Pregnant Women In Hospital Research Articles

Thermal perception and dressing behaviors of pregnant women during different stages of pregnancy: A field study at a hospital in Xi'an, China

Pregnant women have different thermal preferences during pregnancy. This paper aims to investigate the thermal characteristics of pregnant women in hospitals, addressing a research gap in the field of thermal comfort for this population. This study assessed the thermal environments of the pregnancy examination spaces (i.e., B-ultrasound room and waiting area) in a hospital located in Xi'an during the winter season. Data were collected from 1055 pregnant women at different stages of pregnancy, including demographic characteristics, thermal sensation votes (TSVs), thermal comfort votes (TCVs), and clothing insulation. The results show that the thermal sensation was significantly more influenced by the pregnancy stage than the current weight. Pregnant women in the third trimester reported a higher mean thermal sensation vote (MTSV) than in other pregnancy stages. Furthermore, the clothing insulation of pregnant women exhibited a non-normal distribution, resembling a bimodal structure. Based on this structure, typical clothing insulation values were determined to be 0.9 clo in the B-ultrasound room and 1.3 clo in the waiting area. Given these characteristics in both thermal perception and dressing behaviors of pregnant women via a subjective questionnaire, we advise lowering the temperature to ensure their comfort and save heating energy. Some personalized seats are also provided to compensate for differences in thermal preference at various stages of pregnancy. These findings contribute to the creation of comfortable and healthy pregnancy examination environments.

Maternal-Fetal Complications in Renal Colic during Pregnancy: A Scoping Review.

Renal colic is one of the most common non-obstetric causes of hospitalization in pregnant women. Its management is often a challenge for obstetricians/gynecologists, urologists and neonatologists due to the complexity of the problem. The aim of this study was to analyze the possible maternal-fetal complications in renal colic during pregnancy. The authors performed a scoping review of the current literature regarding the analyzed issues. The review was conducted using the PubMed/MEDLINE and Web of Science databases. The search generated a total of 237 articles, out of which 7 original studies were ultimately included in the scoping review. In the women affected by renal colic, the incidence of perinatal complications such as urinary tract infections (UTIs), premature rupture of membranes (pPROM), and preterm birth is markedly higher than reported in the general population of pregnant women. Data regarding the recurrence of other perinatal complications such as gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia (PE), and intrauterine growth restriction (IUGR) are scarce and ambiguous. Further research on these issues is needed to improve the perinatal outcomes of the affected pregnancies.

Assessment of Health Behaviors Related to Nutrition of Pregnant Women in Hospitals

Assessment of Health Behaviors Related to Nutrition of Pregnant Women in Hospitals

Hepatitis C Prevalence and Birth Outcomes among Pregnant Women in the United States: A 2010-2020 Population Study.

The rates of hepatitis C virus (HCV) infection have increased in the pregnant population. We aim to describe the age-stratified clinical outcomes and trends for inpatient pregnant women with HCV in the U.S. We utilized hospitalization data from the 2010-2020 National Inpatient Sample. Pregnancy and HCV were identified according to their ICD-9/ICD-10 codes. Demographic and clinical data including cirrhosis, mortality, preterm birth, and stillbirth were extracted. The age groups were defined as ≤18, 19-25, 26-34, and ≥35 years. We identified 195,852 inpatient pregnant women with HCV, among whom 0.7% were ≤18, 26.7% were 19-25, 57.9% were 26-34, and 14.8% were ≥35 years of age. The hospitalization rates of pregnant women with HCV increased overall between 2010 and 2020, with the highest velocity in the 26-34 age group. The 26-34 age group had the highest HCV burden, with an age-standardized hospitalization rate of 660 per 100,000 in 2020. The rates of mortality and cirrhosis were significantly higher in the HCV cohort and increased further with age (p < 0.05). Among the HCV pregnant cohort, 151,017 (77.1%) delivered during hospitalization. Preterm births and stillbirths were significantly higher in the HCV pregnant cohort compared to the controls across multiple age groups (p < 0.05). Minority race/ethnicity was associated with increased mortality, cirrhosis, preterm birth, and stillbirth (p < 0.001). HIV co-infection, hepatitis B co-infection, and diabetes increased the odds of cirrhosis (p < 0.001). Hospitalizations of pregnant women with HCV are escalating, and these women are at increased risk of mortality, cirrhosis, preterm birth, and stillbirth with modifying factors, exacerbating risks further.

