Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Embarazo gemelar con afectación discordante para body stalk anomaly / Twin pregnancy discordant for body stalk anomaly

Presentamos el caso de un embarazo gemelar con malformación compleja en uno de los fetos. El examen ecográfico evidenció un importante defecto de la pared abdominal anterior, mielomeningocele lumbosacro, cifoescoliosis severa y ausencia del cordón umbilical. Estos hallazgos son compatibles con el diagnóstico de body stalk anomaly. El feto no afectado tuvo un buen resultado neonatal (AU)

We report a case of twin pregnancy with a discordant anomaly of one of the foetus. The ultrasound examination revealed a large abdominal wall defect, lumbosacral myelomeningocele, severe kyphoscoliosis and absence of umbilical cord. These ultrasound findings were diagnosed as Body Stalk Anomaly. The unaffected twin had a positive neonatal outcome (AU)

Agenesia lumbosacra. Expresión del síndrome de regresión caudal / Lumbosacral agenesis. Caudal regression syndrome expresión

La agenesia lumbosacra es una malformación congénita muy infrecuente que forma parte del síndrome de regresión caudal. Presentamos un caso diagnosticado como agenesia lumbosacra en nuestra consulta de diagnóstico prenatal durante el segundo trimestre de gestación. No se presentaron malformaciones asociadas, el cariotipo fetal fue normal y la gestante carecía de antecedentes de interés. La pareja se acogió al derecho de interrupción legal del embarazo (AU)

Lumbosacral agenesis is an uncommon condition which is part of the caudal regression syndrome. We report a case de lumbosacral agenesis detected by ultrasound in the second trimester of gestation. The fetus was not presenting other malformations. The fetal karyotype was normal and the pregnant woman did not have precedents of interest. The parents decide to abort (AU)