND: Asymptomatic carriage of COVID-19 in pregnant women has been reported and could lead to outbreaks in maternity units. We sought to ascertain the impact of rapid isothernal nucleic acid based testing for COVID-19 in an unselected cohort of pregnant women attending our maternity unit. We also assessed the correlation between community prevalence and asymptomatic carriage. METHODS: Data for the retrospective cohort study were collected from a large UK tertiary maternity unit over a 4-week period using computerised hospital records. Literature searches were performed across multiple repositories. COVID-19 prevalence was extracted from online repositories. RESULTS: Nasopharyngeal and oropharyngeal swabs were obtained from 457/465 (98%) women during the study period. The median turnaround time for results was 5.3 h (interquartile range (IQR) 2.6-8.9 h), with 92% of the results returned within 24 h. In our cohort, only one woman tested positive, giving a screen positive rate of 0.22% (1/457; 95% CI: 0.04-1.23%). One woman who tested negative developed a fever postnatally following discharge but was lost to follow-up. From our literature review, we did not find any correlation between asymptomatic carriage in pregnant women and the reported regional prevalence of COVID-19. CONCLUSIONS: Testing using the SAMBA-II machine was acceptable to the vast majority of pregnant women requiring admission and had a low turnaround time. Asymptomatic carriage is low, but not correlated to community prevalence rates. Screening pregnant women on admission will remain an important component in order to minimise nosocomial infection.


Asunto(s)
/métodos , Portador Sano/diagnóstico , Infección Hospitalaria/prevención & control , Complicaciones Infecciosas del Embarazo/diagnóstico , /epidemiología , Portador Sano/epidemiología , Estudios de Cohortes , Femenino , Maternidades , Humanos , Tamizaje Masivo , Pruebas en el Punto de Atención , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Estudios Retrospectivos , Factores de Tiempo , Reino Unido/epidemiología
6.
BMC Infect Dis ; 21(1): 253, 2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33691634

RESUMEN

BACKGROUND: Chinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. A single-center retrospective cohort study was performed in Kunming, a multi-ethnic city in south-western China to examine this issue. METHODS: The singleton pregnancies delivering at ≥28 weeks gestation under our care in 2005-2017 constituted the study cohort. Maternal characteristics and pregnancy outcome were compared between mothers with and without seropositivity for hepatitis B surface antigen (HBsAg) determined at routine antenatal screening. RESULTS: Among the 49,479 gravidae in the cohort, the 1624 (3.3%) HBsAg seropositive gravidae had a lower incidence of nulliparity (RR 0.963, 95% CI 0.935-0.992) and having received tertiary education (RR 0.829, 95% CI 0.784-0.827). There was no significant difference in the medical history, pregnancy complications, or labor or perinatal outcome, except that HBV carriers had significantly lower incidence of labor induction (RR 0.827, 95% CI 0.714-0.958) and of small-for-gestational age (SGA) infants (RR 0.854, 95% CI 0.734-0.994). On regression analysis, maternal HBV carriage was independently associated with spontaneous labor (aRR 1.231, 95% CI 1.044-1.451) and reduced SGA infants (aRR 0.842, 95% CI 0.712-0.997). CONCLUSIONS: Our 3.3% prevalence of maternal HBV infection was around the lower range determined in the Chinese population. The association with spontaneous labor and reduced SGA infants could have helped to promote the perpetuation of the infection through enhanced survival of the offspring infected at birth, thus explaining the high prevalence in the Chinese population.


Asunto(s)
Hepatitis B Crónica/complicaciones , Complicaciones Infecciosas del Embarazo , Resultado del Embarazo , Adulto , China/epidemiología , Estudios de Cohortes , Femenino , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/inmunología , Hepatitis B Crónica/epidemiología , Humanos , Incidencia , Recién Nacido , Madres , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Prevalencia , Estudios Retrospectivos
7.
Adv Exp Med Biol ; 1321: 45-51, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656712

