Fetal Effects Research Articles

Cytomegalovirus seroconversion in pregnant army personnel of the Israel Defense Forces: Trends and risk factors.

Cytomegalovirus (CMV) seroconversion in pregnancy is a major health issue with potentially devastating fetal consequences. We opted to determine rates and trends of CMV seroconversion in pregnant army personnel and to isolate risk factors. In this retrospective cohort study, all pregnancies of army personnel between 2009 and 2019 were evaluated (n=10409) and all pregnancies with CMV laboratory records were included. Seroconversion rate was calculated overall and per year. Demographic and obstetrical characteristics were compared between exposed and unexposed women. Independent predictors of seroconversion were further investigated using logistic regression models. Cytomegalovirus serology status was available in 7665 pregnancies. Seroconversion was evident in 66 women (4.15%) among the seronegative pregnancies. Women in the seroconversion group were significantly more likely to belong to a higher social class. In the regression models, adjusted for age, place of residence, and education, higher parity (adjusted odds ratio [aOR] 2, P<0.001) and residing in a central district (aOR 2.67, P=0.002) were significantly associated with seroconversion. Higher social class appears to be a significant risk factor for CMV seroconversion during pregnancy. Residing in a central district and higher parity appear to be independently associated with an increased risk for seroconversion during pregnancy among army personnel.

Practice of Preconception Care and Associated Factors among Pregnant Women in Manna District, Southwest Ethiopia: A Community-Based Cross-Sectional Study

Background: Preconception care is an intervention provided to women and couples of childbearing ages, regardless of pregnancy status or desire, before pregnancy to improve health outcomes for women, new-borns, and children. Preconception care bridges the gap in the continuum of care and addresses pre-pregnancy health risks and health problems that could have negative maternal and fetal consequences. Therefore, this study aimed to assess the practice of preconception care and associated factors among pregnant women in Manna district, Jimma zone, Oromia Region, Ethiopia. Methods: A community based cross-sectional design and triangulated with qualitative data was conducted among 636 pregnant women from March 02 to April 10, 2019. The 26 Gandas of the district were first stratified into urban and rural. Then, the urban Ganda was taken purposively and among the 25 rural Gandas, 8 Gandas were selected by using a simple random sampling technique. Judgmental sampling technique was used to select the qualitative participants. The data were collected using pre-tested and structured questionnaires through face-to-face interviews. The data were entered into Epi data Manager Version 4.0.2 and then exported to SPSS version 21. Descriptive analysis, Binary and multivariable logistic regression analyses were carried out. Qualitative data were analyzed by using Atlas ti version 7.0.71. Result: Among 623 respondents, 39(6.3%) of pregnant women had good practice of preconception care. Women who had formal education AOR 3.27[95% C.I 1.11-9.60], reside in urban AOR 3.33[95% C.I 1.26-8.81], those who were on follow up for pre-existing medical illnesses AOR 4.52[95% C.I 1.61-12.70] and those who had good knowledge of preconception care 4.18[1.64-10.65] were more likely to had good practice of preconception care compared to their counterparts. Conclusion: In this study, women’s practice of preconception care was low compared to other studies. Attending formal education, residing in urban, being on follow up for pre-existing medical illnesses, and having good knowledge of preconception care were independent predictors of women’s practice of preconception care. Therefore, all the concerned bodies are recommended to work towards the improvements of women’s practice of preconception care especially through raising the awareness of the community.

Maternal, foetal and child consequences of immunosuppressive drugs during pregnancy in women with organ transplant: a review.

Although pregnancy remains exceptional in women after heart, liver or lung transplant, obstetricians and nephrologists are regularly confronted with pregnancy in renal transplant recipients. National and international registries have described the epidemiology of maternal, foetal and neonatal complications, and transplantation societies have published recommendations on the monitoring of these high-risk pregnancies. In this review, we summarize the existing data on maternal and foetal complications of pregnancies in women after renal transplant, especially the management of immunosuppression. We also describe the few available data on the middle- and long-term outcomes of their children who were exposed in utero to immunosuppressive drugs.

Pernicious pregnancy: Type B aortic dissection in pregnant women.

