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1.
BJOG ; 128(1): 97-100, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33021026

RESUMEN

OBJECTIVE: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vaginal secretions of both reproductive-aged and postmenopausal women during acute SARS-CoV-2 infection. DESIGN: Prospective study. SETTING: A single tertiary, university-affiliated medical centre in Israel. Time period, 1 June 2020 through to 31 July 2020. POPULATION: Women who were hospitalised in a single tertiary medical centre, who were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. METHODS: Women were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. Vaginal RT-PCR swabs were obtained from all study participants after a proper cleansing of the perineum. MAIN OUTCOME MEASURES: Detection of SARS-CoV-2 in vaginal RT-PCR swabs. RESULTS: Vaginal and nasopharyngeal swabs were obtained from 35 women, aged 21-93 years. Twenty-one women (60%) were in their reproductive years, of whom, five were in their third trimester of pregnancy. Most of the participants (57%) were healthy without any underlying medical conditions. Of the 35 patients sampled, 2 (5.7%) had a positive vaginal RT-PCR for SARS-CoV-2, one was premenopausal and the other was a postmenopausal woman. Both women had mild disease. CONCLUSION: Our findings contradict most previous reports, which did not detect the presence of viral colonisation in the vagina. Although passage through the birth canal exposes neonates to the vaginal polymicrobial flora, an acquisition of pathogens does not necessarily mandate neonatal infection or clinical disease. Nevertheless, when delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation, even if it is uncommon. TWEETABLE ABSTRACT: When delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Vagina/virología , Adulto , Anciano , /epidemiología , /métodos , Femenino , Humanos , Recién Nacido , Israel/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Prospectivos , Frotis Vaginal/métodos , Frotis Vaginal/estadística & datos numéricos
3.
Lancet Infect Dis ; 21(1): 70-84, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32805200

RESUMEN

BACKGROUND: To eliminate mother-to-child transmission (MTCT) of hepatitis B virus (HBV), peripartum antiviral prophylaxis might be required for pregnant women infected with HBV who have a high risk of MTCT despite infant immunoprophylaxis. We aimed to determine the efficacy and safety of peripartum antiviral prophylaxis to inform the 2020 WHO guidelines. METHODS: In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, CENTRAL, CNKI, and Wanfang for randomised controlled trials and non-randomised studies of peripartum antiviral prophylaxis versus placebo or no prophylaxis, with no language restriction, published from database inception until March 28, 2019. We used search terms covering HBV, antiviral therapy, and pregnancy. We included studies that enrolled pregnant women with chronic infection with HBV who received antiviral prophylaxis anytime during pregnancy; that included any of the following antivirals: adefovir, emtricitabine, entecavir, lamivudine, telbivudine, tenofovir alafenamide fumarate, and tenofovir disoproxil fumarate; and that reported the following outcomes: MTCT, indicated by infant HBsAg positivity or HBV DNA positivity, or both, at age 6-12 months, and any infant or maternal adverse events. Two reviewers independently extracted data. Our primary endpoint was MTCT based on infant HBsAg positivity. We assessed pooled odds ratios (ORs) of the efficacy of peripartum antiviral prophylaxis to reduce the risk of MTCT. We assessed safety of prophylaxis by pooling risk differences. The protocol for the systematic review was pre-registered in PROSPERO, CRD42019134614. FINDINGS: Of 7463 articles identified, 595 articles were eligible for full-text review and 129 studies (in 157 articles) were included. The following antivirals were assessed in the meta-analysis: tenofovir disoproxil fumarate 300 mg (19 studies, with 1092 mothers and 1072 infants), lamivudine 100-150 mg (40 studies, with 2080 mothers and 2007 infants), and telbivudine 600 mg (83 studies, with 6036 mothers and 5971 infants). The pooled ORs for randomised controlled trials were similar, at 0·10 (95% CI 0·03-0·35) for tenofovir disoproxil fumarate, 0·16 (0·10-0·26) for lamivudine, and 0·14 (0·09-0·21) for telbivudine. The pooled ORs in non-randomised studies were 0·17 (0·10-0·29) for tenofovir disoproxil fumarate, 0·17 (0·12-0·24) for lamivudine, and 0·09 (0·06-0·12) for telbivudine. We found no increased risk of any infant or maternal safety outcomes after peripartum antiviral prophylaxis. INTERPRETATION: Peripartum antiviral prophylaxis is highly effective at reducing the risk of HBV MTCT. Our findings support the 2020 WHO recommendation of administering antivirals during pregnancy, specifically tenofovir disoproxil fumarate, for the prevention of HBV MTCT. FUNDING: World Health Organization.


