Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

Maternal COVID-19 exposure and placental characteristics

INTRODUCTION

The impact of COVID-19 on the placenta is poorly described, particularly among minority women.

MATERIALS AND METHODS

This is a retrospective case-control study. Micro- and macroscopic placental pathologic findings were compared for 15 COVID-19 positive and 36 negative mothers. Cases and controls were frequency matched on gestational age, race, maternal comorbidities, and delivery type. Data from the electronic medical record were supplemented with independent review of microscopic slides.

RESULTS

Placentas from cases and controls were similar except the median distance from the site of the cord insertion to the nearest disk margin was statistically significantly shorter among placentas from COVID-19 positive cases (3.5 versus 6.0 cm, p = 0.006). Case status was not associated with an increased risk of placental pathologies.

CONCLUSION

There are few pathologic differences between placentas of COVID-19 positive and negative mothers. Additional studies are needed to investigate the role of timing of infection.

The changes in fear of childbirth in pregnancy during and before the COVID-19 pandemic

We aimed to investigate how factors such as age, education level, planned delivery method and fear of childbirth were affected in pregnant women before and during the pandemic. This cross-sectional study compared a pre-pandemic pregnant group (July 2019 and December 2019) and a pandemic group (November 2020 and May 2021) of patients at Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital. A total of 696 pregnant women in their second trimester were included in the study. All of them were literate and voluntarily agreed to participate in the study. Data were collected with the Wijma delivery expectancy/experience questionnaire (WDEQ-A), and the outpatient doctor asked the questions face-to-face. The mean age of the pregnant women participating in the study was 31.6 ± 6.8 years. While the total Wijma score was 62.1 ± 25.1 in the pre-pandemic group, it was 61.3 ± 26.4 in the pandemic group, and there was no significant difference between the two groups (p = 0.738). Upon analyzing the fear of childbirth among groups based on education level, no statistically significant differences were observed between the pre-pandemic and pandemic periods within any of the groups. While 25.7% (n = 179) of all participants had a normal fear of childbirth, 22% (n = 153) had a mild fear of childbirth, 27% (n = 188) had a moderate fear of childbirth, and 25.3% (n = 176) had a severe fear of childbirth (Wijma score of 85 and above). When the pre-pandemic and the pandemic period were compared, the fear of childbirth was unchanged in pregnant women at all education levels (p = 0.079, p = 0.957, p = 0.626, p = 0.539, p = 0.202). When comparing fear of childbirth before and after the pandemic, it was found that patients with a high school education level have a significantly higher fear of childbirth. To alleviate the fear of childbirth in pregnant women who have completed high school, training or psychosocial support interventions may be prioritized.

Breastfeeding experience and anxiety in mothers with covid-19 in the postnatal period: a qualitative study

BACKGROUND

The fear, panic, and uncertainties arising during the Covid-19 period have caused many questions about breastfeeding. This study was conducted to investigate breastfeeding and anxiety in mothers with Covid-19.

METHODS

The phenomenological research type study was conducted in Istanbul between August and November 2021. The sample of the research consists of women who breastfeed after birth and who had Covid-19. Both content and descriptive analysis were used to analyze the data.

RESULTS

The data were analyzed under three main themes. Under the theme of the impact of Covid-19 on breastfeeding, mothers experienced situations like decreased or increased breastfeeding frequency, cessation of breastfeeding, isolation, anxiety about transmission, and expression of milk. They reported that their anxiety in the breastfeeding process was related to the health of the baby, baby care, decreased milk or not breastfeeding, and the Covid-19 period. They used practices such as receiving spousal and professional support, paying attention to isolation, effective communication with the baby, and praying as methods of coping with anxiety.

CONCLUSION

The study demonstrated that factors like transmission anxiety, decreased breastfeeding frequency, and isolation affected breastfeeding, and mothers were most concerned about the baby's health. In situations such as pandemics, protecting mother and baby health is important and a priority area. More quantitative and qualitative studies on the subject are needed.

The top 50 most-cited articles about COVID-19 and the complications of COVID-19: A bibliometric analysis

Background

This bibliometric analysis examines the top 50 most-cited articles on COVID-19 complications, offering insights into the multifaceted impact of the virus. Since its emergence in Wuhan in December 2019, COVID-19 has evolved into a global health crisis, with over 770 million confirmed cases and 6.9 million deaths as of September 2023. Initially recognized as a respiratory illness causing pneumonia and ARDS, its diverse complications extend to cardiovascular, gastrointestinal, renal, hematological, neurological, endocrinological, ophthalmological, hepatobiliary, and dermatological systems.