Type B aortic dissection (TBAD) occurs seldomly, particularly in pregnancy, but has disastrous consequences for both mother and fetus. The focus of immediate surgical repair of type A aortic dissection due to higher mortality of patients is less clear in its counterpart, TBAD, in which management is controversial and debated. This article collates knowledge so far on this rare event during pregnancy. A comprehensive literature search was performed in PubMed, Scopus, Google Scholar, Embase, and Medline. Key search terms included "type B aortic dissection," "pregnancy," and corresponding synonyms. Non-English papers were excluded. Risk factors for TBAD includeaortic wall stress due to hypertension, previous cardiac surgery, structural abnormalities (bicuspid aortic valve, aortic coarctation), and connective tissue disorders. In pregnancy, pre-eclampsia is a cause of increased aortic wall stress. Management of this condition is often conservative, but this is dependent on a number of factors, including gestation, cardiovascular stability of the patient, and symptomology. In most cases, a cesarean section before intervention is carried outunless certain indications are present. Due to a scarce number of cases across the decades, it is difficult to determine which management is optimal. The gold-standard management of TBAD has traditionally been the medical treatment for uncomplicated cases and open surgery for those needing urgent intervention, but with the advent of techniques,such as thoracic endovascular aortic repair, the management of these group of patients continues to develop.

Intravenous dexmedetomidine enhances the experience of visceral pain in parturients during cesarean delivery under spinal anesthesia

Background and hypothesis Visceral pain is a common incidence in cesarean delivery under spinal anesthesia. Dexmedetomidine (DEX) has analgesic, sedative, anxiolytic effect, as it is an α 2-receptor agonist. Intraoperative visceral pain resulting from manipulation of the uterus and traction of the peritoneum is still a challenge for anesthetists. The present study hypothesized that single intravenous bolus dose of DEX added as a supplement to intrathecal anesthesia for an elective cesarean section could reduce intraoperative visceral pain, lessen blood pressure swings, and produce an acceptable sedative effect, with minimal fetal and maternal consequences. Patients and methods A randomized double-blinded placebo-controlled study was conducted. A total of 70 patients were randomly allocated to receive either intravenous DEX or placebo (saline) before spinal anesthesia. The primary outcomes were decreased intraoperative visceral pain. Secondary outcomes included the stability of hemodynamic parameters (blood pressure and heart rate), sedation score, time to rescue analgesia reduction, neonatal APGAR score, and any adverse effects (nausea and vomiting). Results There was a significant difference between the groups in the incidence of moderate to severe visceral pain (P&lt;0.001), intraoperative fentanyl requirements (P=0.004), and longer time to rescue analgesia (P&lt;0.001). Both groups had comparable mean blood pressure (P&gt;0.005); however, there was a highly significant difference in heart rate (P=0.01). Moreover, a significantly higher sedation score was seen in the DEX group (2.08±0.8) in comparison with the control group (1±0). APGAR score was comparable in the studied groups. Conclusion As a single intravenous bolus, DEX seems to be an excellent supplement to intrathecal anesthesia for an elective cesarean section. It can reduce intraoperative visceral pain and lessen blood pressure swings and produce an acceptable sedative effect with minimal fetal and maternal influence.

A systematic review of the burden of anemia in pregnant women - Indian perspective

