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4.
Curr Opin Anaesthesiol ; 34(3): 254-259, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33927129

RESUMO

PURPOSE OF REVIEW: Maternal sepsis is the second leading cause of maternal death in the United States. A significant number of these deaths are preventable and the purpose of this review is to highlight causes such as delays in recognition and early treatment. RECENT FINDINGS: Maternal sepsis can be difficult to diagnose due to significant overlap of symptoms and signs of normal physiological changes of pregnancy, and current screening tools perform poorly to identify sepsis in pregnant women. Surveillance should not only include during pregnancy, but also throughout the postpartum period, up to 42 days postpartum. Education and awareness to highlight this importance are not only vital for obstetric healthcare provides, but also for nonobstetric healthcare providers, patients, and support persons. SUMMARY: Through education and continual review and analysis of evidence-based practice, a reduction in maternal morbidity and mortality secondary to maternal sepsis should be attainable with dedication from all disciplines that care for obstetric and postpartum patients. Education and vigilance also extend to patients and support persons who should be empowered to escalate care when needed.


Assuntos
Pré-Eclâmpsia , Complicações Infecciosas na Gravidez , Sepse , Feminino , Humanos , Mortalidade Materna , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Sepse/diagnóstico , Sepse/epidemiologia , Sepse/terapia
5.
Z Geburtshilfe Neonatol ; 225(2): 183-187, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33873231

RESUMO

INTRODUCTION: SARS-CoV-2 is a novel coronavirus that was first isolated in Wuhan, China, and resulted in a rapidly spreading pandemic worldwide. Currently there is only limited evidence on the effect of COVID-19 on pregnant women. CASE: Here we present one of the first serious COVID-19 cases in pregnancy at term with subsequent delivery. Postpartum the mother required antibiotic and symptomatic treatment. She experienced acute worsening of symptoms and developed acute respiratory failure requiring endotracheal intubation and subsequently extracorporeal membrane oxygenation. CONCLUSION: COVID-19 affects all medical disciplines, requiring interdisciplinary approaches and development of patient care regimes. Obstetricians should be aware and be prepared for the special needs of pregnant women with potential prenatal and postnatal issues. Ideally pregnant COVID-19 patients should be cared for at a tertiary perinatal center with experienced perinatologists and neonatologists.


Assuntos
Complicações Infecciosas na Gravidez , China , Feminino , Humanos , Período Periparto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , /terapia
6.
BMC Pregnancy Childbirth ; 21(1): 326, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902483

RESUMO

BACKGROUND: Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS: Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS: A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS: Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.


Assuntos
/epidemiologia , Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , /fisiopatologia , Cesárea/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Tosse/fisiopatologia , Diabetes Gestacional/epidemiologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Idade Gestacional , Humanos , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Fatores Imunológicos/uso terapêutico , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Unidades de Terapia Intensiva/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Masculino , Obesidade Materna/epidemiologia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Radiografia Torácica , Respiração Artificial , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia
7.
Am J Perinatol ; 38(7): 741-746, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33853145

RESUMO

OBJECTIVE: This study aimed to describe maternal characteristics and clinical outcomes of infants born to mothers with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests during pregnancy at an urban, safety-net hospital in Boston. STUDY DESIGN: We abstracted electronic chart data from 75 pregnant women with positive SARS-CoV-2 tests at any stage of gestation until 72 hours after birth who delivered consecutively between March 31 and August 6, 2020 at our center. We collected clinical data on maternal and infant characteristics, including testing, signs, and symptoms of coronavirus disease 2019 (COVID-19), delivery outcomes, newborn care practices (skin-to-skin care, location of care, and breastfeeding) and 30-day postdischarge infant emergency room visits and readmissions. We described categorical characteristics as percentages for this case series. RESULTS: Among 75 pregnant women, 47 (63%) were Hispanic, 10 (13%) had hypertension, 23 (30%) had prepregnancy obesity, and 57 (76%) had symptomatic SARS-CoV-2 infection. Regarding birth outcomes, 32 (41%) had cesarean delivery and 14 (19%) had preterm birth. Among 75 infants, 5 (7%) had positive SARS-CoV-2 polymerase chain reaction tests in the first week of life, all of whom were born to Hispanic mothers with symptomatic SARS-CoV-2 infection and had clinical courses consistent with gestational age. Six (8%) infants visited the emergency department within 30 days of discharge; one was admitted with a non-COVID-19 diagnosis. CONCLUSION: At our urban, safety-net hospital among pregnant women with positive SARS-CoV-2 tests, 41% had a cesarean delivery and 19% had a preterm birth. Seven percent of infants had one or more positive SARS-CoV-2 tests and all infants had clinical courses expected for gestational age. KEY POINTS: · Among 75 pregnant women with SARS-CoV-2 positive testing at our center, five infants (7%) had one or more SARS-CoV-2 positive tests in the first week of life.. · Infants with positive SARS-CoV-2 tests had clinical courses expected for gestational age..