RESUMEN

COVID-19 is a fatal respiratory disease caused by a novel coronavirus that quickly became a pandemic. Pregnant women and neonates are two vulnerable groups in COVID-19 infections because the immune system weakens during pregnancy. The present review study was conducted to investigate the rate of vertical transmission in infants born to women with COVID-19 infections and to describe the characteristics of the affected infants. We conducted a search of the various scientific databases using relevant keywords. All English-language studies involving neonates born to women who had COVID-19 infections were included. The main outcomes were rates of vertical transmission and the characteristics of the affected newborns. Out of 13 selected studies, 103 newborns were involved. The rate of vertical transmission was 5.4%. Of the five infected newborns, four were full-term and one was preterm. All were born by Cesarean section. The clinical symptoms were vomiting, fever, lethargy, shortness of breath, and cyanosis. In four newborns, a chest x-ray showed evidence of pneumonia. The most common laboratory finding was leukocytosis and elevated creatine kinase levels. One newborn needed mechanical ventilation. All newborns recovered and were discharged. The findings of this review study showed that the prognosis of newborns of infected mothers was satisfactory, and clinical symptoms of infected neonates did not differ from adults and were nonspecific. Due to the low amount of data regarding this field, further studies with higher sample sizes are required for more definitive conclusions.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Adulto , Cesárea , Femenino , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Mujeres Embarazadas
8.
Adv Exp Med Biol ; 1321: 287-298, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656734

RESUMEN

The outbreak of the novel coronavirus 2019 (COVID-19) disease has been severe and a cause for major concern around the world. Due to immunological and physiological changes during pregnancy, pregnant women have a higher risk of COVID-19 morbidity and mortality. The aim of this study was to collect and integrate the results of previous studies to get an accurate representation and interpretation of the clinical symptoms, laboratory and radiological findings, and characteristics of pregnant women with COVID-19. We conducted a scientific search in main databases with a combination of related MESH terms and keywords. The outcomes included common clinical symptoms at the time of onset of the disease, common laboratory and radiological findings, the rates of vaginal delivery and Cesarean section, Cesarean section indications, maternal complications, and vertical transmission rates. A total of 51 studies comprising 571 pregnant women with COVID-19 pneumonia were included in the study. The most common symptoms were fever, cough, and dyspnea, respectively. Elevated C-reactive protein and ground-glass opacities were the most common laboratory and radiological findings of COVID-19 pneumonia, respectively. A total of 114 Cesarean sections were performed due to COVID-19-related concerns. There were 55 cases of intubation (11.6%) and 13 maternal deaths (2.3%). The vertical transmission rate was 7.9%. We conclude that the characteristics of pneumonia caused by COVID-19 in pregnant women do not appear to be different from those in the general population with COVID-19 infections. However, pregnant women with underlying diseases were more likely to develop COVID-19 than others, and, in those infected with the virus, the rate of Cesarean delivery and preterm birth increased.


Asunto(s)
Coronavirus , Complicaciones Infecciosas del Embarazo , Nacimiento Prematuro , Cesárea , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Nacimiento Prematuro/epidemiología
9.
Adv Exp Med Biol ; 1321: 299-307, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656735

RESUMEN

In December 2019, a respiratory disease caused by a coronavirus called SARS-CoV-2 (COVID-19) began in Wuhan, China, and quickly became a pandemic. In such situations, pregnant women are suspected of being among the vulnerable groups. The aim of this study was to report clinical symptoms, laboratory findings, and obstetrical complications, maternal, fetal, and neonatal complications of COVID-19 infection in pregnant women. We searched the Cochrane library, MEDLINE/PubMed, and Web of Sciences from their inception to April 5, 2020. Any study involving pregnant women with COVID-19 which evaluated the effect of the disease on pregnancy outcomes and fetal and neonatal complications was included in the study. The outcomes were the symptoms and laboratory findings, obstetrical complications, mode of delivery, and maternal, fetal, and neonatal complications. The search resulted in 69 titles and abstracts, which were narrowed down to 12 studies involving 68 women. The three most common symptoms of patients were fever, cough, and fatigue. The most common laboratory findings were an increase in C-reactive protein (CRP) and lymphopenia. The most common obstetrical complication was preterm labor (33.3%). No maternal deaths were reported. The Cesarean section rate was 83.3% and the vertical transition rate was 2.23%. The findings showed that the clinical symptoms and laboratory measures of pregnant women affected by COVID-19 did not differ from the general population. In general, the prognosis of mothers who suffered from COVID-19 and their newborns was satisfactory. However, there is a need for further rigorous studies to confirm these findings as the pandemic progresses.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Cesárea , China/epidemiología , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo
11.
Curr Opin Pediatr ; 33(2): 181-187, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33651756