Methods

Identifying the top 50 articles from a pool of 5940 in Scopus, the analysis spans November 2019 to July 2021, employing terms related to COVID-19 and complications. Rigorous review criteria excluded non-relevant studies, basic science research, and animal models. The authors independently reviewed articles, considering factors like title, citations, publication year, journal, impact factor, authors, study details, and patient demographics.

Results

The focus is primarily on 2020 publications (96%), with all articles being open access. Leading journals include The Lancet, NEJM, and JAMA, with prominent contributions from Internal Medicine (46.9%) and Pulmonary Medicine (14.5%). China played a major role (34.9%), followed by France and Belgium. Clinical features were the primary study topic (68%), often utilizing retrospective designs (24%). Among 22,477 patients analyzed, 54.8% were male, with the most common age group being 26-65 years (63.2%). Complications of COVID-19 affected 13.9% of patients, with a recovery rate of 57.8%.

Conclusion

Analyzing these top-cited articles offers clinicians and researchers a comprehensive, timely understanding of influential COVID-19 literature. This approach uncovers attributes contributing to high citations and provides authors with valuable insights for crafting impactful research. As a strategic tool, this analysis facilitates staying updated and making meaningful contributions to the dynamic field of COVID-19 research.

M. Ahmed S, Alsafar HS, Halwani R. Multiple inborn errors of type I IFN immunity in a 33-year-old male with a fatal case of COVID-19

The host genetic inborn errors of immunity (IEIs) have been shown to contribute to susceptibility to life-threatening coronavirus disease 2019 (COVID-19), as it had been associated previously with other viral infections. Most genetic association studies have described IEIs as a monogenic defect, while there have been no reports of patients with multiple inherited immune deficiencies. This is a complex case of IEIs predisposing to severe viral infections in an unvaccinated 33-year-old male patient. The patient was admitted with no respiratory symptoms, showed a SARS-CoV-2 PCR positive test on the second day of admission, started developing progressive lung consolidation within three days of hospitalization, and was moved from non-invasive to mechanical ventilation within 12 days of hospitalization. Impaired production of type I IFN was detected in patient PBMCs treated with poly(I:C), at both mRNA and protein levels. Whole exome sequencing revealed three mutations across type I IFN production pathway, which were predicted to be loss-of-function (pLOF). The three mutations were predicted to predispose to severe viral infections: monoallelic R488X TLR3, monoallelic His684Arg TLR3, and biallelic Val363Met IRF3. Functional analysis confirmed that all these mutations dysregulated the type I IFN pathway. Evaluation of TLR3 and IRF3 IFN-β1 luciferase reporter activity showed a hypomorphic suppression of function. TOPO TA cloning was used to ascertain the positioning of both TLR3 variants, indicating that both variants were on the same allele. We have described a unique complex IEI patient with multiple mutations, particularly along type I IFN production pathway.

Association between the degree of severity of COVID-19 infection during pregnancy and preterm premature rupture of membranes in a level III hospital in Peru

OBJECTIVES.

To determine the association between the degree of severity of COVID-19 infection during pregnancy and preterm premature rupture of membranes (PPROM) in a level III hospital in Peru.

MATERIALS AND METHODS.

Cross-sectional, analytical and observational study in women older than 18 years diagnosed with COVID-19 infection during pregnancy, between the years 2020 and 2022. Clinical and obstetric variables were collected. The chi-square and Fisher's exact tests were used for the descriptive analysis. For the multivariate analysis, we calculated the prevalence ratio by using Poisson regression in crude and adjusted models. All statistical tests were performed considering a value of p<0.05 as significant and with a confidence level of 95%.

RESULTS.

We analyzed data from 163 pregnant women with COVID-19, of which 9.2% had PPROM; all were symptomatic cases. Mild COVID-19 cases were 1.10 times more likely to have PPROM (RPa=1.10; 95%CI: 1.02-1.18) and moderate/severe cases were 1.64 times more likely (RPa=1.64; 95%CI: 1.43-1.87), compared to asymptomatic cases.

CONCLUSIONS.

We identified that a higher degree of severity of COVID-19 infection during pregnancy was associated with a higher probability of having PPROM.