Assuntos
COVID-19 , Doenças do Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , SARS-CoV-2/isolamento & purificação , Adulto , Boston/epidemiologia , COVID-19/epidemiologia , COVID-19/terapia , COVID-19/transmissão , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Cuidado do Lactente/métodos , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Provedores de Redes de Segurança/estatística & dados numéricos
8.
J Med Case Rep ; 15(1): 104, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648584

RESUMO

BACKGROUND: Pregnancy seems to increase the risk of thrombotic thrombocytopenic purpura (TTP) relapses and make the TTP more severe in any of the pregnancy trimesters, or even during the postpartum period. CASE PRESENTATION: This study highlights details of treating a COVID-19 pregnant patient who survived. This 21-year addicted White woman was admitted at her 29th week and delivered a stillbirth. She was transferred to another hospital after showing signs of TTP, which was caused by a viral infection. CONCLUSION: This viral infection caused fever and dyspnea, and the patient was tested positive for COVID-19 infection. A chest computed tomography scan showed diffuse multiple bilateral consolidations and interlobar septal thickening. She stayed at the Intensive Care Unit for 20 days and treated with plasmapheresis. As far as we know, this is the first report of a TTP pregnant patient with COVID-19 infection.


Assuntos
/diagnóstico , Plasmaferese , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Púrpura Trombocitopênica Trombótica/diagnóstico , Natimorto , Injúria Renal Aguda/terapia , Transtornos Relacionados ao Uso de Anfetaminas , Antivirais/uso terapêutico , Combinação de Medicamentos , Transfusão de Eritrócitos , Feminino , Hemoglobinas/metabolismo , Humanos , Hidroxicloroquina/uso terapêutico , Unidades de Terapia Intensiva , L-Lactato Desidrogenase/metabolismo , Lopinavir/uso terapêutico , Metanfetamina , Gravidez , Complicações Hematológicas na Gravidez/metabolismo , Complicações Hematológicas na Gravidez/terapia , Complicações Infecciosas na Gravidez/metabolismo , Complicações Infecciosas na Gravidez/terapia , Púrpura Trombocitopênica Trombótica/metabolismo , Púrpura Trombocitopênica Trombótica/terapia , Diálise Renal , Ritonavir/uso terapêutico , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
BMJ Case Rep ; 14(3)2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685910

RESUMO

A 35-year-old nurse, who was 27 weeks pregnant at the time, was admitted to hospital with a short history of cough, fever and worsening shortness of breath. Oral and nasopharyngeal swabs were positive for SARS-CoV-2 on real-time viral PCR. During her admission, her breathing further deteriorated and she developed type 1 respiratory failure. A decision was made to trial treatment with continuous positive airway pressure (CPAP) as a means of avoiding intubation. The patient tolerated this well and made rapid improvements on this therapy. She was quickly weaned off and fully recovered before being discharged home. This case highlights the potential for CPAP to be used as a means of avoiding mechanical ventilation and iatrogenic preterm birth in COVID-19 pneumonia in pregnancy. Furthermore, it highlights the need for robust evidence to support this treatment.


Assuntos
/terapia , Pressão Positiva Contínua nas Vias Aéreas , Complicações Infecciosas na Gravidez/terapia , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , Adulto , /diagnóstico por imagem , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Radiografia , Insuficiência Respiratória/diagnóstico por imagem , Resultado do Tratamento
11.
Pediatr Int ; 63(3): 260-263, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33656224