Asunto(s)
Antivirales/uso terapéutico , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B Crónica/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/normas , Tenofovir/uso terapéutico , Adulto , Femenino , Hepatitis B Crónica/tratamiento farmacológico , Humanos , Embarazo
4.
Lancet Infect Dis ; 21(1): 85-96, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32805201

RESUMEN

BACKGROUND: Prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) involves neonatal immunoprophylaxis, with a birth dose of hepatitis B vaccine and immune globulin, and provision of peripartum antiviral prophylaxis in highly viraemic women. However, access to assays to quantify HBV DNA levels remains inadequate in resource-poor settings. This study was commissioned by WHO and aimed to identify the HBV DNA threshold for MTCT, to assess the sensitivity and specificity of hepatitis B e antigen (HBeAg) testing to identify pregnant women with HBV DNA levels above this threshold, and to predict MTCT of HBV infection on the basis of HBeAg testing. METHODS: For this systematic review and meta-analysis, we searched the PubMed, EMBASE, Scopus, CENTRAL, CNKI, and Wanfang databases for studies of pregnant women with chronic HBV infection without concurrent antiviral therapy, published between Jan 1, 2000, and April 3, 2019. Studies were eligible for inclusion if MTCT in mother-child pairs could be stratified by different levels of maternal HBV DNA during pregnancy, if maternal HBeAg status could be stratified by HBV DNA level, and if the MTCT status of infants could be stratified by maternal HBeAg status during pregnancy. Studies that selected pregnant women on the basis of HBeAg serostatus or HBV DNA levels were excluded. Aggregate data were extracted from eligible studies by use of a pre-piloted form; study authors were contacted to clarify any uncertainties about potential duplication or if crucial information was missing. To pool sensitivities and specificities of maternal HBeAg to identify highly viraemic women and to predict MTCT events, we used the DerSimonian-Laird bivariate random effects model. This study is registered with PROSPERO, CRD42019138227. FINDINGS: Of 9007 articles identified, 67 articles (comprising 66 studies) met the inclusion criteria. The risk of MTCT despite infant immunoprophylaxis was negligible (0·04%, 95% CI 0·00-0·25) below a maternal HBV DNA level of 5·30 log10 IU/mL (200 000 IU/mL) and increased above this threshold. The pooled sensitivity of HBeAg testing to identify HBV DNA levels of 5·30 log10 IU/mL or greater in pregnant women was 88·2% (83·9-91·5) and pooled specificity was 92·6% (90·0-94·5). The pooled sensitivity of HBeAg testing in predicting MTCT of HBV infection despite infant immunoprophylaxis was 99·5% (95% CI 91·7-100) and pooled specificity was 62·2% (55·2-68·7). INTERPRETATION: Maternal HBV DNA of 5·30 log10 IU/mL or greater appears to be the optimal threshold for MTCT of HBV infection despite infant immunoprophylaxis. HBeAg is accurate to identify women with HBV DNA levels above this threshold and has high sensitivity to predict cases of immunoprophylaxis failure. In areas where HBV DNA assays are unavailable, HBeAg can be used as an alternative to assess eligibility for antiviral prophylaxis. FUNDING: World Health Organization.