Effect of COVID-19 infection on pregnant women in plateau regions

OBJECTIVE

The present study aims to explore the effect of COVID-19 infection on pregnant women in plateau regions.

STUDY DESIGN

Data from 381 pregnant women infected with COVID-19 who underwent prenatal examination or treatment at Women and Children's Hospital of Tibet Autonomous Region between January 2020 and December 2022 and 314 pregnant women not infected with COVID-19 were retrospectively collected.

METHODS

The study participants were divided into an infected and non-infected group according to whether they were infected with COVID-19. Basic information (ethnicity, age, body mass index and gestational age [GA]), vaccination status, intensive care unit (ICU) admission and delivery outcomes were compared. Binary logistic regression was used to analyse the influencing factors of ICU admission.

RESULTS

The results revealed significant differences in the GA, vaccination rate, blood pressure, partial pressure of oxygen, white blood cell (WBC) count, ICU admission rate, preeclampsia rate, forearm presentation rate, thrombocytopenia rate, syphilis infection rate and placental abruption rate between the two groups (P < 0.05). A univariate analysis showed that COVID-19 infection, hepatitis B virus infection, the WBC count and hypoproteinaemia were risk factors for ICU admission. The results of the multivariate analysis of the ICU admission of pregnant women showed that COVID-19 infection (odds ratio [OR] = 4.271, 95 % confidence interval [CI]: 3.572-5.820, P < 0.05) was a risk factor for ICU admission and the WBC count (OR = 0.935, 95 % CI: 0.874-0.947, P < 0.05) was a protective factor for ICU admission.

CONCLUSION

Pregnant women are vulnerable to the adverse consequences of COVID-19 infection, and public health measures such as vaccination are needed to protect this population subgroup.

Clinical Epidemiological Characteristics and Risk Factors for Severity of SARS-CoV-2 Pneumonia in Pediatric Patients: A Hospital-Based Study in Vietnam

Introduction Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2, which can cause organ failure in several organs, cardiac problems, or acute respiratory distress syndrome (ARDS). Identifying clinical epidemiological characteristics and risk factors for complications of COVID-19 allows clinicians to diagnose and treat promptly. Objectives This study aims to describe the clinical epidemiological characteristics of COVID-19 and assess risk factors for the severity of SARS-CoV-2 pneumonia in children treated at Haiphong Children's Hospital. Methods A descriptive cross-sectional study was conducted in Haiphong Children's Hospital, Haiphong, Vietnam, for one year, from January 1, 2022, to December 31, 2022. Results In our study, 540 children were evaluated; the male-to-female ratio was 1.48/1; the median age was 23 months (IQR=6-74); Children aged under one year accounted for the highest proportion (n=202; 37.4%); 40 (7.4%) children had underlying illnesses. The number of admitted patients diagnosed with COVID-19 peaked in February 2022. Regarding severity, 380 (70.4%) cases were mild, 136 (25.2%) were moderate, only 24 (4.4%) cases were severe, and no children died. Common symptoms were fever in 483 (89.4%), coughing in 399 (73.9%), and tachypnea in 163 (30.2%) children. Laboratory features: white blood cell count, platelet count, serum CRP, and coagulation test showed little change. Around 116 (21.5%) had lymphopenia and 148 (27.4%) had pneumonia. Patients under one year were approximately 1.64 times more likely to experience pneumonia complications from COVID-19 than those without such a history (OR=1.64, 95%CI = 1.12 - 2.41, p=0.0112). Patients with underlying conditions were approximately 2.08 times more likely to experience pneumonia complications from COVID-19 compared to those without such conditions (OR=2.08, 95%CI =1.08 - 4.02, p=0.0289). Conclusion In COVID-19 pediatric patients, the severity of the disease was mild to moderate without any mortality. Children aged under one year accounted for the highest proportion of all COVID-19 patients. This study found that age under one year and underlying illnesses are related to pneumonia in COVID-19 pediatric patients.

Association Between Pandemic-Related Maternal Perinatal Anxiety and Early Postpartum Breastfeeding Success

BACKGROUND AND OBJECTIVES

Prior studies have shown conflicting results on the impact of maternal anxiety on breastfeeding initiation and success. Furthermore, a substantial increase in maternal anxiety levels was shown in response to the COVID-19 pandemic. In this study, we aimed to investigate the relationship between maternal perinatal anxiety induced by the COVID-19 pandemic and early breastfeeding outcomes.