RESUMEN

PURPOSE OF REVIEW: To provide an update on the consequences of severe acute respiratory syndrome (SARS)-CoV-2 infection on the health and perinatal outcomes of pregnant women and their infants. RECENT FINDINGS: The severity of SARS-CoV-2 infection is greater in pregnant compared to nonpregnant women as measured by rates of admission to intensive care units, mechanical ventilation, mortality, and morbidities including myocardial infarction, venous thromboembolic and other thrombotic events, preeclampsia, preterm labor, and preterm birth. The risk of transmission from mother-to-infant is relatively low (1.5-5%) as quantitated by neonatal SARS-CoV-2 testing. Infants appear to be at higher risk of testing positive for SARS-CoV-2 if the mother has tested positive within 1 week of delivery or is herself symptomatic at the time of maternity admission. The rate of positivity is not higher in infants who room in with the mother compared to infants who are initially separated and cared for in a SARS-CoV-2-free environment. Infants who test positive in the hospital have no or mild signs of disease, most of which may be attributable to prematurity, and rarely require readmission for clinical signs consistent with COVID-19. SUMMARY: Pregnant women should take precautions to avoid infection with SARS-CoV-2. Infants born to mothers who test positive for SARS-CoV-2 can receive normal neonatal care in-hospital with their mothers if mother and staff adhere to recommended infection control practices.


Asunto(s)
Complicaciones Infecciosas del Embarazo , /complicaciones , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pandemias , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Resultado del Embarazo , Nacimiento Prematuro/epidemiología
12.
Horm Mol Biol Clin Investig ; 42(1): 57-62, 2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33567179

RESUMEN

OBJECTIVES: Novel coronavirus disease (COVID-19) is rapidly spreading all over the world. Although in many cases the infection causes very weak symptoms, it can be severe in patient with diverse chronical diseases and immunological compromising patients. Pregnancy is a unique condition in which mother and fetus peacefully collaborate. Diverse endocrine-immune mechanisms, mostly under progesterone control work together to protect the fetus from maternal immunocompetent cell activation driven rejection. The physiological shift to Th2 dominant environment, while favourable for fetus, it makes mothers susceptible to infective pathogens, making pregnancy during COVID-19 pandemic challenging. MATERIALS AND METHODS: Studies involving COVID-19 in pregnancy and those analysing changes of immune system induced by COVID-19 were searched in databases such as PubMed, Scopus, Google Scholar and ScienceDirect. Databases were searched using a keyword COVID-19/coronavirus, that was combined with following terms: immune system, pregnancy, oestrogen, or progesterone. Search included studies published up to 01.07.2020. Almost 1,500 articles were found, but only 18 met criteria. RESULTS: Most frequent symptoms of COVID-19 in mothers infected in the late pregnancy were fever and cough accompanied with lymphopenia and elevated C-reactive protein. Mothers reported to have severe disease had comorbidities and were obese. Low rate of neonatal complications of maternal Sars-Coc-2 infection without neonatal mortality was observed. CONCLUSIONS: Currently available data didn't show significant relationship between COVID-19 severity and pregnancy and there is no strong evidence that mother's infection can lead to adverse pregnancy outcome, but further studies are needed to determinate the possible effects of COVID-19 gained during earlier pregnancy.


