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2.
Phys Ther ; 101(1)2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33395476

RESUMO

OBJECTIVE: Mobilization while receiving life support interventions, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO), is a recommended intensive care unit (ICU) intervention to maintain physical function. The purpose of this case report is to describe a novel approach to implementing early mobility interventions for a patient who was pregnant and receiving ECMO while continuing necessary infectious disease precautions because of diagnosed coronavirus disease-19 (COVID-19). METHODS: A 27-year-old woman who was pregnant was admitted to the ICU with COVID-19 and rapidly developed acute respiratory failure requiring 9 days of ECMO support. After a physical therapist consultation, the patient was standing at the bedside by hospital day 5 and ambulating by hospital day 9. RESULTS: The patient safely participated in physical therapy during ICU admission and was discharged to home with outpatient physical therapy follow-up after 14 days of hospitalization. CONCLUSION: Early mobility is feasible during ECMO with COVID-19, and active participation in physical therapy, including in-room ambulation, may facilitate discharge to home. Innovative strategies to facilitate routine activity in a patient who is critically ill with COVID-19 require an established and highly trained team with a focus on maintaining function. IMPACT: Early mobility while intubated, on ECMO, and infected with COVID-19 is feasible while adhering to infectious disease precautions when it is performed by an experienced interdisciplinary team.


Assuntos
/terapia , Oxigenação por Membrana Extracorpórea , Modalidades de Fisioterapia , Complicações Infecciosas na Gravidez/terapia , Caminhada/fisiologia , Adulto , Feminino , Humanos , Gravidez
5.
Eur J Obstet Gynecol Reprod Biol ; 256: 40-45, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33166796

RESUMO

OBJECTIVE: The consequences of the COVID-19 pandemic may lead to exceptional stress in pregnant women. In order to evaluate stress levels of pregnant woman in this difficult time, the Pandemic-Related Pregnancy Scale (PREPS) was introduced in the US. The present study introduces and validates the German version of the PREPS. STUDY DESIGN: In total, 1364 German-speaking pregnant women from Germany and Switzerland took part in this online cohort study and completed the PREPS as well as gave information on sociodemographic, obstetric and other psychological factors. RESULTS: A confirmatory factor analysis of the PREPS showed very good psychometric values and confirmed the structure of the original questionnaire. The PREPS comprises three dimensions: Infection Stress (5 items), Preparedness Stress (7 items) and Positive Appraisal (3 items). Furthermore, correlations between the PREPS and other psychological factors such as Pregnancy Specific Stress and Fear of Childbirth highlight convergent validity. The sensitivity of the questionnaire was demonstrated by its associations with several obstetric and COVID-19 related factors. CONCLUSION: The German PREPS showed good psychometric properties and is a useful instrument for future studies which aim to investigate the impact of pandemic-related stress on birth outcomes and postpartum factors.


Assuntos
Internet , Gestantes/psicologia , Estresse Psicológico/diagnóstico , Adulto , Estudos de Coortes , Infecção Hospitalar , Análise Fatorial , Feminino , Alemanha , Humanos , Gravidez , Complicações Infecciosas na Gravidez , Cuidado Pré-Natal/psicologia , Psicometria , Estresse Psicológico/psicologia , Inquéritos e Questionários , Suíça , Traduções
6.
Eur J Obstet Gynecol Reprod Biol ; 256: 194-204, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246205

RESUMO

Evidence concerning coronavirus disease-19 (covid-19) in pregnancy is still scarce and scattered. This meta-analysis aims to evaluate maternal and neonatal outcomes in covid-19 pregnancies and identify factors associated with perinatal viral transmission. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched to 3 June 2020. Overall, 16 observational studies and 44 case reports/series were included. Fever was the most frequent maternal symptom, followed by cough and shortness of breath, while about 15 % of infected were asymptomatic. Severe disease was estimated to occur in 11 % of women in case reports/series and in 7 % (95 % CI: 4 %-10 %) in observational studies. Two maternal deaths were reported. The rate of neonatal transmission did not differ between women with and without severe disease (OR: 1.94, 95 % CI: 0.50-7.60). Preterm birth occurred in 29.7 % and 16 % (95 % CI: 11 %-21 %) in data obtained from case series and observational studies, respectively. Stillbirth occurred in 3 cases and 2 neonatal deaths were observed. Vertical transmission was suspected in 4 cases. Fever was the most common neonatal symptom (40 %), followed by shortness of breath (28 %) and vomiting (24 %), while 20 % of neonates were totally asymptomatic. In conclusion, the maternal and neonatal clinical course the infection is typically mild, presenting low mortality rates. The risk of vertical transmission is suggested to be low and may not be affected by the severity of maternal disease. Further large-scale studies are needed to clarify the risk factors associated with viral transmission and severe infection in the neonatal population.