MATERIALS AND METHODS

This cross-sectional study was conducted in two regional maternity hospitals, involving 220 first-time pregnant patients with a gestational age of ≥37 weeks. All patients had no current diagnosis of COVID-19 and no cases of COVID-19 in their close environment at the time of admission. At 24-48 hours postpartum or at the time of discharge, three following scoring systems were employed: the Coronavirus Anxiety Scale (CAS), the State-Trait Anxiety Inventory (STAI), and the LATCH (short for latch, audible swallowing, type of nipple, comfort, and hold) score. A LATCH score of ≥8 was chosen as the cutoff point for defining successful breastfeeding performance. Spearman's rank correlation was used to evaluate relationships between the CAS, STAI scores, maternal and infant factors, and LATCH scores.

RESULTS

There were no differences in baseline characteristics between groups categorized as successful and unsuccessful in breastfeeding initiation. The mean total STAI score was 86.3±13.2, the CAS score was 1.07±1.91, and the LATCH score was 8.42±1.7. Although there was an increase in State-Trait Anxiety Inventory-State Anxiety (STAI-S) scores compared to State-Trait Anxiety Inventory-Trait Anxiety (STAI-T) scores, and the STAI-S score and CAS score were higher in the unsuccessful group, these differences did not reach statistical significance (p = 0.22 and 0.16, respectively). When we evaluated the correlation of the LATCH score with STAI total, STAI-S and STAI-T scores, CAS score, and maternal and infant factors, only the type of delivery showed a significant correlation with the LATCH score (p = 0.008).

CONCLUSIONS

Early postpartum breastfeeding efficiency, as measured by the LATCH score, was only correlated with the type of delivery. No significant correlation was found between pandemic-related maternal perinatal anxiety and early postpartum breastfeeding success.

The Multi-faceted Effects of COVID-19 on Female Reproductive Health: An Updated Narrative Review

Concerns about the SARS-CoV-2 pandemic's possible impact on sexual and reproductive health have grown significantly. In this narrative review, the latest research on the effects of SARS-CoV-2 infection on several facets of sexual and reproductive health is reviewed. The review starts initially by going through the possible consequences of SARS-CoV-2 on female menstrual cycles. The virus may interfere with the menstrual cycle, which could affect hormone synthesis and endometrial reactions, according to newly available evidence. Menstrual blood loss may be impacted by COVID-19's potential to influence endothelial cell function and systemic hemostasis. Hypothalamic amenorrhea may be brought on by severe COVID-19 disease. There is little research on this subject, although most women resume their regular menstrual cycles after 1-2 months of recuperation. The review also examines how SARS-CoV-2 infection may affect assisted reproductive technology (ART) treatments. There are few clinical data, although some research points to potential effects on embryo quality. Overall, ART results, however, did not materially change from the time before the epidemic. Obstetric problems are more likely when SARS-CoV-2 infection occurs during pregnancy, especially in the third trimester. Even though the maternal death rate is still low, pregnant women, especially those with comorbidities, are more likely to experience serious sickness. The review emphasizes how the COVID-19 vaccine affects menstrual cycles, showing brief, modest modifications without serious health hazards. Also included are the psychological effects of family planning choices during the pandemic. In conclusion, this narrative review offers a thorough assessment of the complicated and changing effects of SARS-CoV-2 on sexual and reproductive health. The different requirements of people and couples during and after the pandemic are highlighted, underscoring the necessity for ongoing study and specialized healthcare practices.

The impact of gestational weeks of Coronavirus disease 2019 (COVID-19) infection on perinatal outcomes

BACKGROUND

To evaluate the relationship between coronavirus disease 2019 (COVID-19) infection at different time points during pregnancy and perinatal outcomes.

METHODS

This retrospective study included 611 women who hospitalized for delivery between December 7 and April 30, 2023. Based on the different pregnancy weeks infected with COVID-19, the participants were divided into four groups: Group 1 (14-27+6 weeks gestation), Group 2 (28-36+6 weeks gestation), Group 3 (37-39+6 weeks gestation), and Group 4 (≥ 40 weeks gestation). Data including maternal demographic characteristics, clinical profiles, and perinatal outcomes were analyzed.