Asunto(s)
/epidemiología , Pandemias , Complicaciones Infecciosas del Embarazo , Resultado del Embarazo , /complicaciones , Comorbilidad , Femenino , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/inmunología , Resultado del Embarazo/epidemiología , /fisiología
13.
J Perinat Med ; 49(2): 141-147, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33544531

RESUMEN

OBJECTIVES: To evaluate the relationship between Coronavirus Disease 2019 (COVID-19) in pregnancy and adverse perinatal outcomes. The secondary aim is to analyze the diagnostic value of hematologic parameters in COVID-19 complicated pregnancies. METHODS: The current study is conducted in a high volume tertiary obstetrics center burdened by COVID-19 pandemics, in Turkey. In this cohort study, perinatal outcomes and complete blood count indices performed at the time of admission of 39 pregnancies (Study group) complicated by COVID-19 were compared with 69 uncomplicated pregnancies (Control group). RESULTS: There was no significant difference between the obstetric and neonatal outcomes of pregnancies with COVID-19 compared to data of healthy pregnancies, except the increased C-section rate (p=0.026). Monocyte count, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) were significantly increased (p<0.0001, p=0.009, p=0.043, p<0.0001, respectively) whereas the MPV and plateletcrit were significantly decreased (p=0.001, p=0.008) in pregnants with COVID-19. ROC analysis revealed that the optimal cut-off value for MLR was 0.354 which indicated 96.7% specificity and 59.5% sensitivity in diagnosis of pregnant women with COVID-19. A strong positive correlation was found between the MLR and the presence of cough symptom (r=41.4, p=<0.0001). CONCLUSIONS: The study revealed that, pregnancies complicated by COVID-19 is not related with adverse perinatal outcomes. MLR may serve as a supportive diagnostic parameter together with the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in assessment of COVID-19 in pregnant cohort.


Asunto(s)
/sangre , Complicaciones Infecciosas del Embarazo/sangre , Resultado del Embarazo/epidemiología , Adulto , Recuento de Células Sanguíneas , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Turquia/epidemiología , Adulto Joven
14.
J Perinat Med ; 49(2): 138-140, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33544532

RESUMEN

OBJECTIVES: To report clinical data on maternal outcome, mode of delivery and immediate neonatal outcome in women infected with COVID-19. METHODS: Retrospective data collection. RESULTS: A total of 8.6% of the total population of hospitalised SARS-CoV-2 positive pregnant women were admitted to a critical care unit. The premature birth rate for births before 34+0 weeks of gestation among pregnant women who tested positive for SARS-CoV-2 was 7.1%. One newborn (3.6%) tested positive for SARS-CoV-2 two days after birth and showed symptoms. CONCLUSIONS: Pregnant women with COVID-19 seem to be at higher risk of invasive ventilation, admission to a critical care unit and preterm birth, and should therefore be considered a high-risk-population.


Asunto(s)
/complicaciones , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo/epidemiología , Adulto , Austria/epidemiología , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Nacimiento Prematuro/virología , Estudios Retrospectivos , Adulto Joven
15.
Obstet Gynecol ; 137(4): 571-580, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33560778

RESUMEN

OBJECTIVE: To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes. METHODS: We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling. RESULTS: A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients. CONCLUSION: Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.


Asunto(s)
/epidemiología , Gravedad del Paciente , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Infecciones Asintomáticas , Índice de Masa Corporal , /diagnóstico , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Hipertensión Inducida en el Embarazo/epidemiología , Recién Nacido , Edad Materna , Mortalidad Materna , Mortalidad Perinatal , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Nacimiento Prematuro/epidemiología , Factores de Riesgo , Estados Unidos/epidemiología , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/virología , Adulto Joven
16.
Medicine (Baltimore) ; 100(7): e24847, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607856