RESUMO

Coronavirus disease 2019 (COVID-19) has spread worldwide within a short period, and there is still no sign of an end to the pandemic. Management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pregnant women at the time of delivery presents a unique challenge. To fulfill the goal of providing adequate management of such women and their infants, and to decrease the risk of exposure of the healthcare providers, tentative guidelines are needed until more evidence is collected. Practical preventative action is required that takes into account the following infection routes: (i) aerosol transmission from mothers to healthcare providers, (ii) horizontal transmission to healthcare providers from infants infected by their mothers, and (iii) horizontal transmission from mothers to infants. To develop standard operating procedures, briefings/training simulations should be carried out, taking into account the latest information. Briefings should be carefully conducted to clarify the role and procedures. Healthcare providers should wear personal protective equipment. If it is physically possible, neonatal resuscitation should be performed in a separate area next to the delivery room. If a separate area is not available, the infant warmer should be placed at least 2 m away from the delivery table, or partitioned off in the same room. A minimum number of skilled personnel should participate in resuscitation using the latest neonatal resuscitation algorithms.


Assuntos
/transmissão , Salas de Parto , Controle de Infecções/métodos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , /terapia , Feminino , Pessoal de Saúde , Humanos , Recém-Nascido , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Mães , Equipamento de Proteção Individual , Gravidez , Complicações Infecciosas na Gravidez/terapia , Ressuscitação/métodos , Treinamento por Simulação
12.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33727296

RESUMO

A 31-year-old pregnant woman presented with symptomatic COVID-19, which was complicated by progressive hypoxaemia requiring intensive care and emergent delivery by caesarean section. Afterward, she was successfully supported with mechanical ventilation and prone positioning and ultimately recovered. We review literature regarding complications of COVID-19 affecting pregnancy and evidence-based treatment strategies.


Assuntos
/terapia , Cesárea , Posicionamento do Paciente/métodos , Complicações Infecciosas na Gravidez/terapia , Respiração Artificial/métodos , Adulto , Feminino , Humanos , Gravidez , Decúbito Ventral
13.
Am J Perinatol ; 38(6): 622-631, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33723834

RESUMO

OBJECTIVE: There is a paucity of evidence to guide the clinical care of late preterm and term neonates born to women with perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The objective of this case series is to describe early neonatal outcomes and inpatient management in U.S. hospitals. STUDY DESIGN: We solicited cases of mother-infant dyads affected by novel coronavirus disease 2019 (COVID-19) from the Better Outcomes through Research for Newborns (BORN) Network members. Using a structured case template, participating sites contributed deidentified, retrospective birth hospitalization data for neonates ≥35 weeks of gestation at birth with mothers who tested positive for SARS-CoV-2 before delivery. We describe demographic and clinical characteristics, clinical management, and neonatal outcomes. RESULTS: Sixteen U.S. hospitals contributed 70 cases. Birth hospitalizations were uncomplicated for 66 (94%) neonates in which 4 (6%) required admission to a neonatal intensive care unit. None required evaluation or treatment for infection, and all who were tested for SARS-CoV-2 were negative (n = 57). Half of the dyads were colocated (n = 34) and 40% directly breastfed (n = 28). Outpatient follow-up data were available for 13 neonates, all of whom remained asymptomatic. CONCLUSION: In this multisite case series of 70 neonates born to women with SARS-CoV-2 infection, clinical outcomes were overall good, and there were no documented neonatal SARS-CoV-2 infections. Clinical management was largely inconsistent with contemporaneous U.S. COVID-19 guidelines for nursery care, suggesting concerns about the acceptability and feasibility of those recommendations. Longitudinal studies are urgently needed to assess the benefits and harms of current practices to inform evidence-based clinical care and aid shared decision-making. KEY POINTS: · Birth hospitalizations were uncomplicated for late preterm and term infants with maternal COVID-19.. · Nursery management of dyads affected by COVID-19 varied between hospitals.. · Adherence to contemporaneous U.S. clinical guidelines for nursery care was low.. · Breastfeeding rates were lower for dyads roomed separately than those who were colocated..