Knowledge, attitudes and practices of pregnant women regarding urinary tract infections living in peripheral areas of Pakistan: A questionnaire-based cross-sectional study

BackgroundUrinary tract infections (UTIs) are some of the most common infections affecting women during pregnancy, which – if left untreated – may lead to severe consequences for both mother and infant health. Low socio-economic status and educational attainment levels, inappropriate personal hygiene practices – especially in rural women – may lead to an increased risk of developing UTIs. The present study aims to assess the knowledge, attitudes and practices of pregnant women – who are living in peripheral areas of the Chakwal district, Punjab, Pakistan – regarding UTIs, according to the Health Belief Model (HBM). MethodsA descriptive, cross-sectional study was carried out using a 91-item questionnaire, including six HBM domains. Data collection was performed with convenience sampling among pregnant women in hospitals between July and September 2021. Statistical analyses (descriptive statistics, χ2-tests) were carried out using IBM SPSS 25.0. Results98.4% (n = 243) of the respondents were married, 77.7% (n = 192) were housewives, 41.7% (n = 103) attended up to an intermediate college education, while 43.7% (n = 108) were in their first trimester. Majority of women (81.8%) had positive attitudes towards UTI-related knowledge-acquisition, and most of them (94.7%) had good hygiene practices; on the other hand, only around half of the participants (55.5%) had acceptable knowledge levels. Advanced age (p = 0.005) and higher educational attainment levels (p = 0.025) were associated with better attitudes, while higher income levels were associated with better knowledge (p < 0.001). In the HBM domains, major obstacles noted by the respondents’ were finding it difficult to go for a urine/laboratory test and feelings of hesitation to refuse intimacy with their husband while having a UTI; on the other hand, good hygiene practices were not denoted as a barrier to prevent UTI occurrence. Participant age and the responses in the perceived benefits domain showed significant associations (p < 0.05). ConclusionAs attitudes towards learning were overwhelmingly positive, our results suggest that educational interventions may enhance rural women's knowledge regarding UTIs, which may helpful in the prevention of recurrent infections and the associated health risks for the mother and fetus.

The Influence of Doctors Therapeutic Communication and Nurses Communication Style on the Quality Services for Pregnant Women in Hospitals Deli Serdang

The maternal mortality rate is the number of women who die during pregnancy (the 42 day period after giving birth). The higher maternal mortality rate, the lowest welfare of a country. The highest MMR in North Sumatra province 2021 was in Deli Serdang district with 23 cases. Therefore, health professional are required to have communication skills with therapeutic meaning. This study aims to analyze the influence of doctors' therapeutic communication and nurses' communication styles on the quality of services for pregnant women in hospitals deli serdang district. This quantitative research uses analytical observational methods with a cross sectional approach. Data collection was conducted on 97 pregnant women who consulted at the polyclinic gynecology and obstetrics at Drs. H. Amri Tambunan Hospital, Grandmed Hospital and Haji Hospital. The data collection technique was carried out by distributing a questionnaire. The results of this study indicate that that doctors' therapeutic communication influences the quality of service at the Deli Serdang district hospital. The nurse's communication style influences the quality of service at the Deli Serdang district hospital. There is an influence of doctors' therapeutic communication and nurses' communication styles on the quality service of hospital at the Deli Serdang district. Has a very strong relationship with a adjusted R square of 73.2%. The remaining 26.8% was influenced by other factors outside this research