RESULTS

There were no significant differences in maternal demographic characteristics among the four groups (P > 0.05). Compared to Groups 3 and 4, a higher rate of fever was noted in Groups 1 and 2 (P < 0.05). The frequency of preeclampsia and gestational diabetes mellitus showed a decreasing trend as pregnancy progressing (P < 0.05). Preterm delivery and neonatal intensive care unit admission were more frequently observed in Groups 1 and 2 than in Groups 3 and 4 (P < 0.05). Multivariate logistic regression analysis demonstrated that the timing of gestation in which COVID-19 was infected was not associated with preterm delivery and neonatal intensive care unit admission (P > 0.05), whereas gestational age at COVID-19 infection was negatively associated with the occurrence of preeclampsia and gestational diabetes mellitus (P < 0.05).

CONCLUSIONS

Gestational age at COVID-19 infection is a simple parameter that predicts adverse perinatal outcomes to aid clinicians in determining to provide early enhanced prenatal care and increased monitoring to reduce maternal complications.

Maternal and neonatal outcomes during COVID-19 pandemic and pre-pandemic in an urban slum in North India - A community-based ambispective cohort study

Background

Coronavirus disease 2019 (COVID-19) has affected millions of people globally since its first case reported on December 2019 in Wuhan, China. The maternal and neonatal outcomes during COVID-19 pandemic were not much reported in low- and middle-income countries. Therefore, we aimed to assess the maternal and neonatal outcomes during COVID-19 and compared them with those of the pre-pandemic period (i.e., 2019).

Materials and Methods

We obtained data from the cohort of pregnant women who delivered during COVID-19 pandemic and women who delivered in the pre-pandemic period. All registered antenatal mothers resident of the selected dispensary who delivered in health care facilities from January 2019 to June 2019 and from January 2021 to June 2021 were included in the study for assessing the socio-demographic, antenatal, natal, post-natal, and new-born characteristics. A semi-structed questionnaire was used for obtaining details regarding pregnancy and COVID-19 status. The neuro-development assessment of the newborn was done in the community using Trivandrum Developmental Screening Chart (TDSC). Chi-square test and Fischer exact test were used to draw association between the maternal and neonatal outcomes during COVID-19 pandemic and the pre-COVID-19 period. A P value of <0.05 was considered statistically significant.

Results

A total of 158 and 220 women delivered in pre-COVID and during COVID, respectively. Out of them, 83 mothers (47.4%) who delivered in 2019 (pre-COVID) and 158 mothers (76.4%) who delivered in 2021 (during pandemic) were contacted. The mean age was 25 ± 3.9 years. The prevalence of anemia was significantly higher during COVID pandemic. The proportion of Rh-negative mothers and other antenatal investigation reports was similar in both the groups. The proportion of high-risk pregnancy is high among mothers who delivered during COVID than the pre-COVID period. On applying multivariate analysis, developmental delay at 3 months was found to be significant among children who were born during pandemic.

Conclusion

A simple tool was used for assessing development milestones, and we have found that newborns delivered during COVID-19 pandemic were reported to have inappropriate developmental milestone at 3 months post-delivery. However, further research needed to assess the neuro-developmental status and follow-up of children born during COVID-19 pandemic for comprehensive neuro-developmental assessment. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.

Airborne respiratory aerosol transport and deposition in a two-person office using a novel diffusion-based numerical model

BACKGROUND

The COVID-19 pandemic was caused by the SARS-CoV-2 coronaviruses transmitted mainly through exposure to airborne respiratory droplets and aerosols carrying the virus.

OBJECTIVE

To assess the transport and dispersion of respiratory aerosols containing the SARS-CoV-2 virus and other viruses in a small office space using a diffusion-based computational modeling approach.

METHODS

A 3-D computational model was used to simulate the airflow inside the 70.2 m3 ventilated office. A novel diffusion model accounting for turbulence dispersion and gravitational sedimentation was utilized to predict droplet concentration transport and deposition. The numerical model was validated and used to investigate the influences of partition height and different ventilation rates on the concentration of respiratory aerosols of various sizes (1, 10, 20, and 50 µm) emitted by continuous speaking.