Background: It has been observed that anemia during pregnancy represents one of the primary obstetric causes of maternal deaths in developing countries like India. It results in appalling fetal and maternal health consequences. A significant number of studies have been conducted on the prevalence of anemia during pregnancy in India, but the finding that was reported has been variable. Therefore, this review was planned to compile the findings conducted in different parts of the country and sum up the national level of anemia amongst pregnant women in India in the past 5 years. Aim and Objectives: To do a systematic review of the prevalence of anemia during pregnancy in India from published studies from 2017 to 2021 and to find common causes of increased prevalence of anemia in different regions of India. Materials and Methods: This systematic review was done under the guidelines established by PRISMA – “Preferred Reporting Items for Systematic Reviews and Meta-Analyses.” The databases used were PUBMED, Cochrane Library, and Google Scholar. The following terms were used for search – anemia, pregnancy related anemia, anemia in India, State name, and anemia. Critical appraisal of every study was done using the instrument – Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. The pooled regression was computed to present the pooled prevalence with 95% confidence interval (CI). Results: Thirty-one studies were chosen to be studies in the review with a total of 93,324 pregnant women. The pooled prevalence of anemia in the entire country was calculated among pregnant women in India was 51% (95% CI: [46.1–53.2]). Based on this result of the pooled prevalence, an analysis with subgroups was done which showed, the lowest prevalence of anemia among pregnant women was observed in Andhra Pradesh, 11.6% (95% CI [8.92, 19.96]) and the highest prevalence was in Uttar Pradesh, 92% (95% CI [89.76, 97.84]). Conclusion: A little more than 50% of pregnant women in India are anemic. Association was observed between anemia during pregnancy and rural dwelling, age of the pregnant women, education level of the women and their socio-economic status. States and areas with higher prevalence of anemia among pregnant women should be focused more and given importance. The concerned government organizations and NGOs should intervene on the detected factors to reduce the high prevalence of anemia among pregnant women. Women should also be educated on the causes and effects of anemia.

Timing of Delivery in Women with Cardiac Disease.

Guidelines do not exist to determine timing of delivery for women with cardiovascular disease (CVD) in pregnancy. The neonatal benefit of a term delivery as compared with an early term delivery is well described. We sought to examine maternal outcomes in women with CVD who delivered in the early term period (370/7 through 386/7 weeks) compared with those who delivered later. This is a prospective cohort study examining cardiac and obstetric outcomes in women with CVD delivering between September 2011 and December 2016. The associations between gestational age at delivery and maternal, fetal, and obstetric characteristics were evaluated. Two-hundred twenty-five women with CVD were included, 83 (37%) delivered in the early term period and 142 (63%) delivered at term. While the early term group had significantly higher rates of any hypertension during pregnancy (18.1 vs. 7%, p = 0.01) and intrauterine growth restriction (22.9 vs. 2.8%, p < 0.001), there was no difference in high-risk cardiac or obstetric characteristics. No difference in composite cardiac morbidity was found (4.8 vs. 3.5%, p = 0.24). Women in the early term group were more likely to undergo cesarean delivery than women in the term group (43.4 vs. 24.7%, p = 0.004). There is no maternal benefit of an early term delivery in otherwise healthy women with CVD. Given the known fetal consequences of early term delivery, this study offers support to existing literature suggesting term delivery in these women. · Question of delivery timing in women with cardiac disease.. · No difference in cardiac morbidity, term versus early term.. · Term delivery in women with asymptomatic cardiac disease..

Consultation préconceptionnelle dans les maladies auto-immunes systémiques

Many systemic autoimmune diseases and chronic inflammatory rheumatic conditions affect women of childbearing age. Pregnancy is most often possible, with generally acceptable fetal-maternal risks. So, pregnancy wish must be regularly sought and the optimal timing of pregnancy is essential. Women should be reassured that a good pregnancy outcome is generally possible if conception occurs in a stable remission state. The planification is ideally carried out during a preconception counseling appointment in order to look for possible contraindications (infrequent) and risk factors for obstetrical complications (previous obstetrical complication, antiphospholipid biology or syndrome, activity of the disease at conception, and definite organ failure) in order to optimize the management. The most frequent obstetrical complications are fetal losses and/or consequences of placental insufficiency. Anti-SSA and/or anti-SSB antibodies exposes to a low risk of fetal atrioventricular block. Adequate drugs adjustment should be done before conception to avoid an early relapse and to replace teratogenic drugs. Finally, organization of the follow up of this future pregnancy need to be defined in a multidisciplinary approach and explained to the patient at this time.