Experience of Pregnant Mothers in Receiving Ante Natal Care Services in Hospital

ABSTRACT Antenatal care services for pregnant women are health services received by mothers during pregnancy to determine the health condition of the mother and fetus. To determine the experience of pregnant women in receiving services at the hospital. This research method is qualitative phenomenology, data collection is carried out in natural settings with participant observation techniques and in-depth interviews. Data were analyzed with the Colaizzi method. Among mothers as hospital visitors, 3 themes were found, namely 1) Utilization of technology in antenatal care services for pregnant women in hospitals, 2) Effective communication with pregnant women as customers in hospitals, 3) Educational literacy for mothers pregnant antenatal care in health services in hospitals. Among health workers as stewards of antenatal care, two themes were found, namely: 1) the use of technology as a means of educational media, and 2) the expectations of health workers in providing services for pregnant women. The use of technology in the form of educational facilities is very important for pregnant women, especially during the antenatal care period, this is useful to help reduce the incidence of complications in the mother and fetus based on health technology monitoring. The involvement of health workers including doctors, nurses, and midwives is a determining factor for success in service excellence in 5 standard policies, namely police, place, product, process, and people in the hospital.

Preferences of pregnant women toward a future maternal Group B Streptococcus vaccine in China: A cross-sectional survey with a discrete choice experiment

ABSTRACT Group B streptococcus (GBS) is a major cause of neonatal death worldwide. A GBS vaccine for pregnant women is under development and is expected to be available in the near future. The perceptions and preferences of pregnant women in China of GBS vaccines has not been investigated, and this study aimed to investigate pregnant women‘s awareness of GBS and their potential preferences for the GBS vaccine. A discrete choice experiment was conducted among pregnant women in hospitals from Shaanxi, Hunan, and Zhejiang provinces located in Western, Central, and Eastern China, respectively. A conditional logit model was used to analyze the data and calculate willingness to pay values and choice probabilities of different GBS vaccine programs. A total of 354 pregnant women were included in the final analysis, 45.8% of whom were willing to receive a GBS vaccine if it were licensed. Vaccine safety was the most important attribute of a future vaccine, while cost was the least important attribute. Compared with no vaccination, pregnant women had a strong preference for future GBS vaccination (ASC = 1.267, p < .001). Pregnant women’s decisions were highly influenced by those of other pregnant women. Improving the safety, efficacy, and vaccination rate of the GBS vaccine in China is of great significance for future GBS vaccine development and vaccination. Compared to other variable options, the cost of a GBS vaccine was of the least importance among pregnant women in mainland China. These findings can inform public health policy decisions related to GBS vaccination in China.

Humanized childbirth, a link to humanitarian treatment, synonymous with quality obstetric care at the 1st level of care in Mexico

Bringing a new being into the world is a relevant and transcendent event in a woman's life, which will be marked for the rest of her life. However, it can be experienced as a painful and traumatic experience. Objective: Analyze the most effective actions to improve the quality of humanized delivery care in low-risk pregnant women in hospitals of 1st and 2nd level of care. Methodology: A narrative review was carried out that includes a critical, reflective analysis of humanized childbirth. The review of: original articles, revision of doctoral and master's theses was carried out. The adopted search strategy included keywords or descriptors, connected by means of the boolean operator and. The keywords used were "humanization", "delivery", "human needs", and breastfeeding, these being identified through Medical Subject Headings 2020 Serach MeSH, in this way the referred articles, descriptors in language were used for the search. Spanish and English. The search was carried out in various databases. Information collection time 6 months, (August 2022 to February 2023). Results: The review allowed us to analyze in a standardized way the historical evolution of humanized childbirth and the transcultural significance that it represents and to a large extent to be carried out, and how it will reinforce the multidisciplinary health team that cares for women in this process, to offer different strategies. to be this stage an unforgettable and humanistic experience that you will never forget. Conclusions: Humanized childbirth is translated into a birth with a humanistic character which includes: the prenatal stage, labor, delivery and the puerperium, where the protagonists are the pregnant woman and the newborn, receiving dignified, free treatment. of violence and based on human and ethical rights

Histopathological autopsy findings in lungs of pregnant and postpartum women who died of COVID-19 infections.