Asunto(s)
Antivirales/uso terapéutico , Vacunas contra Hepatitis B/uso terapéutico , Antígenos e de la Hepatitis B/uso terapéutico , Hepatitis B Crónica/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Adulto , Femenino , Humanos , Embarazo
6.
Midwifery ; 92: 102876, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33220602

RESUMEN

OBJECTIVE: The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) presents significant challenges to midwives and nurses. This study aimed to explore midwifery and nursing interventions to limit the transmission of COVID-19 among women in their third trimester of pregnancy, to reduce the incidence of nosocomial infection and promote safety of care for women and their infants. METHOD: We completed a retrospective review of medical records from 35 women in their third trimester of pregnancy with SARS-CoV-2, admitted to one hospital in Wuhan, China in January and February 2020. We investigated the clinical characteristics of the COVID-19 infection in pregnancy, and the individualized midwifery and nursing care offered, including environmental protection, prevention of nosocomial infection, maternal observations, monitoring of signs and symptoms of COVID-19, and psychological care. RESULT: Thirty-one women had a caesarean section, and four had vaginal births. Retrospective analysis of midwifery and nursing strategies implemented to care for these women showed no maternal complications or nosocomial infections. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The care strategies we implemented could prevent complications and nosocomial infection in the third trimester of pregnancy, thus ensuring the safety of women and their infants. Further research needs to determine treatment priorities for women infected with COVID-19 during pregnancy and the postnatal period.


Asunto(s)
/prevención & control , Parto Obstétrico/enfermería , Partería/métodos , Complicaciones Infecciosas del Embarazo/prevención & control , Resultado del Embarazo/epidemiología , Adulto , China , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pandemias/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/enfermería , Tercer Trimestre del Embarazo , Estudios Retrospectivos
7.
MCN Am J Matern Child Nurs ; 46(1): 21-29, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33009009

RESUMEN

PURPOSE: The aim of this study is to describe how the COVID-19 (coronavirus) pandemic has affected pregnancy, prenatal maternity care practices, and infant feeding plans among pregnant persons in the United States. STUDY DESIGN: Cross-sectional descriptive study using an app-based survey. METHODS: A link to the survey was sent via email to users of the Ovia Pregnancy app on May 20, 2020 and was open for 1 week. Participants were asked to complete the survey as it applied to their pregnancy, breastfeeding, and maternity care received during the COVID-19 pandemic, beginning approximately February 2020 through the time of the survey. There were 258 respondents who completed the survey. RESULTS: The majority (96.4%; n = 251) of pregnant women felt they received safe prenatal care during this time period. Slightly less 86.3% (n = 215) felt they received adequate prenatal care during this time period. 14.2% (n = 33) reported changing or considering changing the location where they planned to give birth due to COVID-19. Of those who reported they had begun purchasing items for their baby, 52.7% reported that the COVID-19 pandemic has affected their ability to get items they need for their baby. CLINICAL IMPLICATIONS: Although it is imperative to implement policies that reduce risk of transmission of COVID-19 to pregnant women and health care providers, it is necessary for health care providers and policy makers to listen to the collective voices of women during pregnancy about how COVID-19 has affected their birth and infant feeding plans and their perception of changes in prenatal care.


Asunto(s)
Lactancia Materna/psicología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/psicología , Atención Prenatal/psicología , Adulto , Lactancia Materna/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Lactante , Servicios de Salud Materna/estadística & datos numéricos , Educación del Paciente como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/estadística & datos numéricos
8.
PLoS One ; 15(12): e0242659, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33264295