Meta-analysis of Irisin Levels in Gestational Diabetes Mellitus

Background: Irisin is known as a miracle myo-adipokine that is secreted by skeletal muscle and fat tissue that increases insulin sensitivity. Current literature supports its role as a pathogenic agent in development of gestational diabetes; however, others have reported little or no difference between the two groups. Therefore, this meta-analysis aims to compare Irisin levels in gestational diabetes mellitus (GDM) pregnancies and non-GDM control pregnancies. A detailed literature search was carried via electronic databases, such as Medline, PubMed, and EMBase, for current related papers dating from January 1, 2017 over the last ten years. Only papers published in English were selected. Meta-analysis was preformed according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Effect size and relative weights for each study were estimated and results of individual and combined effect size were plotted in the forest plots. p values <0.05 were regarded to be significant. In most studies, irisin levels in GDM were significantly lower, as compared to the control group. This level favored development of GDM in these subjects. This was confirmed by the forest plot report and contour-enhanced funnel plot of trials compared the GDM and Control group for effect estimates and standard error [I-V pooled SMD -0.482 (95%CI -0.610 to -0.353); Heterogeneity Chi2 = 54.53 (d.f. = 7) p = 0.000; I2 (variation in SMD attributable to heterogeneity) = 87.2%; Test of SMD = 0: z =7.32 p =0.000]. Lower circulating Irisin can contribute to hyperglycemic disorders such as GDM, through a collective loss of its normal anti-diabetic mechanisms. This revelation paves the way for research into the use of recombinant Irisin as treatment or prevention of GDM, so that the prevalence of GDM and its maternal and fetal consequences may be reduced.

Grandmultiparity, Maternal Age, and the Risk for Uterine Rupture—A Multicenter Cohort Study

(Acta Obstet Gynecol Scand. 2020;99:267–273) The rare complication of uterine rupture can potentially result in catastrophic consequences for both mother and fetus. The most common risk factor for uterine rupture is previous cesarean delivery (CD), but few published studies exist addressing uterine rupture in women without a history of previous CD. Conflicting conclusions have been reported regarding any association between grandmultiparity and uterine rupture. In this population, obstetricians have been cautious due to a fear of increased risk for uterine rupture. This approach might trigger the performance of unnecessary CDs. Therefore, this study was undertaken to determine if grandmultiparity is an independent risk factor for intrapartum uterine rupture in women without a history of previous uterine surgery.

Food intake in pregnant women with gestational diabetes mellitus

Rationale: The aim of this study was to verify the fulfillment of the nutritional requirements of macronutrients in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM) at Lusíadas Lisboa Hospital. Inadequate glycemic control in GDM increases the risk of maternal, fetal and neonatal consequences. In this sense, nutritional therapy is essential during the follow-up of these pregnant women.

Spectrochemical differentiation in gestational diabetes mellitus based on attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy and multivariate analysis

Gestational diabetes mellitus (GDM) is a hyperglycaemic imbalance first recognized during pregnancy, and affects up to 22% of pregnancies worldwide, bringing negative maternal–fetal consequences in the short- and long-term. In order to better characterize GDM in pregnant women, 100 blood plasma samples (50 GDM and 50 healthy pregnant control group) were submitted Attenuated Total Reflection Fourier-transform infrared (ATR-FTIR) spectroscopy, using chemometric approaches, including feature selection algorithms associated with discriminant analysis, such as Linear Discriminant Analysis (LDA), Quadratic Discriminant Analysis (QDA) and Support Vector Machines (SVM), analyzed in the biofingerprint region between 1800 and 900 cm−1 followed by Savitzky–Golay smoothing, baseline correction and normalization to Amide-I band (~ 1650 cm−1). An initial exploratory analysis of the data by Principal Component Analysis (PCA) showed a separation tendency between the two groups, which were then classified by supervised algorithms. Overall, the results obtained by Genetic Algorithm Linear Discriminant Analysis (GA-LDA) were the most satisfactory, with an accuracy, sensitivity and specificity of 100%. The spectral features responsible for group differentiation were attributed mainly to the lipid/protein regions (1462–1747 cm−1). These findings demonstrate, for the first time, the potential of ATR-FTIR spectroscopy combined with multivariate analysis as a screening tool for fast and low-cost GDM detection.