Assuntos
/epidemiologia , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Infecções Assintomáticas , /transmissão , Cesárea/estatística & dados numéricos , Tosse/fisiopatologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Índice de Gravidade de Doença , Natimorto/epidemiologia , Vômito/fisiopatologia
8.
Eur J Obstet Gynecol Reprod Biol ; 256: 400-404, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33285496

RESUMO

OBJECTIVE: To screen pregnant women at risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery using reverse-transcription polymerase chain reaction (RT-PCR) test and serum immunoglobulin (Ig) testing. METHOD: Between March 31 st and August 31 st of 2020, consecutive pregnant women admitted for labor and delivery in a single hospital were screened for SARS-CoV-2 with nasopharyngeal RT-PCR swab tests and detection of serum IgG and IgM. RESULTS: We studied 266 pregnant women admitted for labor and delivery. The prevalence of acute or past SARS-CoV-2 infection was 9.0 %, including (i) two cases with respiratory symptoms of SARS-Co-V-2 infection and positive RT-PCR; (ii) four asymptomatic women with positive RT-PCR without clinical symptoms and negative serological tests between two and 15 weeks later; and (iii) two women with false positive RT-PCR due to technical problems. All newborns of the 6 pregnant women with RT-PCR positive had negative RT-PCR and did not require Neonatal Intensive Care Unit admission. There were eighteen asymptomatic women with positive serological IgG tests and negative RT-PCR. CONCLUSION: In our cohort of gravids, we found 2.2 % of women with positive RT-PRC tests and 6.7 % with positive serological tests during the first wave of the SARS-CoV-2 pandemic.


Assuntos
/epidemiologia , Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Infecções Assintomáticas/epidemiologia , /imunologia , Portador Sadio/diagnóstico , Parto Obstétrico , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Recém-Nascido , Trabalho de Parto , Programas de Rastreamento , Nasofaringe/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/imunologia , Complicações Infecciosas na Gravidez/fisiopatologia , Prevalência , Adulto Jovem
10.
Obstet Gynecol ; 137(1): 49-55, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33116054

RESUMO

OBJECTIVE: To investigate the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in parturient women, their partners, and their newborns and the association of such antibodies with obstetric and neonatal outcomes. METHODS: From April 4 to July 3, 2020, in a single university hospital in Denmark, all parturient women and their partners were invited to participate in the study, along with their newborns. Participating women and partners had a pharyngeal swab and a blood sample taken at admission; immediately after delivery, a blood sample was drawn from the umbilical cord. The swabs were analyzed for SARS-CoV-2 RNA by polymerase chain reaction, and the blood samples were analyzed for SARS-CoV-2 antibodies. Full medical history and obstetric and neonatal information were available. RESULTS: A total of 1,313 parturient women (72.5.% of all women admitted for delivery at the hospital in the study period), 1,188 partners, and 1,206 newborns participated in the study. The adjusted serologic prevalence was 2.6% in women and 3.5% in partners. Seventeen newborns had SARS-CoV-2 immunoglobulin G (IgG) antibodies, and none had immunoglobulin M antibodies. No associations between SARS-CoV-2 antibodies and obstetric or neonatal complications were found (eg, preterm birth, preeclampsia, cesarean delivery, Apgar score, low birth weight, umbilical arterial pH, need for continuous positive airway pressure, or neonatal admission), but statistical power to detect such differences was low. Full serologic data from 1,051 families showed an absolute risk of maternal infection of 39% if the partner had antibodies. CONCLUSION: We found no association between SARS-CoV-2 infection and obstetric or neonatal complications. Sixty-seven percent of newborns delivered by mothers with antibodies had SARS-CoV-2 IgG antibodies. A limitation of our study is that we lacked statistical power to detect small but potentially meaningful differences between those with and without evidence of infection.


Assuntos
Anticorpos Antivirais/sangue , /epidemiologia , Recém-Nascido/sangue , Parceiros Sexuais , Adulto , Dinamarca/epidemiologia , Feminino , Hospitalização , Hospitais Universitários , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Masculino , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Análise de Regressão , Fatores de Risco , /imunologia
13.
Am J Emerg Med ; 39: 252.e3-252.e5, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33008706

RESUMO

The evolving coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a rapid expansion of knowledge on the disease's clinical manifestations, laboratory and radiographic abnormalities, and patient trajectories. One area of particular focus is the effect that this illness may have on pregnancy and maternal-fetal disease. As of April 24, 2020, we identified 55 English language reports in the scientific literature summarizing data for 339 women and 258 fetuses and neonates. The majority of these data have focused on maternal-fetal transmission and neonatal outcomes. One systematic review and meta-analysis including the spectrum of coronaviruses [Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and COVID-19] in pregnancy noted increased rates of adverse outcomes associated with this group of infections. Here, we report the case of a COVID-19 positive woman presenting to our emergency department (ED) at 34 weeks gestation with preeclampsia. This case highlights the unique diagnostic and therapeutic challenges associated with treating patients with these concomitant diseases.