RESUMEN

INTRODUCTION: Mother-to-child transmission (MTCT) of HIV infection remains a major public health problem and constitutes the most important cause of HIV infection in children. Knowledge of married women on MTCT of HIV is very important for successful intervention toward prevention of mother-to-child transmission (PMTCT) and achieving the goal of eliminating the new HIV infection. The objective of the study was to assess knowledge of married women on MTCT of HIV and associated factors in Mecha district Northwest Ethiopia. METHODS: A community based cross sectional study was conducted involving 520 married women from January 1 to February 30 /2017 in Mecha district. Interviewer administered questionnaires were used to collect the data. The collected data was entered, cleaned and checked using Epi Data version 3.1 and then analyzed with SPSS version 20. Bivariate and multivariable logistic regression was computed for all explanatory variables to identify determinant factors at 95% confidence interval. Explanatory variables having P-value <0.05 taken as a predictor for knowledge of married women on mother to child transmission of HIV. RESULT: This study was carried out among a total of 520 married reproductive age group women with a response rate of 98%. From the total of 510 respondents, 160(31.4%) of women were knowledgeable on vertical transmission of HIV (MTCT). Women who were knowledgeable on MTCT of HIV was positively associated with urban residence (AOR = 1.75, 95% CI: 1.05-2.92), women who had history of ANC follow up (AOR = 2.68, 95% CI: 1.17-6.13), women who were pregnant during the study period (AOR = 1.86, 95%CI: 1.10-3.13) and those who had discussions with their husband about HIV/AIDS/ MTCT (AOR = 2.40, 95% CI: 1.52-.3.80). CONCLUSION AND RECOMMENDATION: The finding from this study revealed that knowledge of married women on MTCT of HIV was low. This may contribute to increase the spread of MTCT of HIV. Therefore, giving more attention and emphasis on continuous education regarding MTCT of HIV is highly recommended.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Transmisión Vertical de Enfermedad Infecciosa , Matrimonio , Características de la Residencia , Adulto , Etiopía , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Obstetricia , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Factores Socioeconómicos
9.
Hum Vaccin Immunother ; 16(12): 2932-2937, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33175602

RESUMEN

The COVID-19 pandemic has imposed unprecedented health and socioeconomic challenges on public health, disrupting it on a global scale. Given that women and children are widely considered the most vulnerable in the times of emergency, whether in war or during a pandemic, the current pandemic has also severely disrupted access to reproductive and child health services. Despite this, data on the effect of the pandemic on pregnant women and newborns remain scarce, and gender-disaggregated indicators of mortality and morbidity are not available. In this context, we suggest the implementation of a gendered approach to ensure the specific needs of women and their newborns are considered during the development of COVID-19 vaccines. Taking into account gender-based biological differences, the inclusion of pregnant and lactating mothers in clinical trials for the development of COVID-19 vaccines is of vital importance.


Asunto(s)
/uso terapéutico , Desarrollo de Medicamentos/métodos , Complicaciones Infecciosas del Embarazo/prevención & control , Poblaciones Vulnerables , /epidemiología , Niño , Desarrollo de Medicamentos/tendencias , Femenino , Humanos , Lactancia/efectos de los fármacos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Factores Sexuales
10.
BMC Infect Dis ; 20(1): 876, 2020 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-33228559

RESUMEN

BACKGROUND: The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16 to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU. The purpose of this study is to explore perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants' mortality. METHOD: Explorative, descriptive qualitative study conducted in five zones of Amhara region. The sample consisted of mothers enrolled to the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes. RESULTS: Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment. CONCLUSIONS: Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.


Asunto(s)
Mortalidad del Niño , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Personal de Salud/psicología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Perdida de Seguimiento , Madres/psicología , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/psicología , Adulto , Niño , Preescolar , Etiopía/epidemiología , Femenino , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/mortalidad , Investigación Cualitativa , Derivación y Consulta , Estigma Social , Adulto Joven
11.
BMC Infect Dis ; 20(1): 839, 2020 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-33183254