RESULTS

An increase in the hourly air change rate (ACH) from 2.0 to 5.6 decreased the 1 μm droplet concentration inside the office by a factor of 2.8 and in the breathing zone of the receptor occupant by a factor of 3.2. The concentration at the receptor breathing zone is estimated by the area-weighted average of a 1 m diameter circular disk, with its centroid at the center of the receptor mannequin mouth. While all aerosols were dispersed by airflow turbulence, the gravitational sedimentation significantly influenced the transport of larger aerosols in the room. The 1 and 10 μm aerosols remained suspended in the air and dispersed throughout the room. In contrast, the larger 20 and 50 μm aerosols deposited on the floor quickly due to the gravitational sedimentation. Increasing the partition between cubicles by 0.254 m (10") has little effect on the smaller aerosols and overall exposure.

IMPACT

This paper provides an efficient computational model for analyzing the concentration of different respiratory droplets and aerosols in an indoor environment. Thus, the approach could be used for assessing the influence of the spatial concentration variations on exposure for which the fully mixed model cannot be used.

Mystery of COVID 19: Focusing on important ncRNAs and effective signaling pathways

This article provides a thorough investigation of the essential role of non-coding RNAs (ncRNAs) in the context of COVID-19, emphasizing their impact on the complex molecular dynamics of the viral infection. By conducting a systematic review of existing literature, we identify key ncRNAs involved in different stages of the viral life cycle, modulation of host immune response, and disease progression. The importance of microRNAs, long non-coding RNAs, and other ncRNA types emerges as influential factors in shaping the interaction between the host and the virus. Additionally, the study delves into the effective signaling pathways linked to COVID-19 pathogenesis, uncovering intricate molecular cascades that govern viral entry, replication, and host cell response. This exploration encompasses established pathways such as IL-6/JAK/STAT signaling, highlighting their interplay within the context of COVID-19. By synthesizing this knowledge, our aim is not only to enhance our understanding of the molecular complexities of COVID-19 but also to reveal potential therapeutic targets. Through elucidating the interaction between ncRNAs and signaling pathways, our article seeks to contribute to ongoing efforts in developing targeted interventions against COVID-19, ultimately advancing our ability to address this global health crisis.

Newborn Hospitalizations Before and During COVID-19 Pandemic in Poland: A Comparative Study Based on a National Hospital Registry

Objectives: There are limited data on the impact of the COVID-19 outbreak in Poland on newborn health. The aim of the study is to show recent information on hospitalizations of newborns in Poland in the pre-pandemic and COVID-19 pandemic era. Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized in 2017-2021. Results: The data on which the study was based consisted of a substantial number of 104,450 hospitalization records. Annual hospitalization rate was estimated to be 50.3-51.9 per 1,000 in 2017-2019, 56 per 1,000 in 2020 and it rose to 77.7 per 1,000 in 2021. In comparison to the pre-pandemic period, in the COVID-19 era, we observed significantly more hospitalization cases of newborns affected by maternal renal and urinary tract diseases (p < 0.001), syndrome of infant of mother with gestational diabetes (p < 0.001), maternal complications of pregnancy (p < 0.001). In the COVID-19 era, the prevalence of COVID-19 among newborns was 4.5 cases per 1,000 newborn hospitalizations. Conclusion: The COVID-19 pandemic outbreak could significantly contribute to qualitative and quantitative changes in hospitalizations among newborns.

COVID-19 Resulted in Reduction Trainee Bedside Experience, But No Reduction in Surgical Experience

Purpose

Because of the concerns regarding residency process during the pandemic, this study aimed to investigate the volume of clinical interactions of orthopaedic residents at a tertiary hospital by reporting the number of patients treated in the outpatient clinic, inpatient ward, and operating room.

Methods

This retrospective chart study evaluated variables such as volume of clinical interactions of orthopaedic residents at a tertiary hospital by reporting the number of patients treated in the outpatient clinic, inpatient ward, and operating room, from an orthopaedic department in a tertiary trauma center throughout the COVID-19 pandemic era. Comparing these measures was an indirect evaluation tool for measuring the amount of work completed and clinical exposure gained by the residents.

Results

Occupancy percentage, hospitalization days, admissions to the department, and attendance of the outpatient clinic were all decreased during the pandemic. No significant changes were evident in the total number of surgeries nor the number of elective surgeries during the pandemic.

Conclusions

Overall, a reduction in overall hospitalization days, admissions to the department, total number of visits in the outpatient clinic, and occupancy percentage of the ward was observed during COVID-19. However, there was no difference in the average number of monthly surgeries between the pre-COVID-19 and COVID-19 timeframes.

Level of Evidence

Level III, retrospective comparative review.