The coronavirus disease 2019 outbreak (COVID-19) caused by the SARS-CoV coronavirus, has been declared as apandemic by the World Health Organization on 11March 2020, as aresult of which about 315,000,000 people all over the world have been infected and more than 5,000,000 died. Many scientific articles have been published concerning histopathological changes in different organs, but data concerning the lung changes of pregnant and postpartum period women who died of COVID-19 infections are still scarce. The aim of our study was to review and summarize autopsy findings and histopathological changes in lungs of pregnant and postpartum period women who died of COVID-19 infections in Armenia during 2020-2021. Lung tissue specimens of 14pregnant and postpartum period women who died of COVID-19 infections and its complications were examined. Hematoxylin-eosin and van Gieson staining methods as well as immunohistochemical examinations were used. The average age of the dead women was33.9 years. From 14cases in 9there were comorbidities. All cases of death were in the 2ndand 3rdtrimester of pregnancy or early and late postpartum period. Forensic medical diagnosis included COVID-19 infection with bilateral polysegmented pneumonia and acute respiratory failure. Histopathological examination revealed diffuse alveolar damage of lungs (DAD) in predominantly proliferation/organizing stage. Histopathological examination of lungs showed proliferative stage of DAD with signs of fibrosing pneumonia. Early diagnosis and hospitalization of pregnant women may prevent late complications of COVID-19 infection and fibrosing pneumonia development, as well as future risks of fatal outcomes in pregnant and early postpartum period.

Influenza in Pregnancy

Pregnant women should avoid places with too many people during a influenza epidemic and people who already have influenza. The immune system of pregnant women is very sensitive and prone to attacks by viruses and bacteria, and the treatment of flu during pregnancy takes longer than usual. Influenza during pregnancy can increase the duration of the infection and can lead to more serious complications, such as pneumonia. More severe cases of influenza in pregnant women can end up in hospitalization of pregnant women. As the influenza has a bad effect on the health of the pregnant woman herself, it can unfortunately also affect the fetus and can lead to the birth of a child with a low birth weight and premature birth.

INFOGRÁFICO PARA GESTANTES E ACOMPANHANTES: TECNOLOGIA EDUCACIONAL NO CONTEXTO DO ATENDIMENTO OBSTÉTRICO

ABSTRACT Objective: to describe the process of construction and validation of an educational infographic with guidelines for pregnant women and companions in obstetric care in the context of Covid-19. Method: methodological research based on Instructional System Design guidelines and conducted from January 2021 to March 2022, in the State of Santa Catarina - Brazil, in three moments: scoping review, interviews with nurses from an Obstetric Emergency, and elaboration of educational technology and validation with experts. The analysis was anchored in content analysis with Content Validity Index. Results: the infographic addresses care for the prevention of Covid-19 infection, guidance on the onset of labor, when to seek maternity care, and care during hospitalization of pregnant women. The infographic obtained a Content Validity Index of 83.3%. Conclusion: educational technology was considered adequate for disseminating information and assisting professionals in promoting health and preventing injuries to the obstetric population.

Factors Influencing the Occurrence of Preeclampsia in Pregnant Women at Sibuhuan Hospital, Barumun District, Regency The Old Field in 2022

Preeclampsia is still the biggest cause of maternal and fetal morbidity and mortality worldwide. One of the basic theories that is most responsible for the occurrence of this syndrome is endothelial dysfunction in placentation defects. (Keman, 2014). Maternal mortality in Indonesia is still dominated by the three main causes of death, namely bleeding, preeclampsia and infection. Preeclampsia affects 3-5% of pregnancies and is responsible for more than 60,000 maternal deaths and 500,000 fetal deaths per year worldwide. The purpose of this research is to find outFactors Affecting the occurrence of Pre-eclampsia in pregnant women in hospitals. Sibuhuan Barumun District, Padang Lawas Regency in 2022. The type of research conducted is analytic observational with a case control approach, the population in the study is 733 people and the number of samples is 27 people using the techniquepurposive sampling. The data collected in this study is secondary data, namely data obtained from medical records. The data analysis used was univariate analysis and bivariate analysis. The research results areFactors that do not influence the occurrence of pre-eclampsia are age, parity, spacing of pregnancies, history of diabetes mellitus, and factors that influence the occurrence of pre-eclampsia are factors of history of hypertension in pregnant women in hospitals. Sibuhuan, Barumun District, Padang Lawas Regency in 2022. It is hoped that all health workers inHOSPITAL. Sibuhuanexpected to be more active in providing counseling related tofactors that influence the occurrence of pre-eclampsia in pregnant women