Assuntos
Aleitamento Materno , COVID-19 , Hospitalização/estatística & dados numéricos , Complicações Infecciosas na Gravidez , Nascimento Prematuro/epidemiologia , Nascimento a Termo , Adulto , Aleitamento Materno/métodos , Aleitamento Materno/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/terapia , Feminino , Idade Gestacional , Fidelidade a Diretrizes , Necessidades e Demandas de Serviços de Saúde , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , Estados Unidos/epidemiologia
14.
Lupus ; 30(7): 1188-1191, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33715506

RESUMO

Background: The ongoing corona virus disease 2019 (COVID-19) pandemic is having a worldwide impact. Valuable information on the clinical characteristics of COVID-19 in pregnant patients with an autoimmune disease, such as systemic lupus erythematosus (SLE), is currently lacking. Methods: Herein, we describe the clinical presentation of 2 pregnant patients with SLE and mild symptomatic COVID-19 infection. Results: In both pregnant SLE patients, a watchful-waiting approach without initiation of treatment for COVID-19 was taken. No adverse outcomes were reported and both pregnancies resulted in healthy neonates born at term. In one patient we observed a flare in SLE disease activity, most likely attributed to discontinuing SLE treatment. Conclusion: Our report highlights the importance of multidisciplinary collaboration between health care professionals as well as individualized treatment decisions during unprecedented periods such as the current COVID-19 pandemic. Discontinuation of immunosuppressive drugs during the acute phase of a COVID-19 infection should be considered on a case-by-case basis. Maternal treatment decisions should be in line with current recommendations for treatment of rheumatic and musculoskeletal diseases during COVID-19 infection and in line with treatment of COVID- 19 during pregnancy.


Assuntos
/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Adulto , Feminino , Humanos , Lúpus Eritematoso Sistêmico/terapia , Gravidez , Complicações Infecciosas na Gravidez/virologia
15.
Obstet Gynecol Clin North Am ; 48(1): 53-74, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33573790

RESUMO

Viral infections are common complications of pregnancy. Although some infections have maternal sequelae, many viral infections can be perinatally transmitted to cause congenital or chronic infection in fetuses or infants. Treatments of such infections are geared toward reducing maternal symptoms and complications and toward preventing maternal-to-child transmission of viruses. The authors review updates in the treatment of herpes simplex virus, cytomegalovirus, hepatitis B and C viruses, human immunodeficiency virus, and COVID-19 during pregnancy.


Assuntos
Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/terapia , Viroses/terapia , Viroses/transmissão , Adulto , Antivirais/uso terapêutico , /transmissão , Infecções por Citomegalovirus/terapia , Infecções por Citomegalovirus/transmissão , Feminino , Infecções por HIV/terapia , Infecções por HIV/transmissão , Hepatite B/terapia , Hepatite B/transmissão , Hepatite C/terapia , Hepatite C/transmissão , Herpes Simples/terapia , Herpes Simples/transmissão , Humanos , Lactente , Gravidez , Complicações Infecciosas na Gravidez/virologia
16.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541967

RESUMO

A 29-year-old pregnant woman presented at 26 weeks of gestation with fever and cough for 4 days. On admission, her nasopharyngeal swab confirmed COVID-19. As her respiratory distress worsened, she was shifted to the intensive care unit (ICU). Since the patient was unable to maintain saturation even on high settings of mechanical ventilation, she underwent venovenous extracorporeal membrane oxygenation (VV-ECMO) and was monitored in surgical ICU by a multidisciplinary team. The obstetrical team was on standby to perform urgent delivery if needed. Her condition improved, and she was weaned off after 5 days on extracorporeal membrane oxygenation. She was observed in the antenatal ward for another week and discharged home with the mother and fetus in good condition. VV-ECMO can be considered as rescue therapy for pregnant women with refractory hypoxaemia of severe respiratory failure due to COVID-19. It can save two lives, the mother and fetus.


Assuntos
/terapia , Oxigenação por Membrana Extracorpórea/métodos , Complicações Infecciosas na Gravidez/terapia , /terapia , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Gravidez , Complicações Infecciosas na Gravidez/virologia , Segundo Trimestre da Gravidez , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Resultado do Tratamento
17.
Curr Opin Pediatr ; 33(2): 188-194, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534424

RESUMO

PURPOSE OF REVIEW: The aim of this review was to describe the process of and challenges in developing national guidance for management of infants born to mothers with COVID-19. RECENT FINDINGS: Beginning in January 2020, infection with the novel coronavirus SARS-CoV-2 spread across the USA, causing the illness COVID-19. As pregnant women began to present for delivery while sick with COVID-19, the American Academy of Pediatrics (AAP) convened a writing group in March 2020 to develop guidance for the management of their newborns. The initial guidance was developed emergently and was forced to rely on extremely limited data from China. The initial guidance advocated for a conservative approach that included temporary physical separation of infected mother and newborn. To address the knowledge deficit, the AAP sponsored a volunteer registry to collect data on perinatal infection and management. As data have emerged informing the natural history of COVID-19, the performance of PCR-based diagnostics, the value of infection control measures and the risk of infant disease, AAP has issued serial updates to newborn guidance. SUMMARY: Evolving knowledge on the epidemiology of perinatal COVID-19 has informed newborn guidance. The most recent guidance focuses on the use of infection control measures to support maternal-newborn contact and breastfeeding.