Comparison of maternal and foetal outcomes between adolescent and adult pregnancies; a descriptive cross sectional study

Introduction: Adolescent pregnancy is a global issue and the trend is increasing specially in South East Asia. Pregnancies at a younger age have major maternal and fetal health consequences. The aim of this study was to compare selected maternal and fetal outcomes of adolescent pregnancies with its adult counterpart in atertiary care center. Methods: A hospital based descriptive study was conducted at Teaching Hospital Mahamodara (THM), Galle. One hundred adolescent mothers (10-19 years) were compared with 100 adult mothers (20 -35 years) who had singleton uncomplicated pregnancy. Pre-tested interviewer administered questionnaire was used as the tool to collect data on basic demography, perinatal, maternal outcomes and mode of delivery. Chi-squared test and t-test were used to compare data and presented as proportions, mean (SD), with 95% CI. Results: Mean (SD) age at delivery of adolescent and adult mothers were 18 (0.2) and 27 (0.8) years respectively. Of the adolescent mothers 16% were unmarried. More adolescent mothers had anaemia compared to adults (38% vs. 32%), but the difference was not statistically significant (p=0.37). Adolescent mothers had higher pre term delivery rate compared to adult mothers (23% vs.15%) but the difference was not statistically significant (p=0.18). There were no significant differences in birth weight (2.77 vs. 2.82; p=0.5) rate of admissions to premature baby unit (6% vs. 7%; p=0.8) and mean APGAR scores (9.9 vs 9.8; p=0.3) between the two groups. A significantly greater proportion of vaginal deliveries were carried out in adolescents compared to adults (75% vs. 55%; p= 0.003). Conclusions: Adolescent mothers underwent a significantly larger proportion of vaginal deliveries compared to adults. Though not significant, anaemia and preterm deliveries were higher than in their adult counter-parts. There was no significant difference between the two groups for the selected perinatal outcomes.

VP45.23: Fetal sonographic follow‐up after maternal COVID‐19 infection: is there a matter of concern?

Although there is no evidence of vertical transmission of COVID-19, fetal consequences of maternal COVID-19 remain unknown. The objective of the present study is to assess the impact of COVID-19 during pregnancy in terms of adverse perinatal outcomes, intrauterine growth restriction, fetal cardiac or neurosonographic abnormalities, and identify the association with maternal severity of COVID-19 disease or with gestational age at infection. Multicentric prospective cohort study including singleton pregnant women with diagnosis of SARS-CoV2 infection in 5 hospitals in Spain, starting from April 2020. Inclusion will continue until the end of the pandemic, with a minimum estimated sample size of 100 women. Maternal infection will be confirmed by nasopharyngeal PCR in the acute phase, or by further serologic test, and COVID-19 clinical presentation parameters will be collected. Once the patient has overcome the disease, ultrasound follow-up will be performed, including fetal growth assessment every 4 weeks, fetal neurosonography and echocardiographic evaluation in the third trimester, at least 4 weeks after maternal infection. All patients will be followed-up until delivery and perinatal outcome will be assessed. Analysis of associated factors related with echographic findings will be performed. We hypothesised that patients with severe COVID-19 disease have a higher risk of adverse perinatal outcome, fetal growth restriction, neurodevelopmental impairment and/or fetal cardiac function remodelling. To date a total of 52 patients have been included and results will be available by the end of September. This study will provide relevant information of fetal consequences of COVID-19 during pregnancy depending on maternal severity or trimester of infection.

Innate Immune Responses to Acute Viral Infection During Pregnancy.

