Enfermedad por coronavirus (COVID-19) en embarazo, parto y lactancia / Coronavirus disease 2019 (COVID-19) in pregnancy, childbirth, and lactation

Resumen La pandemia de COVID-19 ha generado múltiples interrogantes respecto a su comportamiento en la población gestante y en los resultados peri- natales. Los datos disponibles sobre la infección por SARS-CoV-2 en el embarazo son limitados. Se realizó una búsqueda de artículos publicados en las bases de datos PubMed, Scopus y Embase utilizando los términos asociados a COVID-19 y embarazo, hasta el 4 de abril de 2020. En la revisión de 43 artículos se tuvieron en cuenta 25, que corresponden a reportes y series de casos, revisiones y guías de manejo. No se encontró evidencia concluyente respecto a transmisión vertical o a mal resultado perinatal en enfermedad leve o moderada. Los síntomas clínicos de COVID-19 en el embarazo no varían de los de la población general. Existe controversia en cuanto a lactancia materna. En conclusión, existe escasa evidencia de calidad sobre el efecto de COVID-19 en el embarazo. Dada la ausencia de evidencia concluyente se plantea la realización de un registro nacional de COVID-19 y embarazo para Colombia y la región.

Abstract The COVID-19 pandemic has raised a number of questions regarding its behavior in the pregnant population and perinatal outcomes. Currently, data available on the COVID-19 infection during pregnancy is limited. A search was conducted of all the articles published in the PubMed, Scopus, and Embase databases, using terms associated with COVID-19 and pregnancy from January 2017 to 04 April 2020, and including all the types of articles published on COVID-19 and pregnancy. The review of 43 articles, of which 23 were considered, demonstrated that all refer to case reports, case series and reviews and management guides. No conclusive evidence was found with respect to vertical transmission or poor perinatal outcome in mild-moderate disease. The clinical symptoms of COVID-19 during pregnancy do not vary from those in the general population. Controversy exists with regards to breastfeeding. In conclusion, quality evidence is scarce on the effect of COVID-19 during pregnancy. Given the lack of conclusive evidence, a national registry is proposed on COVID-19 and pregnancy for Colombia.

Síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) y embarazo / Obstructive sleep apnea-hypopnea syndrome (OSAHS) and pregnancy

Resumen El embarazo es una condición temporal de la vida en la que ocurren importantes cambios en la fisiología de la mujer, los cuales se resuelven, en gran medida, después del parto. Hay cambios físicos, hormonales y psicológicos, con un aumento progresivo de peso. Estos factores pueden predisponer a un trastorno respiratorio del sueño o a exacerbar alguno ya existente. La literatura científica sugiere una mayor prevalencia de ronquido en las mujeres embarazadas. Las bases de datos demuestran que en menos del 1% de los embarazos aparece el código del diagnóstico de apnea de sueño. Se ha relacionado la presencia tanto de ronquido como de apnea durante el embarazo con algunos desenlaces adversos que se tratan en este artículo, el cual busca sensibilizar a los médicos para que consideren este diagnóstico durante el embarazo.

Abstract Pregnancy is a temporary condition of life during which important changes in the physiology of women occur; such changes are resolved, to a large extent, after childbirth. Physical, hormonal and psychological changes can be observed as weight increases progressively. These factors may predispose to a respiratory sleep disorder or exacerbate an existing sleep disorder. The scientific literature suggests a higher prevalence of snoring in pregnant women, although databases show the diagnosis code of sleep apnea in less than 1% of pregnancies. The presence of both snoring and apnea during pregnancy has been associated with some adverse outcomes discussed in this article, which seeks to sensitize physicians to consider this diagnosis during pregnancy.

Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients.

The use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. Prognostic models in critical care have been used to characterize the severity of illness of specific diseases. Physiological changes in pregnancy may result in general critical illness prediction models overestimating mortality in obstetric patients. Models that specifically reflect the unique characteristics of obstetric patients may have better prognostic value. Recently developed tools have focused on identifying at-risk patients before they require intensive care unit (ICU) admission to target early interventions and prevent acute clinical decompensation. The aim of the newest scoring systems, specifically designed for groups of obstetric patients receiving non-ICU care, is to reduce maternal morbidity and mortality by identifying early high-risk patients and initiating prompt effective medical responses.

Global obstetric medicine: Collaborating towards global progress in maternal health.

Globally, the nature of maternal mortality and morbidity is shifting from direct obstetric causes to an increasing proportion of indirect causes due to chronic conditions and ageing of the maternal population. Obstetric medicine can address an important gap in the care of women by broadening its scope to include colleagues, communities and countries that do not yet have established obstetric medicine training, education and resources. We present the concept of global obstetric medicine by highlighting three low- and middle-income country experiences as well as an example of successful collaboration. The article also discusses ideas and initiatives to build future partnerships within the global obstetric medicine community.

Consenso colombiano para la definición de los criterios de ingreso a unidades de cuidados intensivos en la paciente embarazada críticamente enferma / Colombian consensus for definition of admission criteria to intensive care units in critically ill pregnant patient

Cada una de las decisiones alrededor de pacientes obstétricas críticas requiere un equipo multidisciplinario de especialistas en cuidado crítico de adultos y en medicina materno-fetal para el difícil entendimiento y manejo de la historia natural de las enfermedades y sus complicaciones durante la gestación, el parto y el puerperio. No existen guías detalladas en Colombia que describan los planes de acción frente a una paciente embarazada en condiciones críticas; de ahí la importancia de un consenso que permita establecer el nivel de cuidado crítico requerido por este grupo poblacional especial, estandarizar las condiciones de atención de las gestantes críticas y generar planteamientos académicos y éticos frente a esta estrategia de alto impacto para la reducción de la mortalidad materna.

Each of the decisions about critical obstetric patients requires a multidisciplinary team of specialists in adult critical care and maternal-fetal medicine, for the difficult understanding and management of the natural history of the disease and its complications during pregnancy, childbirth and the postpartum period. There are not detailed guidelines in Colombia that describe the action plans in front of a pregnant or recently pregnant patient in a critical condition. For this reason, it is important to establish a consensus aiming to determine the level of critical care required for this particular population group, standardize care conditions of pregnant women and generate critical academic and ethical approaches to address this high impact strategy for reducing maternal mortality.

Disección aórtica aguda tipo A, una enfermedad catastrófica asociada al embarazo / Type A acute aortic dissection: a catastrophic event associated with pregnancy

Objetivo. Describir 2 casos mortales de disección aórtica aguda tipo A asociada al embarazo. Métodos. Se revisan las historias clínicas y las necropsias de las pacientes, luego se explican algunos mecanismos que relacionan a esta entidad con el embarazo. Resultados. Ambas defunciones se dieron en mujeres menores de 35 años, al final de la gestación. Un caso, asociado con una coartación aórtica y aorta bicúspide, la otra paciente sin factores de riesgo. Conclusión. Algunos cambios hemodinámicos del tercer trimestre del embarazo podrían estar involucrados con la aparición de esta enfermedad; considerar su diagnóstico es vital para evitar su gran mortalidad (AU)

Objective. To describe two fatal cases of type A acute aortic dissection associated with pregnancy. Methods. We reviewed the medical records and autopsies of patients, and then identified some mechanisms linking this entity to pregnancy. Results. Both deaths occurred in women aged less than 35 years at the end of gestation. One patient had aortic coarctation and bicuspid aortic valve, while the other had no risk factors. Conclusion. Hemodynamic changes in the third trimester of pregnancy may be involved in the onset of this entity. Rapid diagnosis is essential to prevent its high associated mortality (AU)