The financial burden of SARS-CoV-2 pregnancies in a tertiary exclusive COVID-19 maternity.

The COVID-19 pandemic had a major impact on health systems worldwide, and Romania was no exception. The impact on healthcare expenses for pregnant women was considerable, especially in COVID-19-only tertiary centers. This study aimed to analyze the impact of the COVID-19 pandemic on healthcare costs in a designated COVID-19 maternity ward. We conducted an observational study comparing pregnant women with SARS-CoV-2 (study group) to those without the infection (control group). Patients were recruited at Bucur Maternity Hospital from March 2020 to March 2022. We evaluated expenses for the entire period of hospitalization, treatment, medical supplies, and medical investigations. The study included 600 pregnant women, divided equally into two groups of 300 each. Significant cost differences were observed between the COVID-19 and non-COVID-19 groups: medication costs (664.56 EUR vs. 39.49 EUR), administrative costs (191.79 EUR vs. 30.28 EUR), and medical investigation costs (191.15 EUR vs. 29.42 EUR). The costs for a severe case of COVID-19 were about two times higher than a mild case and 70 times higher than a non-COVID-19 case (P <0.001). We identified a significant cost increase due to SARS-CoV-2 infection in our unit. The expenses were augmented by the time of hospitalization, medication, and medical investigations. COVID-19 had a significant impact on healthcare costs, mostly among pregnant women with severe disease. The strategy of operating exclusively as a COVID-19 unit proved to be inefficient and highly costly to our hospital.

Hysteroscopy for Infertility in Young Women - Our Experience.

Objective: Infertility is a complex condition that depends on numerous mechanisms regarding its occurrence and evolution. It does not appear as a single pathology, and therefore the diagnosis and management involve both the identification of etiological causes and other possible systemic interactions. Infertility is defined as a succession of unsuccessful attempts of unprotected intercourse within a couple for 12 months, during the reproductive life. Among the many causes related to infertility, uterine pathology has an important place and hysteroscopy is outstanding in diagnosing and treating various pathologies in this category. Material and methods: This descriptive study was conducted on a retrospective analysis of a group of patients from Bucur Clinical Hospital, Bucharest, Romania. The main data were obtained from medical electronic records and included the type of infertility, associated diagnoses and symptoms, previous investigations, hysteroscopic procedure and follow-up. In order to obtain the database, the above parameters were evaluated and processed in the IBM SPSS Statistics version 28, including other few graphs processed in Microsoft Office Excel 2007. Results:The present study included 51 patients aged between 20 and 40 years, with a mean of 32.02 ± 3.7. Out of the total number of patients, 76.47% of participants to the present study were diagnosed with secondary infertility and 58.82% described menometrorrhagias as the most common symptom. Endometrial polyps were more frequently associated with menometrorrhagias (70% of patients), while synechiae and secondary amenorrhea were found together in 75% of cases. Previous ultrasound evaluation identified uterine cavity abnormalities as nonhomogeneous echo-pattern in 58.82% of cases, with some of them being suggestive of endometrial polyps (37.25%), intrauterine synechiae (3.92%) and uterine fibromas (9.8%). We noticed that 12% of cases required laparoscopy and 4% laparotomy. The outcomes of hysteroscopic management resulted in a conception rate of 39%. We found that 20% of pregnancies achieved were complicated with placenta praevia, 5% with gestational hypertension and 15% with imminence of abortion. Conclusions:Secondary infertility was more frequently encountered than primary infertility and the most common associated manifestations included menometrorrhagia, followed by secondary amenorrhea and pelvic-abdominal pain. Transvaginal ultrasound was correlated with hysteroscopic diagnosed pathology; posthysteroscopic results were favourable, regardless of the size and location of changes in the uterine cavity, thus highlighting the importance of hysteroscopic therapeutic techniques in increasing the chances of conception.

Placenta, the Key Witness of COVID-19 Infection in Premature Births.

Adverse perinatal outcomes, such as increased risks of pre-eclampsia, miscarriage, premature birth, and stillbirth have been reported in SARS-CoV-2 infection. For a better understanding of COVID-19 complications in pregnancy, histopathological changes in the placenta, which is the interface between mother and foetus, could be the place to look at. The aim of this study was to determine placental histopathological changes and their role in preterm birth in pregnant women with SARS-CoV-2 infection. We performed a prospective, observational study in a COVID-only hospital, which included 39 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 39 women COVID-19 negative with preterm birth and a placental pathology exam available. The microscopic examination of all placentas revealed placental infarction (64.1% vs. 30.8%), decidual arteriopathy (66.7% vs. 23.1%), intervillous thrombi (53.8% vs. 38.5%), perivillous fibrin deposits (59% vs. 46.2%), inflammatory infiltrate (69.2% vs. 46.2%), chorangiosis (17.9% vs. 10.3%), and accelerated maturation of the villi (23.1% vs. 28.2%).

The Impact of SARS-CoV-2 Infection on Premature Birth-Our Experience as COVID Center.

Information about the impact of SARS-CoV-2 infection on pregnant women is still limited and raises challenges, even as publications are increasing rapidly. The aim of the present study was to determine the impact of SARS-CoV-2 infection on preterm birth pregnancies. We performed a prospective, observational study in a COVID-only hospital, which included 34 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 48 healthy women with preterm birth. The rate of cesarean delivery was 82% in the study group versus 6% for the control group. We observed a strong correlation between premature birth and the presence of COVID-19 symptoms (cough p = 0.029, fever p = 0.001, and chills p = 0.001). The risk for premature birth is correlated to a lower value of oxygen saturation (p = 0.001) and extensive radiologic pulmonary lesions (p = 0.025). The COVID-19 pregnant women with preterm delivery were older, and experienced an exacerbation of severe respiratory symptoms, decreased saturation of oxygen, increased inflammatory markers, severe pulmonary lesions and decreased lymphocytes.