SARS-CoV-2 Infection and C-Section: A Prospective Observational Study.

Pregnant women are particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In addition to unfavorable perinatal outcomes, there has been an increase in obstetric interventions. With this study, we aimed to clarify the reasons, using Robson's classification model, and risk factors for cesarean section (C-section) in SARS-CoV-2-infected mothers and their perinatal results. This was a prospective observational study that was carried out in 79 hospitals (Spanish Obstetric Emergency Group) with a cohort of 1704 SARS-CoV-2 PCR-positive pregnant women that were registered consecutively between 26 February and 5 November 2020. The data from 1248 pregnant women who delivered vaginally (vaginal + operative vaginal) was compared with those from 456 (26.8%) who underwent a C-section. C-section patients were older with higher rates of comorbidities, in vitro fertilization and multiple pregnancies (p < 0.05) compared with women who delivered vaginally. Moreover, C-section risk was associated with the presence of pneumonia (p < 0.001) and 41.1% of C-sections in patients with pneumonia were preterm (Robson's 10th category). However, delivery care was similar between asymptomatic and mild-moderate symptomatic patients (p = 0.228) and their predisposing factors to C-section were the presence of uterine scarring (due to a previous C-section) and the induction of labor or programmed C-section for unspecified obstetric reasons. On the other hand, higher rates of hemorrhagic events, hypertensive disorders and thrombotic events were observed in the C-section group (p < 0.001 for all three outcomes), as well as for ICU admission. These findings suggest that this type of delivery was associated with the mother's clinical conditions that required a rapid and early termination of pregnancy.

Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study.

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients' information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

Late stillbirth due to listeriosis

Listeriosis is a sporadic infectious disease, which affects high-risk populations, such as the elderly, pregnant women, newborns, and immunocompromised patients. During pregnancy, listeriosis usually presents like a mild non-specific infection, but it may be responsible for fetal loss, preterm labor, early onset neonatal sepsis, and neonatal death. We report the case of a late stillbirth secondary to maternal chorioamnionitis. Listeria monocytogenes was isolated from the amniotic fluid and the fetal pleural fluid. The fetal autopsy revealed a disseminated inflammatory response with multi-organ involvement. This case illustrates the importance of the prevention and the diagnosis of listeriosis during gestation and may help us to understand the physiopathology of fetal loss due to listeriosis.

Late stillbirth due to listeriosis.

Listeriosis is a sporadic infectious disease, which affects high-risk populations, such as the elderly, pregnant women, newborns, and immunocompromised patients. During pregnancy, listeriosis usually presents like a mild non-specific infection, but it may be responsible for fetal loss, preterm labor, early onset neonatal sepsis, and neonatal death. We report the case of a late stillbirth secondary to maternal chorioamnionitis. Listeria monocytogenes was isolated from the amniotic fluid and the fetal pleural fluid. The fetal autopsy revealed a disseminated inflammatory response with multi-organ involvement. This case illustrates the importance of the prevention and the diagnosis of listeriosis during gestation and may help us to understand the physiopathology of fetal loss due to listeriosis.

Defectos de la pared abdominal: complejo OEIS complex. Afectación de uno de los gemelos en una gestación monocorial monoamniótica / Defects of the abdominal wall: OEIS complex. Affection of one of the twins in a monoamniotic monocorial gestation

Los defectos de la pared abdominal engloban un amplio grupo de patologías que pueden clasificarse en distintos tipos según sus características anatomopatológicas y patogenia. El complejo OEIS complex es una rara entidad compuesta por onfalocele, extrofia vesical, ano imperforado y defectos espinales, dando origen a las siglas en inglés (Omphalocele, bladder Exstrophy, Imperforateanu and Spinal defects) y asociándose también a ausencia de genitales externos, deformidad en la flexión de miembros, defectos en pie y arteria umbilical única. Su incidencia estimada es de 1/200.000 a 1/400.000 nacidos en gestaciones únicas, menor en gestaciones gemelares. Su etiología en la mayoría de las ocasiones es desconocida, esporádica y heterogénea, pudiendo asociarse a varios factores. Presentamos el caso de una mujer con gestación monocorial monoamniótica y afectación de uno de los gemelos por este defecto (complejo OEIS complex), presentando un segundo gemelo totalmente sano, lo que demuestra la falta de conocimiento en cuanto a la etiología de esta rara entidad y la improbable implicación de los factores genéticos (AU)

The abdominal wall defects encompass a variety of disorders that can be classified into different types according to their pathologic features and pathogenesis. The OEIS complex is a rare complex composed of omphalocele, bladder exstrophy , imperforate anus and spinal defects, giving rise to the acronym (Omphalocele, bladder Exstrophy, Imperforate anus and Spinal defects) and associating with the absence of external genitalia, flexion deformity member, standing defects, and single umbilical artery. Its incidence is estimated from 1/400,000 to 1/200,000 born in singleton pregnancies, lower in twin pregnancies. The etiology in most cases is unknown, sporadic and heterogeneous it may be associated with several factors. We report the case of a woman with monochorionic monoamniotic gestation and involvement of one of the twins for this defect (OEIS complex complex), presenting one second fully healthy twin, demonstrating the lack of knowledge regarding the etiology of this rare entity and the unlikely involvement of genetic factors (AU)