Prevalence, Knowledge and Risk Factors of Hepatitis B Among Pregnant Women in the Loum Health District, Cameroon

Infection with Hepatitis B virus continues to be an important global public health problem with millions of people worldwide affected. Around 2 billion people have been exposed to hepatitis B globally, and about 257 million people are living with hepatitis B particularly in the Low and Middle-income countries. Cameroon is endemic and pregnant women are rarely screened routinely in most health facilities in Cameroon. The objective of this study was to determine the prevalence, knowledge and risk factors of hepatitis B among pregnant women in Loum Health District. This study was a cross sectional hospital and community-based carried out among pregnant women in the Loum Health District. All the 5 health areas and 24 health facilities were included. Data on the socio demography and knowledge on hepatitis B infection was collected using a structured questionnaire. Pregnant women were screened for hepatitis B surface antigens (HBsAg) using the DiaSpot One Step Hepatitis B test. Data was analyzed using SPSS version 26. The Chi square test was used to compare proportions and the logistic regression model was fitted to find out factors independently associated with knowledge, prevalence and attitude. Of the 200 pregnant women screened, 18 (9%) were positive for hepatitis B virus. Higher prevalence was observed for the age group 16-25 (10.8%) and primary level of education 7 (13.5%). The results showed that pregnant women had inadequate knowledge on HBV infection. History of multiple sex partners (AOR=5.58, P=0.001), history of surgery (AOR=3.04, P=0.026) and history of tattooing (AOR=2.36, P=0.041) were all significantly associated with hepatitis B sero-positivity. The prevalence of HBsAg was 9% with only one third of participants having adequate knowledge on Hepatitis B. Although hepatitis B is recognized to be one of the major health problems, pregnant women in the Loum health district were less aware of its mode of transmission, consequences and prevention. History of surgery, tattooing, multiple sexual partners were factors that increase hepatitis transmission. Compulsory screening of pregnant women in hospital and health educative talks on Hepatitis B during antenatal visit could create more awareness among pregnant women.

Comparison of the effectiveness of ondansetron versus metoclopramide in hyperemesis gravidarum: a randomized clinical trial

Objective: Nausea and vomiting are the most common complications and the first cause of hospitalization of pregnant women in the first trimester of pregnancy. Given the maternal and fetal complications as well as the negative psychosocial and economic effects of nausea and vomiting, the present study aimed to compare the antiemetic effects of ondansetron and metoclopramide.&#x0D; Methods: The present double-blind randomized clinical trial study was conducted on 153 pregnant women with a complaint of nausea and vomiting during pregnancy referred to the obstetrics and gynecology ward. Patients were randomly divided into two metoclopramide and ondansetron groups. The outcomes of interest were nausea and vomiting, the number of used doses of the drug, and the length of hospital stay. The Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire was used to assess the severity of nausea and vomiting.&#x0D; Results: The mean age was significantly higher in the metoclopramide group (28.44±6.45 vs. 25.43±5.42 years, P=0.004). On day 3, the PUQE score was significantly higher in the ondansetron group (6.60±1.10 vs. 6.56±0.88, P&lt;0.001). The decrease in the severity of nausea and vomiting was significantly higher in the ondansetron group (5.29±1.35 vs. 4.90±1.17, P=0.05) in the second day compared to the first day. In the repeated measure analysis, significant differences were found between the two treatment groups (F=7.01, P=0.009). There was no significant difference between the two groups in terms of the length of hospital stay (P&gt;0.05).&#x0D; Conclusion: In this study, ondansetron revealed more efficacy than metoclopramide on the nausea and vomiting of pregnancy (NVP) management. Ondansetron may, therefore, be considered as a safe and effective alternative for metoclopramide in the treatment of NVP.