Assuntos
/diagnóstico , Pré-Eclâmpsia/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Adulto , Feminino , Idade Gestacional , Humanos , Pré-Eclâmpsia/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Radiografia Torácica , Tomografia Computadorizada por Raios X
14.
BJOG ; 128(1): 97-100, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33021026

RESUMO

OBJECTIVE: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vaginal secretions of both reproductive-aged and postmenopausal women during acute SARS-CoV-2 infection. DESIGN: Prospective study. SETTING: A single tertiary, university-affiliated medical centre in Israel. Time period, 1 June 2020 through to 31 July 2020. POPULATION: Women who were hospitalised in a single tertiary medical centre, who were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. METHODS: Women were diagnosed with acute SARS-CoV-2 infection by a nasopharyngeal RT-PCR test. Vaginal RT-PCR swabs were obtained from all study participants after a proper cleansing of the perineum. MAIN OUTCOME MEASURES: Detection of SARS-CoV-2 in vaginal RT-PCR swabs. RESULTS: Vaginal and nasopharyngeal swabs were obtained from 35 women, aged 21-93 years. Twenty-one women (60%) were in their reproductive years, of whom, five were in their third trimester of pregnancy. Most of the participants (57%) were healthy without any underlying medical conditions. Of the 35 patients sampled, 2 (5.7%) had a positive vaginal RT-PCR for SARS-CoV-2, one was premenopausal and the other was a postmenopausal woman. Both women had mild disease. CONCLUSION: Our findings contradict most previous reports, which did not detect the presence of viral colonisation in the vagina. Although passage through the birth canal exposes neonates to the vaginal polymicrobial flora, an acquisition of pathogens does not necessarily mandate neonatal infection or clinical disease. Nevertheless, when delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation, even if it is uncommon. TWEETABLE ABSTRACT: When delivering the infant of a woman with acute SARS-CoV-2 infection, a clinician should consider the possibility of vaginal colonisation.


Assuntos
Complicações Infecciosas na Gravidez , Vagina/virologia , Adulto , Idoso , /epidemiologia , /métodos , Feminino , Humanos , Recém-Nascido , Israel/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Estudos Prospectivos , Esfregaço Vaginal/métodos , Esfregaço Vaginal/estatística & dados numéricos
15.
Int J Cardiol ; 323: 29-33, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-32800917

RESUMO

The pandemic of Novel Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has provoked hundreds of thousands of deaths, resulting in catastrophe for humans. Although some insights have been garnered in studies on women, children and young adults infected with COVID-19, these often remain fragmented in literature. Therefore, we discussed the impact of COVID-19 pandemic on women, children and young patients, particularly those with underlying cardiovascular comorbidities or congenital heart disease. Furthermore, we gathered and distilled the existing body of literature that describes their cardiovascular complications and the recommended actions in favour of those patients toward the post-peak pandemic period. Although many questions still require answers, this article is sought to help the practicing clinician in the understanding and management of the threatening disease in special populations.


Assuntos
/terapia , Saúde da Mulher , Antipiréticos/uso terapêutico , Antivirais/uso terapêutico , Cardiomiopatias/virologia , Criança , Controle de Doenças Transmissíveis , Feminino , Cardiopatias Congênitas/complicações , Humanos , Pandemias , Gravidez , Complicações Cardiovasculares na Gravidez/virologia , Complicações Infecciosas na Gravidez , Distribuição por Sexo , Cardiomiopatia de Takotsubo/virologia
16.
J Ultrasound Med ; 40(1): 191-203, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32478445

RESUMO

Lung ultrasound (LUS) is an effective tool to detect and monitor patients infected with 2019 coronavirus disease (COVID-19). The use of LUS on pregnant women is an emerging trend, considering its effectiveness during the outbreak. Eight pregnant women with a diagnosis of COVID-19 confirmed by nasal/throat real-time reverse transcription polymerase chain reaction testing who underwent point-of-care LUS examinations after routine obstetric ultrasound are described. A routinely performed LUS examination revealed serious lung involvement in 7 cases: 2 were initially asymptomatic; 3 have chest computed tomography; 1 had initial negative real-time reverse transcription polymerase chain reaction results; and 1 had initial negative computed tomographic findings. Treatment for COVID-19 was either commenced or changed in 87.5% of the patients (n = 7 of 8) on LUS findings. Among patients with abnormal LUS findings, treatment was commenced in 5 patients (71.5%) and changed in 2 patients (28.5%). One normal and 7 abnormal LUS cases indicate the impact of routine LUS on the clinical outcome and treatment of pregnant women.


Assuntos
/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Complicações Infecciosas na Gravidez/terapia , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Gravidez , Índice de Gravidade de Doença , Adulto Jovem
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