Immunological adaptations in pregnancy allow maternal tolerance of the semi-allogeneic fetus but also increase maternal susceptibility to infection. At implantation, the endometrial stroma, glands, arteries and immune cells undergo anatomical and functional transformation to create the decidua, the specialized secretory endometrium of pregnancy. The maternal decidua and the invading fetal trophoblast constitute a dynamic junction that facilitates a complex immunological dialogue between the two. The decidual and peripheral immune systems together assume a pivotal role in regulating the critical balance between tolerance and defense against infection. Throughout pregnancy, this equilibrium is repeatedly subjected to microbial challenge. Acute viral infection in pregnancy is associated with a wide spectrum of adverse consequences for both mother and fetus. Vertical transmission from mother to fetus can cause developmental anomalies, growth restriction, preterm birth and stillbirth, while the mother is predisposed to heightened morbidity and maternal death. A rapid, effective response to invasive pathogens is therefore essential in order to avoid overwhelming maternal infection and consequent fetal compromise. This sentinel response is mediated by the innate immune system: a heritable, highly evolutionarily conserved system comprising physical barriers, antimicrobial peptides (AMP) and a variety of immune cells—principally neutrophils, macrophages, dendritic cells, and natural killer cells—which express pattern-receptors that detect invariant molecular signatures unique to pathogenic micro-organisms. Recognition of these signatures during acute infection triggers signaling cascades that enhance antimicrobial properties such as phagocytosis, secretion of pro-inflammatory cytokines and activation of the complement system. As well as coordinating the initial immune response, macrophages and dendritic cells present microbial antigens to lymphocytes, initiating and influencing the development of specific, long-lasting adaptive immunity. Despite extensive progress in unraveling the immunological adaptations of pregnancy, pregnant women remain particularly susceptible to certain acute viral infections and continue to experience mortality rates equivalent to those observed in pandemics several decades ago. Here, we focus specifically on the pregnancy-induced vulnerabilities in innate immunity that contribute to the disproportionately high maternal mortality observed in the following acute viral infections: Lassa fever, Ebola virus disease (EVD), dengue fever, hepatitis E, influenza, and novel coronavirus infections.

The incidence, maternal, fetal and neonatal consequences of single intrauterine fetal death in monochorionic twins: A prospective observational UKOSS study.

Report maternal, fetal and neonatal complications associated with single intrauterine fetal death (sIUFD) in monochorionic twin pregnancies. Prospective observational study. UK. 81 monochorionic twin pregnancies with sIUFD after 14 weeks gestation, irrespective of cause. UKOSS reporters submitted data collection forms using data from hospital records. Aetiology of sIUFD; surviving co-twin outcomes: perinatal mortality, central nervous system (CNS) imaging, gestation and mode of delivery, neonatal outcomes; post-mortem findings; maternal outcomes. The commonest aetiology was twin-twin transfusion syndrome (38/81, 47%), "spontaneous" sIUFD (22/81, 27%) was second commonest. Death of the co-twin was common (10/70, 14%). Preterm birth (<37 weeks gestation) was the commonest adverse outcome (77%): half were spontaneous and half iatrogenic. Only 46/75 (61%) cases had antenatal CNS imaging, of which 33 cases had known results of which 7/33 (21%) had radiological findings suggestive of neurological damage. Postnatal CNS imaging revealed an additional 7 babies with CNS abnormalities, all born at <36 weeks, including all 4 babies exhibiting abnormal CNS signs. Major maternal morbidity was relatively common, with 6% requiring ITU admission, all related to infection. Monochorionic twin pregnancies with single IUD are complex and require specialist care. Further research is required regarding optimal gestation at delivery of the surviving co-twin, preterm birth prevention, and classifying the cause of death in twin pregnancies. Awareness of the importance of CNS imaging, and follow-up, needs improvement.

Snake bite of a surrogate woman: A social dilemma

India has one of the highest number of snakebites in the world with annual mortality rate of 2.4 per 100, 000 due to severe envenomation. However, the incidence of snake bite in pregnancy is rare. Diagnosis and management of snake bite in pregnancy poses challenges to an obstetrician due to its rarity. This case report presents such a scenario of a snake bite in a surrogate mother with twin pregnancy at 32 weeks with premature rupture of membranes complicated by coagulopathy. The surrogacy added to the complexity of the case. This case report addresses the early detection and multidisciplinary management of the above case preventing grave consequences for fetus and mother.

Attitudes and collateral psychological effects of COVID-19 in pregnant women in Colombia.

ObjectiveTo assess clinical impact, psychological effects, and knowledge of pregnant women during the COVID‐19 outbreak in seven cities in Colombia. Currently, there are uncertainty and concerns about the maternal and fetal consequences of SARS‐CoV‐2 infection during pregnancy.MethodsA cross‐sectional web survey was carried out including pregnant women in seven cities in Colombia. Women were evaluated during the mitigation phase of the SARS‐CoV‐2 pandemic between April 13 and May 18, 2020. The questions evaluated demographic, knowledge, psychological symptoms, and attitudes data regarding the COVID‐19 pandemic.ResultsA total of 1021 patients were invited to participate, obtaining 946 valid surveys for analysis. The rate of psychological consequences of the pandemic was much larger than the number of patients clinically affected by the virus, with 50.4% of the entire cohort reporting symptoms of anxiety, 49.1% insomnia, and 25% reporting depressive symptoms. Poorly informed women were more likely to be younger, affiliated to the subsidized regime, and with lower levels of education.ConclusionThe knowledge of pregnant women about SARS‐CoV‐2 infection is far from reality and this seems to be associated with an indirect effect on the concern and psychological stress of pregnant women in Colombia.