Assuntos
Complicações Infecciosas na Gravidez , Aleitamento Materno , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Gestantes
18.
Am J Perinatol ; 38(5): 515-522, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33548937

RESUMO

OBJECTIVE: This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. STUDY DESIGN: This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. RESULTS: Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. CONCLUSION: Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. KEY POINTS: · The majority of pregnant patients with COVID-19 are asymptomatic and <1 in 20 require oxygen support.. · Women in the later stages of pregnancy may be at increased risk for severe infection.. · Anemia, leukopenia, CRP, ferritin, and procalcitonin are associated with increasing severity..


Assuntos
Doenças Assintomáticas , Gravidade do Paciente , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Adolescente , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Humanos , Oxigenoterapia , Gravidez , Complicações Infecciosas na Gravidez/terapia , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
Placenta ; 106: 25-29, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33610934

RESUMO

INTRODUCTION: The possibility of vertical transmission of SARS-CoV-2 from the mother to the fetus is one of the most crucial issues regarding the COVID-19 effects on pregnancy. In this study, we aimed to explore the risk of maternal-fetal transmission before 24 weeks of gestation, through analysis of abortion materials collected from PCR-positive women with pregnancy loss. To the best of our knowledge, apart from case reports, this study is the first prospective work on the vertical transmission of SARS-CoV-2 in early pregnancy. METHODS: The patients who had attended our clinic with the diagnosis of pregnancy loss before 24 weeks of gestation were screened for COVID-19. Vertical transmission in PCR-positive women was assessed through the presence of SARS-CoV-2 RNA in fetal-placental tissues by rt-PCR test. RESULTS: 24 of 210 (%11,4) pregnant women participating in the study had positive rt-PCR results. Placenta and curettage material samples of these PCR-positive patients were analyzed and all valid test results (21 samples) were negative for SARS CoV-2 RNA. In three cases, the rt-PCR results were invalid due to failed internal controls. DISCUSSION: In the literature, the possibility of intrauterine vertical transmission of SARS-CoV-2 is still controversial. The findings of the present study did not reveal any evidence of vertical transmission of SARS-CoV-2 in early pregnancy.


Assuntos
/diagnóstico , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/diagnóstico , /fisiologia , Aborto Espontâneo/diagnóstico , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Aborto Espontâneo/virologia , Adulto , /terapia , Feminino , Feto/patologia , Feto/virologia , Idade Gestacional , Humanos , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Troca Materno-Fetal/fisiologia , Placenta/patologia , Placenta/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , RNA Viral/isolamento & purificação , Fatores de Risco , Turquia/epidemiologia , Adulto Jovem
20.
J Obstet Gynaecol Res ; 47(4): 1579-1582, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33590575

RESUMO

BACKGROUND: The infection by SARS-COV-2 leading to coronavirus disease has become a worldwide pandemic. It is not clear whether the coronavirus disease (COVID-19) and its severity differ in pregnant compared to the nonpregnant outcome. CONCERNS: Out of four, three pregnant women were discharged with mild symptoms but one pregnant woman admitted at 24 weeks gestation with 3 days of vomiting, breathlessness, and cough had fatal outcome. DIAGNOSES: After the medical staff prepared for isolation and protection, the patients quickly underwent with series of diagnostic tests, such as laboratory, imaging, and SARS-COV-2 nucleic-acid examinations. OUTCOMES: Among all four SARS CoV-2 infected pregnant women, three discharged after recovery and delivered healthy babies but one had severe COVID-19 disease. The women began to exhibit fever, reduced blood oxygen saturation, and despite the interventions, she could not be saved and succumbed to death. There is an early requirement of effective management strategies for pregnant women with COVID-19.


Assuntos
/fisiopatologia , Complicações Infecciosas na Gravidez/fisiopatologia , Adulto , /diagnóstico , Evolução Fatal , Feminino , Humanos , Índia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos
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