TP9.2.11Venous Thromboembolism Assessment and Thromboprophylaxis in Pregnant Women admitted to Hospital under Non-Obstetric Specialties

Abstract Aims During a non-obstetric admission, there is minimal awareness amongst other specialties regarding the need to reassess venous thromboembolism (VTE) prophylaxis requirements. The primary aim of this study was to review whether perinatal patients are accurately assessed for VTE risk factors during non-obstetric admissions and being prescribed appropriate thromboprophylaxis upon discharge. Methods Data collection was carried out by retrospectively identifying all admissions of pregnant women in hospital under a non-obstetric team over a period of six months. Patients were scored according to their individual risk factors related to pregnancy and the admission. Comparison was made between the recommended and actual prophylaxis given. Results 152 patients were included in the study. Only 13 women received appropriate VTE management whilst 35 patients were deemed high-risk and did not receive prophylaxis. VTE assessment was not documented in nearly 60% of patients. 68% of patients were found to be at intermediate risk. Conclusion Reassessment for risk of VTE in antenatal and postnatal patients is poorly documented when managed by non-obstetric led teams. Women with both established and transient risk factors for VTE are not receiving appropriate thromboprophylaxis. Raised awareness of this specific problem is required amongst non-obstetric teams. Key Statement Appropriate thromboprophylaxis is vital at the point of admission of a pregnant patient to hospital as this is associated with an 18-fold increased risk of VTE. Further improvements need to be made in order to educate non-obstetric teams caring for obstetric patients regarding the importance of VTE risk assessment.

Doppler Ultrasound Imaging Combined with Fetal Heart Detection in Predicting Fetal Distress in Pregnancy-Induced Hypertension under the Guidance of Artificial Intelligence Algorithm.

This study was to improve the feasibility and economic benefits of intelligent medical system Doppler ultrasound (DUS) imaging technology combined with fetal heart detection to predict the fetal distress in pregnancy-induced hypertension (PIH), so as to reduce the risk of deterioration of the patient's condition. The characteristics of DUS images were analyzed, and a diffusion filter reducing the specificity was adopted to improve the smooth speckle noise of DUS images. 120 pregnant women in hospital were the subjects of the study, all of whom received ultrasound cord blood flow testing and fetal heart monitoring. 88 PIH patients with fetal distress were diagnosed and included in the observation group, and 32 healthy pregnant women tested during the same period were identified as the control group. Clinical data were reviewed and analyzed. The diagnostic rates of fetal distress by simple fetal heart monitoring and DUS detection combined with fetal heart monitoring were compared. The results showed that 26.7% of fetal distress were diagnosed by fetal heart monitoring alone, and 73.3% of fetal distress were diagnosed by combined testing, so the diagnostic accuracy of the combined detection method was greatly higher than the single fetal heart detection (P < 0.05). The Pulsatility index (PI), resistance index (RI), and S/D values detected by the umbilical artery in the observation group were 1.48, 0.85, and 4.31, respectively. The PI, RI, and S/D values detected by the umbilical artery in the control group were 0.96, 0.64, and 3.59, respectively. The results of arterial detection were significantly higher than those of the control group, and the difference was of significant scientific significance (P < 0.05). In summary, the PI and RI values of the middle cerebral artery (MCA) detected by DUS diagnosis can effectively reflect the current status of the fetus in the uterus and reduce the mortality of the fetus. The images guided by DUS imaging technology can clearly show the current status of the fetus in the uterus, effectively improve the medical diagnostic efficiency, and have important reference value for the development of intelligent medical equipment.

Prevalance of Pre-Eclampsia and Factors Responsible among Third Trimester Pregnant Women in Hospital of Dhaka

Pre-eclampsia (PE) is an idiopathic disorder of pregnancy characterized by proteinuric hypertension and still one of the most important causes of maternal and fetal mortality...