RESUMEN

BACKGROUND: Hepatitis B virus (HBV) infection is a public health problem in Togo and transmission to the child occurs mainly during childbirth. The objective of this study was to estimate the prevalence of HBV among childbearing women and infants born to HBV positive mothers in Togo. METHODS: A national cross-sectional study was carried out in six cities in Togo in the six health regions in Togo. Mother-child pairs were recruited from immunization centers or pediatric wards in Lomé, Tsévié, Atakpamé, Sokodé, Kara and Dapaong in 2017. Women aged 18 and over with one child of at least 6 months old were included. A standardized questionnaire was used for data collection and HBV screening was performed using Determine® rapid tests. The prevalence of HBV, defined by a positive HBV surface antigen (HBsAg), was estimated in mothers and then in infants of mothers who were positive for HBsAg. Logistic regression model was performed to identify risk factors for HBsAg positivity in mothers. RESULTS: A total of 2105 mothers-pairs child were recruited. The median age of mothers and infants was 29 years, interquartile range (IQR) [25-33] and 2.1 years, IQR [1-3] respectively. About 35% of women were screened for HBV during antenatal care and 85% of infants received three doses of HBV immunization. Among mothers, the prevalence of HBV was 10.6, 95% confidence interval (95% CI) [9.4-12.0%], and 177 had detectable HBV viral load (> 10 IU/mL). Among mothers with positive HBsAg, three infants also had positive HBsAg, a prevalence of 1.3, 95% CI [0.2-3.8%]. In multivariable analysis, HIV-infection (aOR = 2.19; p = 0.018), having at least three pregnancies (aOR = 1.46; p = 0.025) and living in Tsévié (aOR = 0.31; p < 0.001) compared to those living in Lomé, were associated to HBV infection in mothers. CONCLUSION: In this study, one out of 10 childbearing women were infected with HBV, but less than 2% of infant born to HBV positive mothers under 5 years' old who received immunization under the Expanded Program on Immunization were infected. Improving antenatal screening and providing targeted interventions in babies could help eliminate HBV in Togo.


Asunto(s)
Virus de la Hepatitis B/inmunología , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Vacunación , Adulto , Preescolar , Estudios Transversales , Femenino , VIH , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Hepatitis B/virología , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Virus de la Hepatitis B/genética , Humanos , Lactante , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Atención Prenatal , Prevalencia , Togo/epidemiología , Adulto Joven
12.
Artículo en Inglés | MEDLINE | ID: mdl-33182412

RESUMEN

Pregnant women seem to be at risk for developing complications from COVID-19. Given the limited knowledge about the impact of COVID-19 on pregnancy, management guidelines are fundamental. Our aim was to examine the obstetrics guidelines released from December 2019 to April 2020 to compare their recommendations and to assess how useful they could be to maternal health workers. We reviewed 11 guidelines on obstetrics management, assessing four domains: (1) timeliness: the time between the declaration of pandemics by WHO and a guideline release and update; (2) accessibility: the readiness to access a guideline by searching it on a common browser; (3) completeness: the amount of foundational topics covered; and (4) consistency: the agreement among different guidelines. In terms of timeliness, the Royal College of Obstetricians and Gynaecologists (RCOG) was the first organization to release their recommendation. Only four guidelines were accessible with one click, while only 6/11 guidelines covered more than 80% of the 30 foundational topics we identified. For consistency, the study highlights the existence of 10 points of conflict among the recommendations. The present research revealed a lack of uniformity and consistency, resulting in potentially challenging decisions for healthcare providers.


Asunto(s)
Infecciones por Coronavirus , Servicios de Salud Materna/normas , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo/prevención & control , Betacoronavirus , Femenino , Humanos , Guías de Práctica Clínica como Asunto , Embarazo , Salud Pública
13.
J Womens Health (Larchmt) ; 29(11): 1361-1371, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33196330

RESUMEN

After its identification as a human pathogen in 2019, the novel coronavirus, SARS-CoV-2, has spread rapidly around the world. Health care workers worldwide have had the task of preparing and responding to the pandemic with little evolving data or guidelines. Regarding the protocols for our labor and delivery unit, we focused on applying the four pillars of biomedical ethics-beneficence, nonmaleficence, autonomy, and justice-while considering the women, their fetuses, their significant others and support persons, health care professionals and auxiliary staff, and society as a whole. We also considered the downstream effect of our decisions in labor and delivery on other disciplines of medicine, including pediatrics, anesthesiology, and critical care. This article focuses on how these prima facie principles helped guide our recommendations in this unprecedented time.