Maternal and neonatal outcomes in COVID-19 infected pregnancies: a prospective cohort study

BackgroundDespite the large number of pregnant women with the coronavirus disease 2019 (COVID-19), there is not enough analytical study to compare maternal and fetal consequences of COVID-19 infected with non-infected pregnancies. This cohort study aimed to compare maternal and fetal consequences of COVID-19 infected with non-infected pregnancies.MethodsWe included pregnant women with and without COVID-19 who were admitted to Arash Hospital in Tehran, Iran from March 1 to Sep 1, 2020. Clinical features, treatments, and maternal and fetal outcomes were assessed.ResultsOne hundred and ninety-nine women enrolled, including 66 COVID-19 infected and 133 non-infected pregnant women prospectively. Caesarean Section (CS) was carried out in total 105 women (52.76%). A significant difference was found in term of delivery type between COVID-19 infected and non-infected pregnant women (aRR: 1.31, 95%CI: 1.04, 1.65, p = 0.024). No significant association was found between COVID-19 infection and preterm birth (PB) (aRR: 1.16, 95%CI: 0.54, 2.48, p = 0.689), low birth weight (LBW) (aRR: 1.13, 95%CI: 0.55, 2.31, p = 0.723), gestational diabetes (GDM) (aRR: 1.67, 95%CI: 0.81, 3.42, p = 0.160), preeclampsia (aRR: 2.02, 95%CI: 0.42, 6.78, p = 0.315), intrauterine growth restriction (IUGR) (aRR: 0.16, 95%CI: 0.02, 1.86, p = 0.145), preterm rupture of membrane (PROM) (aRR: 0.19, 95%CI: 0.02, 2.20, p = 0.186), stillbirth (aRR: 1.41, 95%CI: 0.08, 18.37, p = 0.614), postpartum haemorrhage (aRR: 1.84, 95%CI: 0.39, 8.63, p = 0.185), neonatal intensive care unit (NICU) admission (aRR: 1.84, 95%CI: 0.77, 4.39, p = 0.168), neonatal sepsis (aRR: 0.84, 95%CI: 0.48, 1.48, p = 0.568). The percentage of patients (4/66, 6.06%) being admitted to the ICU was significantly higher than the control group (0%) (p < 0.001).ConclusionBasically, although pregnancy and neonatal outcomes were not significantly different, the need for ICU care for pregnant women with COVID-19 was significantly higher compared with those without COVID-19.

Emergency Department Cesarean Section for Placental Abruption; Anticipation from Prehospital History with Preparation for Immediate Delivery

Emergency department cesarean section for placental abruption is an uncommon surgical procedure that requires anticipation in the prehospital environment as well as preemptive recognition of impending fetal demise by the emergency physician. The presence of an obstetrician ready to perform immediate cesarean section on an unstable patient with placental abruption may be lifesaving for both the mother and the fetus. However, there are no specific guidelines for prehospital recognition of patients with placental abruption that require emergency cesarean section. While the emergency department is not the optimum surgical theatre for an emergency cesarean section, placental abruption often deteriorates so quickly that even a few minutes of delay can have catastrophic consequences for both mother and fetus. We describe a case of placental abruption following moderate motor vehicular trauma in an eight month pregnant woman whose only complaint was moderate abdominal pain. The emergency physician’s suspicion based on the mechanism of injury caused her to mobilize the obstetrician, who was ready to perform an emergency department cesarean section with successful delivery of the fetus. Subsequent managing of the mother’s surgical incision and coagulopathy was performed in the operating room. This case highlights the importance of vigilance that prehospital providers, emergency department physicians, and obstetricians should have for a pregnant patient involved in a motor vehicle crash.