RESUMEN

ABSTRACT: The objective of this study was to evaluate the risk factors, pathogenic bacteria and drug sensitivity of maternal sepsis, and provide evidence for clinical prevention and treatment.A retrospective investigation of pregnant women with full-term maternal sepsis was performed to analyze the risk factors, pathogenic bacteria, and drug sensitivity of maternal sepsis.Univariate analysis showed that temperature, serum procalcitonin (PCT) and C-reactive protein (CRP) at admission, white blood cell count (WBC), PCT, CRP and neutrophilic granulocyte percentage (N%) during fever, premature rupture of membranes (PROM), antibiotic use within 1 week, mode of production, onset and duration of fever, between groups were statistically significant (P < .05). Logistic regression analysis showed that cesarean section was an independent risk factor for sepsis (OR = 11.839, 95%CI: 3.121-44.906). Apparent increase was found in body temperature (OR = 3.664, 95%CI: 1.722-7.795), duration of fever (OR = 1.953, 95%CI: 1.242-3.071), and PCT (OR = 1.080, 95%CI: 1.002-1.163). Also, increasing neutrophil ratio (OR = 1.180, 95%CI: 1.073-1.297) indicated a high possibility of maternal sepsis. The organism Escherichia coli (E. coli) was the most common pathogenic bacteria in the positive blood culture group (90%), and the sensitivity to carbapenems (meropenem and imipenem/cilastatin) was 100%, that to piperacillin-tazobactam and amoxicillin sulbactam was over 90%, and that to ceftazidime was 95%.Cesarean section was an independent risk factor for maternal sepsis in term pregnant women with positive blood culture. Besides, the E. coli was the most common pathogenic bacteria in the positive blood culture group. Antibiotics should be used in time and reasonably when the temperature was significantly increased with elevated PCT and N% after a cesarean section.


Asunto(s)
Antibacterianos/uso terapéutico , Bacterias/patogenicidad , Hospitalización/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/microbiología , Adulto , Antibacterianos/normas , Bacterias/efectos de los fármacos , Cultivo de Sangre/métodos , Cultivo de Sangre/estadística & datos numéricos , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Cesárea/estadística & datos numéricos , China/epidemiología , Escherichia coli/patogenicidad , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Fiebre , Humanos , Recuento de Leucocitos/métodos , Recuento de Leucocitos/estadística & datos numéricos , Pruebas de Sensibilidad Microbiana/métodos , Neutrófilos/citología , Neutrófilos/patología , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Mujeres Embarazadas , Polipéptido alfa Relacionado con Calcitonina/sangre , Estudios Retrospectivos , Factores de Riesgo
17.
Curr Opin Pediatr ; 33(2): 188-194, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33534424

RESUMEN

PURPOSE OF REVIEW: The aim of this review was to describe the process of and challenges in developing national guidance for management of infants born to mothers with COVID-19. RECENT FINDINGS: Beginning in January 2020, infection with the novel coronavirus SARS-CoV-2 spread across the USA, causing the illness COVID-19. As pregnant women began to present for delivery while sick with COVID-19, the American Academy of Pediatrics (AAP) convened a writing group in March 2020 to develop guidance for the management of their newborns. The initial guidance was developed emergently and was forced to rely on extremely limited data from China. The initial guidance advocated for a conservative approach that included temporary physical separation of infected mother and newborn. To address the knowledge deficit, the AAP sponsored a volunteer registry to collect data on perinatal infection and management. As data have emerged informing the natural history of COVID-19, the performance of PCR-based diagnostics, the value of infection control measures and the risk of infant disease, AAP has issued serial updates to newborn guidance. SUMMARY: Evolving knowledge on the epidemiology of perinatal COVID-19 has informed newborn guidance. The most recent guidance focuses on the use of infection control measures to support maternal-newborn contact and breastfeeding.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Lactancia Materna , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/terapia , Mujeres Embarazadas
19.
BMC Pregnancy Childbirth ; 21(1): 108, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546624

RESUMEN

BACKGROUND: As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. METHODS: Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. RESULTS: One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. CONCLUSIONS: Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.


Asunto(s)
/epidemiología , Coagulación Intravascular Diseminada/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Hematológicas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Tromboembolia/epidemiología , Trombosis de la Vena/epidemiología , /virología , Comorbilidad , Coagulación Intravascular Diseminada/virología , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/virología , Complicaciones Hematológicas del Embarazo/virología , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Tromboembolia/virología , Trombosis de la Vena/virología
20.
Ginekol Pol ; 92(1): 57-63, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33576491

RESUMEN

Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 (COVID-19). Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.


Asunto(s)
/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , /prevención & control , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Polonia , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/prevención & control , Factores de Riesgo
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