Asunto(s)
Bioética , Infecciones por Coronavirus/prevención & control , Personal de Salud/psicología , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/virología , Betacoronavirus , Coronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Trabajo de Parto , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Embarazo
14.
Taiwan J Obstet Gynecol ; 59(6): 795-800, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33218391

RESUMEN

The spread of COVID-19 has resulted in a high risk of infection in hospitals worldwide. The medical staff in emergency rooms, in particular, have borne the brunt of the pandemic, and strict protection measures are needed to avoid infection in these units. Taiwan as a whole has performed extremely well in this epidemic, an achievement that has been acknowledged internationally. This success can be attributed to the Taiwan Epidemic Prevention Management Center's extensive experience and courageous strategy. The emergency department professionals of all hospitals, in conjunction with the outstanding performance of the center's policy, have also done much to control the infection's spread. However, excessive protection can also negatively affect patients' safety and the quality of medical care, especially for pregnant and parturient women. This article uses two actual cases from a medical center in northern Taiwan to discuss the impact of COVID-19 on pregnant women. This case study serves to highlight that, to ensure more effective coordination during severe epidemics, a comprehensive infection prevention plan should be formulated. In addition, pregnant women's human rights must be safeguarded so that various protective mechanisms can be effectively used to achieve win-win solutions. Hospitals need to plan their production methods and timing in advance for when pregnant patients are in critical condition. The findings include that obstetricians recommend caesarean sections as a safer method in during epidemics. Emergency room physicians and obstetricians should also actively assist mothers prepare for birth to enhance maternal and fetal safety.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Servicio de Urgencia en Hospital/normas , Pandemias/prevención & control , Atención Perinatal/normas , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Adulto , Betacoronavirus , Cesárea/normas , Infección Hospitalaria/virología , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Humanos , Obstetricia/normas , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Taiwán/epidemiología
15.
Taiwan J Obstet Gynecol ; 59(6): 791-794, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33218390

RESUMEN

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Covid-19 pandemic began in the end of 2019 and spread all over the world in a short duration of time. Measures have been taken such as social distancing, compulsory lockdown and restriction of activities so as to prevent spread of virus. It has posed problem to both the antenatal women and maternity care workers. The care and management of pregnant women is an essential service to identify high-risk mothers and also to have good pregnancy outcome for both mother and baby. Any delay in this may lead to catastrophe, hence this issue needs to be addressed properly. This review briefs about the literature available on antenatal care during covid-19 pandemic. Pregnancy is not very adversely affected by the virus itself but extra caution should be taken to prevent and complications should they arise. The norms of social distancing by patients and wearing personal protective equipment by hospital staff, testing of pregnant women should be followed as per regional and national guidelines. This will help ensure safety of all people along with care to the expecting mother. The presence of covid-19 infection should not deter women from receiving antenatal care nor should the obstetric treatment be delayed during labor. Decision for timing and mode of delivery should be individualised based on obstetric indications and maternal-fetal status.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/métodos , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Femenino , Humanos , Neumonía Viral/transmisión , Neumonía Viral/virología , Embarazo , Complicaciones Infecciosas del Embarazo/virología
16.
Taiwan J Obstet Gynecol ; 59(6): 808-811, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33218393

RESUMEN

Many routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented pandemic of COVID-19. Healthcare systems everywhere in the world are under pressure. Being a component of essential health services, family planning and abortion services should continue to cater the population in order to prevent the complications arising from unintended pregnancies and sudden rise in STIs. Due to airborne nature of transmission of the virus, it is advisable for all consultations relating to family planning services to be done remotely unless and until visit is absolutely necessary. Contraception initiation and continuation can be done by telemedicine in most individuals. Post partum contraception can be advised before discharge from hospital. In an individual planning for pregnancy, currently it is not advisable to discontinue contraceptive and plan for pregnancy as not much is known about the effect of the virus on foetal development. Also, pregnancy requires routine antenatal and peripartum care and complications arising from pregnancy may necessitate frequent hospital visits, exposing the individual to the risk of infection. Abortion services are time sensitive therefore should not be denied or delayed beyond legal limit. We need to change from real to virtual consultation to prevent the rise in unplanned pregnancies, sexually transmitted infections and unsafe abortions.