Developing a stepwise approach by integrating nutrition and lifestyle modifications in the management of diabetes amongst pregnant women in hospitals of urban Vadodara

Introduction: With estimated rates of Gestational Diabetes Mellitus being much higher in Indiathan West (10-14.3%) and an approximate of about 4 million women being affected nationwide at anygiven point in time has made Diabetes a major antenatal concern in India.Objective: To develop a stepwise approach by integrating nutrition and lifestyle modifications inmanagement of diabetes amongst pregnant womenMethods: The cross-sectional study comprised of situational analysis under Phase I wherein onetime in-depth interviews of doctors and pregnant women were conducted to identify screening, assessmentand management protocols being used. Six hundred pregnant women from government and privatehospitals across all four zones of Vadodara city were interviewed along with the doctors. Phase IIcomprised of an interactive session with doctors and nutritionists to discuss the issues faced whileimplementing routine screening, assessment and management protocols. Information was used to developstepwise approach.Results: Prevalence of Gestational Diabetes Mellitus and Diabetes in pregnancy were found to bedifferent as reported by the doctors versus what was observed by the researcher in the situational analysis.Majority (76%) women reported of being tested for diabetes using fasting or random blood sugar test.However, only 16% got Oral Glucose tolerance test done whereas 80% of the doctors reported of gettingOGTT done as an assessment method for these women. Almost all doctors (94.7) reported of dietcounselling being administered to the subjects however, only one hospital had a dietician. A stepwiseapproach was developed for screening and assessment of this pregnancy risk using the existing protocolsand including recommendations from Phase-II.Conclusion: A universal approach for integrated management with nutrition as the key componentfor efficient management and risk reduction for a safe pregnancy is the way forward which was the focalpoint of this study.

Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study

BackgroundThe coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited.ObjectiveThis study aimed to describe the clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnant women with positive laboratory testing for severe acute respiratory syndrome coronavirus 2.Study DesignThis is a cohort study of pregnant women with severe or critical coronavirus disease 2019 hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020. Severe disease was defined according to published criteria as patient-reported dyspnea, respiratory rate >30 per minute, blood oxygen saturation ≤93% on room air, ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen <300 mm Hg, or lung infiltrates >50% within 24–48 hours on chest imaging. Critical disease was defined as respiratory failure, septic shock, or multiple organ dysfunction or failure. Women were excluded from the study if they had presumed coronavirus disease 2019, but laboratory testing was negative. The primary outcome was median duration from hospital admission to discharge. Secondary outcomes included need for supplemental oxygen, intubation, cardiomyopathy, cardiac arrest, death, and timing of delivery. The clinical courses are described by the median disease day on which these outcomes occurred after the onset of symptoms. Treatment and neonatal outcomes are also reported.ResultsOf 64 hospitalized pregnant women with coronavirus disease 2019, 44 (69%) had severe disease, and 20 (31%) had critical disease. The following preexisting comorbidities were observed: 25% had a pulmonary condition, 17% had cardiac disease, and the mean body mass index was 34 kg/m2. Gestational age was at a mean of 29±6 weeks at symptom onset and a mean of 30±6 weeks at hospital admission, with a median disease day 7 since first symptoms. Most women (81%) were treated with hydroxychloroquine; 7% of women with severe disease and 65% of women with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation during their admission. The median duration of hospital stay was 6 days (6 days [severe group] and 10.5 days [critical group]; P=.01). Intubation was usually performed around day 9 on patients who required it, and peak respiratory support for women with severe disease was performed on day 8. In women with critical disease, prone positioning was required in 20% of cases, the rate of acute respiratory distress syndrome was 70%, and reintubation was necessary in 20%. There was 1 case of maternal cardiac arrest, but there were no cases of cardiomyopathy or maternal death. Thirty-two of 64 (50%) women with coronavirus disease 2019 in this cohort delivered during their hospitalization (34% [severe group] and 85% [critical group]). Furthermore, 15 of 17 (88%) pregnant women with critical coronavirus disease 2019 delivered preterm during their disease course, with 16 of 17 (94%) pregnant women giving birth through cesarean delivery; overall, 15 of 20 (75%) women with critical disease delivered preterm. There were no stillbirths or neonatal deaths or cases of vertical transmission.ConclusionIn pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.