Clinical characteristics and risk factors for SARS-CoV-2 infection in pregnant women attending a third level reference center in Mexico City.

BACKGROUND: COVID-19 symptoms vary widely among pregnant women. We aimed to assess the most frequent symptoms amongst pregnant women with SARS-CoV-2 infection in a tertiary hospital in Mexico City. METHODS: A cross-sectional study of pregnant women attending the National Institute of Perinatology in Mexico City was performed. All women who attended the hospital, despite their symptoms, were tested for SARS-CoV-2. A multivariate-age-adjusted logistic regression was used to assess the association between the main outcome and each characteristic of the clinical history. RESULTS: A total of 1880 women were included in the data analysis. Among all women, 30.74% (n = 578) had a positive PCR for SARS-CoV-2 from which 2.7 (n = 50) were symptomatic. Symptoms associated with a positive PCR result were headache (p=.01), dyspnea (p=.043), and myalgia (p=.043). CONCLUSIONS: At universal screening for SARS-CoV-2, one-third of the population had a positive result, while those symptoms associated with a positive PCR were headache, dyspnea, and myalgia.

Molecular Insights into the Thrombotic and Microvascular Injury in Placental Endothelium of Women with Mild or Severe COVID-19.

Clinical manifestations of coronavirus disease 2019 (COVID-19) in pregnant women are diverse, and little is known of the impact of the disease on placental physiology. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been detected in the human placenta, and its binding receptor ACE2 is present in a variety of placental cells, including endothelium. Here, we analyze the impact of COVID-19 in placental endothelium, studying by immunofluorescence the expression of von Willebrand factor (vWf), claudin-5, and vascular endothelial (VE) cadherin in the decidua and chorionic villi of placentas from women with mild and severe COVID-19 in comparison to healthy controls. Our results indicate that: (1) vWf expression increases in the endothelium of decidua and chorionic villi of placentas derived from women with COVID-19, being higher in severe cases; (2) Claudin-5 and VE-cadherin expression decrease in the decidua and chorionic villus of placentas from women with severe COVID-19 but not in those with mild disease. Placental histological analysis reveals thrombosis, infarcts, and vascular wall remodeling, confirming the deleterious effect of COVID-19 on placental vessels. Together, these results suggest that placentas from women with COVID-19 have a condition of leaky endothelium and thrombosis, which is sensitive to disease severity.

Cervical ectopic pregnancy: A case series and literature review

Objective: To describe a case series of nine patients diagnosed with cervical ectopic pregnancy. Design: Descriptive retrospective study of the clinical records of nine consecutive cases of women diagnosed with cervical pregnancy attended at the Instituto Nacional de Perinatología, Mexico City. Results: 448 ectopic pregnancies were attended from January 2011 through June 2018. They represented 2.2% of all pregnancies during the period studied. Of these, nine were cervical pregnancies (2% of all ectopic pregnancies). Five of these patients were admitted because of vaginal bleeding. All nine patients were diagnosed with cervical pregnancy by ultrasonography. Eight patients were initially offered pharmacological treatment with resolution of the ectopic pregnancy confirmed by hCG in two patients. Six patients required surgical intervention, and fertility was preserved in five cases. Conclusions: Cervical ectopic pregnancy is a risk factor for extreme maternal morbidity. It can present as an unexpected massive hemorrhage that commonly leads to hysterectomy and even death. Nowadays, there is no universal algorithm for treatment as it is performed in a regional and non-standardized manner, and in many cases, fertility preservation is not contemplated. Prospective studies are needed to issue recommendations on the management of these patients.

Objetivo. Describir una serie de casos de nueve pacientes con diagnóstico de embarazo ectópico cervical atendidas. Metodología. Estudio retrospectivo descriptivo, con revisión del expediente clínico de nueve casos consecutivos de mujeres con diagnóstico de embarazo ectópico cervical entre enero 2011 y junio 2018, en el Instituto Nacional de Perinatología de Ciudad de México. Resultados. Se halló un total de 448 embarazos ectópicos, que representaron 2,2% del total de embarazos, de los cuales, 9 (2% de los ectópicos) resultaron cervicales. Clínicamente, 5 pacientes presentaron sangrado transvaginal, 3 cursaron con dolor cólico y 2 estuvieron asintomáticas. La edad gestacional promedio fue 7,5 semanas. El diagnóstico de embarazo cervical fue mediante ultrasonografía de segunda dimensión. Con respecto al tratamiento, a 8 de las 9 pacientes se les ofreció inicialmente tratamiento farmacológico; solamente dos de las pacientes mostraron resolución de la hCG (gonadotropina coriónica humana) con la terapia farmacológica; el resto requirió alguna intervención quirúrgica. Se logró tratamiento preservador de la fertilidad en 5 pacientes. Conclusiones. El embarazo ectópico cervical es un factor de riesgo de morbilidad materna extrema. Puede presentarse con hemorragia masiva inesperada, que comúnmente conduce a la histerectomía e incluso a la muerte. Actualmente no existe un algoritmo universal de tratamiento; se realiza de forma regional y no estandarizada y, en muchos casos, no se contempla la preservación de la fertilidad. Se requiere estudios prospectivos para poder emitir una recomendación sobre el manejo de este grupo de pacientes.

Anemia aplásica durante el embarazo: reporte de un caso y revisión de la literatura / Aplastic anemia in pregnancy: Case report and review of the literature

We present the case of a pregnant woman with aplastic anemia. The 22-year-old patient presented with 27 weeks of gestation and lymphoproliferative syndrome at the Instituto Nacional de Perinatología in Mexico City. The bone marrow biopsy confirmed the diagnosis and the immunophenotype was negative for malignancy. The treatment consisted of transfusions and planned birth at 35 weeks. Afterwards, the patient was referred to a bone marrow transplant unit.

Se presenta los resultados perinatales de una paciente con anemia aplásica. Se revisa el caso atendido en el Instituto Nacional de Perinatología, Ciudad de México. La paciente tenía 22 años de edad y embarazo de 27,0 semanas con síndrome linfoproliferativo. La biopsia de médula ósea determinó anemia aplásica; el inmunofenotipo fue negativo a malignidad. El manejo consistió en soporte transfusional, con resolución del embarazo a las 35 semanas. Luego, se refirió la paciente a la unidad de trasplante de médula ósea.