Asunto(s)
Aborto Inducido/métodos , Infecciones por Coronavirus/prevención & control , Servicios de Planificación Familiar/métodos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Telemedicina/métodos , Betacoronavirus , Anticoncepción/métodos , Femenino , Humanos , Atención Preconceptiva/métodos , Embarazo , Complicaciones Infecciosas del Embarazo/virología
17.
Ann Acad Med Singap ; 49(8): 543-552, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33164024

RESUMEN

INTRODUCTION: To assess the level of anxiety and knowledge regarding COVID-19 amongst antenatal women. MATERIALS AND METHODS: This cross-sectional survey was conducted in the antenatal clinics of KK Women's and Children's Hospital, Singapore, from 31 March to 25 April 2020 to assess pregnant women's knowledge of COVID-19, their perceptions of its impact upon pregnancy and psychological impact using the validated Depression, Anxiety, and Stress Scales (DASS-21). RESULTS: Of the 324 women who participated in the study, the mean age was 31.8 years (range, 20-45). The majority (53.7%) were multiparous with mean gestational age of 23.4 weeks (SD 10). The commonest sources of information were Internet-based social media platforms. A significant proportion were unaware, or associated COVID-19 infection during pregnancy with fetal distress (82.1%), intrauterine death (71.3%), fetal anomalies (69.8%), miscarriages (64.8%), preterm labour (67.9%) and rupture of membranes (61.4%). A total of 116 (35.8%) women screened positive for anxiety, 59 (18.2%) for depression, and 36 (11.1%) for stress. There was a significant association between household size and stress scores [B = 0.0454 (95% CI, 0.0035-0.0873)]. Women who associated COVID-19 infection with fetal anomalies and intrauterine fetal death had significantly higher anxiety scores [B = -0.395 (95% CI, -0.660 to -0.130) and B = -0.291 (95% CI, -0.562 to -0.021) respectively]. CONCLUSION: Our study highlights that a lack of timely and reliable information on the impact of COVID-19 on pregnancy and its outcomes results in increased levels of depression, anxiety and stress. The healthcare provider must address these issues urgently by providing evidence-based information using Internet-based resources and psychological support.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Emociones , Conocimientos, Actitudes y Práctica en Salud , Neumonía Viral/complicaciones , Complicaciones Infecciosas del Embarazo/virología , Mujeres Embarazadas/psicología , Adulto , Ansiedad/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Singapur , Medios de Comunicación Sociales , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Adulto Joven
18.
BMC Pregnancy Childbirth ; 20(1): 675, 2020 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-33167918

RESUMEN

BACKGROUND: COVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects. It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitudes and precaution practices of non-infected pregnant women towards the COVID-19 outbreak in Singapore. METHODS: An online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Multiple linear regression analysis was performed to examine women's precaution practices among six independent socio-demographic variables, including age, ethnicity, education, front-line jobs, history of miscarriage and type of antenatal clinic (general, high risk). RESULTS: A total of 167 survey responses were obtained over 8 weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n = 127), were of Chinese ethnicity (55%, n = 91), attained tertiary education (62%, n = 104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, ß 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (ß 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (ß 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, ß 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, ß 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, ß 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, ß 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home. CONCLUSION: Social demographical factors including age > 36 years old, Malay ethnicity, employment in front line jobs and attendance at high-risk clinics are likely to influence the attitudes and precaution practices among pregnant women towards COVID-19 in Singapore. Knowledge gained from our cross-sectional online survey can better guide clinicians to communicate better with pregnant women. Hence, it is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental well being.


Asunto(s)
Infecciones por Coronavirus/psicología , Conocimientos, Actitudes y Práctica en Salud , Neumonía Viral/psicología , Complicaciones Infecciosas del Embarazo/psicología , Mujeres Embarazadas/psicología , Adulto , Infecciones por Coronavirus/prevención & control , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Singapur
19.
Rev. esp. anestesiol. reanim ; 67(9): 487-495, nov. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-194385

RESUMEN

INTRODUCCIÓN: La pandemia actual de SARS-CoV-2 ha supuesto la mayor crisis sociosanitaria mundial experimentada en el último siglo. Cada centro asistencial se ha visto impelido a adecuar las guías de tratamiento establecidas por las distintas sociedades científicas. OBJETIVOS: Analizar el impacto de la metodología basada en la simulación como herramienta de mejora de nuestra práctica clínica: dinámica de trabajo, efectividad y seguridad de todos los facultativos implicados en el manejo del parto en gestantes COVID y su utilidad para facilitar la adecuación de los protocolos a un contexto clínico específico. MÉTODO: Estudio observacional descriptivo que incluye las cesáreas y partos de gestante COVID realizados en nuestro hospital. Se analizaron de manera multidisciplinar las actuaciones ejecutadas utilizando las herramientas de la simulación briefing y debriefing, antes y después de cada caso. RESULTADOS: Se analizaron un total de 5 casos clínicos. Se encontraron dificultades en la ejecución de los protocolos establecidos para la atención de la gestante COVID a nivel organizativo, estructural, de recursos materiales y de factores humanos. CONCLUSIONES: Este modelo de análisis ha resultado una herramienta de gran valor en tres aspectos: la mejora del trabajo en equipo, la realización de protocolos de actuación consensuados y el establecimiento de propuestas efectivas para la adecuación de los protocolos


INTRODUCTION: The current SARS-CoV-2 pandemic has been the world's largest socio-health crisis experienced in the last century. Each healthcare center has been compelled to adapt the treatment guidelines established by the different scientific societies. OBJECTIVES: Analyze the impact of the methodology based on simulation as a tool to improve our clinical practice: work dynamics, effectiveness and safety of all the physicians involved in the management of labor in COVID pregnant women and its usefulness to facilitate the adaptation of protocols to a specific clinical context. METHOD: Descriptive observational study that includes the C-sections and deliveries of COVID pregnant women performed in our hospital. The actions carried out in each procedure were analyzed using the simulation multidisciplinary briefing and debriefing tools, before and after each case. RESULTS: A total of 5 clinical cases were analyzed. Difficulties were found in the execution of the protocols established for the care of the COVID pregnant. Organizational, structural, material resources and human factors obstacles were the most common. CONCLUSIONS: Our results showed that the analysis example using simulation methodology was a tool of great value in three aspects: teamwork improvement, actions consent and improvement proposals for the adaptation and implementation of protocols


Asunto(s)
Humanos , Infecciones por Coronavirus/prevención & control , Virus del SRAS/patogenicidad , Complicaciones Infecciosas del Embarazo/prevención & control , Pandemias , Parto Obstétrico/normas , Cesárea/normas , Ejercicio de Simulación , Precauciones Universales/métodos , Infecciones por Coronavirus/complicaciones , Factores de Riesgo , Complicaciones Infecciosas del Embarazo/virología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa
20.
Indian Pediatr ; 57(12): 1166-1171, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33103659

RESUMEN

The limited evidence on neonatal coronavirus disease (COVID-19) suggests that vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rare, and most neonates seem to acquire the infection postnatally through respiratory droplets and contact. Testing of neonates with perinatal or postnatal exposure to COVID-19 infection plays a vital role in the early diagnosis, management and institution of infection prevention measures thereby cutting off the chain of epidemic transmission. A recently concluded online neonatal COVID-19 conference conducted by the National Neonatology Forum (NNF) of India and a nationwide online survey pointed to substantial variation in neonatal testing strategies. We, herein, summarize the relevant literature about the incidence and outcomes of neonatal COVID-19 and call for a universal and uniform testing strategy for exposed neonates. We anticipate that the testing strategy put forth in this article will facilitate better management and safe infection prevention measures among all units offering neonatal care in the country.


Asunto(s)
/métodos , Transmisión de Enfermedad Infecciosa/prevención & control , Atención Perinatal/métodos , Complicaciones Infecciosas del Embarazo , /aislamiento & purificación , /epidemiología , /terapia , Diagnóstico Precoz , Femenino , Humanos , Incidencia , India/epidemiología , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Neonatología/métodos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Tiempo de Tratamiento
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