Risk of Transmission of COVID-19 from the Mother to the Foetus: A Systematic Review

INTRODUCTION

People's lives have been impacted in every way by the COVID-19 pandemic and it had a variety of effects on pregnancy and childbirth, including decreased access to healthcare providers who can attend to the needs of expectant mothers and their foetuses. These effects can be attributed to the infection's effects on the mother and foetus.

AIM

The aim of this research was to investigate the probability of vertical transmission of COVID-19 from the pregnant mother to the foetus.

METHODS

A comprehensive systematic search was conducted on the PubMed, SCOPUS, and Web of Science databases to identify original research articles published from 2019 to 2021. The search aimed to locate cohort studies, case series, and reports focusing on pregnant individuals with COVID-19, specifically those containing information on COVID-19 testing for foetuses or newborns.

RESULTS

In this systematic review, studies showed that the possibility of vertical transmission from a COVID-19-infected mother to the foetus or neonate is rare.

CONCLUSION

With regards to the theoretical framework proposed regarding the vertical transmission of COVID-19 from the pregnant woman to the foetus or neonate, there exists a potential risk of transmission. Nevertheless, documented instances of confirmed vertical transmission are limited and inadequately documented in the available literature.

Perinatal Outcomes of Newborns of COVID-19-Infected Pregnant Women: An Updated Systematic Review and Meta-Analysis

In this systematic review and meta-analysis, we aimed to review the characteristics and outcomes of the newborns of Coronavirus disease 2019 (COVID-19) infected pregnant women. We conducted an online bibliographic search using the following electronic databases: MEDLINE via PubMed, Scopus, Web of Science, and Cochrane Central. Studies were deemed eligible if they recruited newborns from mothers with confirmed COVID-19 and reported the perinatal outcomes of neonatal COVID-19 cases. A total of 20 studies were included. Neonates born to mothers with positive COVID-19 results have been shown to have significantly lower birth weights (mean difference, MD = -48.54 g, p = 0.04), increased risks of fetal distress (odds ratio, OR = 1.76, p < 0.00001), respiratory distress (OR = 1.96, p = 0.006), premature birth (OR = 2.08, p < 0.00001), neonatal death (OR = 2.20, p = 0.004), and a lower 5-minute Apgar score (OR = 1.44, p = 0.02). Additionally, they were more likely to be admitted to the neonatal intensive care unit (NICU) (OR = 2.25, p = 0.007) and test positive for COVID-19 themselves (OR = 9.88, p = 0.03). However, other parameters, such as risks for malformations, mechanical ventilation, hypoglycemia, and sepsis, appeared to be comparable between the two groups. Maternal infection with COVID-19 during pregnancy is associated with several neonatal outcomes, some of which are adverse and others that do not show significant deviation from norms. While our meta-analysis clearly illustrates heightened risks associated with premature birth, reduced neonatal weight, and other challenges, it also emphasizes that not all neonatal outcomes can be directly attributed to maternal SARS-CoV-2 infection.

Anti-SARS-CoV-2-specific antibodies in human breast milk following SARS-CoV-2 infection during pregnancy: a prospective cohort study

BACKGROUND

While the presence of SARS-CoV-2 in human breast milk is contentious, anti-SARS-CoV-2 antibodies have been consistently detected in human breast milk. However, it is uncertain when and how long the antibodies are present.

METHODS

This was a prospective cohort study including all consecutive pregnant women with confirmed SARS-CoV-2 infection during pregnancy, recruited at six maternity units in Spain and Hong Kong from March 2020 to March 2021. Colostrum (day of birth until day 4 postpartum) and mature milk (day 7 postpartum until 6 weeks postpartum) were prospectively collected, and paired maternal blood samples were also collected. Colostrum samples were tested with rRT-PCR-SARS-CoV-2, and skimmed acellular milk and maternal sera were tested against SARS-CoV-2 specific immunoglobulin M, A, and G reactive to receptor binding domain of SARS-CoV-2 spike protein 1 to determine the presence of immunoglobulins. Then, we examined how each immunoglobulin type in the colostrum was related to the time of infection by logistic regression analysis, the concordance between these immunoglobulins in the colostrum, maternal serum, and mature milk by Cohen's kappa statistic, and the relationship between immunoglobulin levels in mature milk and colostrum with McNemar.

RESULTS

One hundred eighty-seven pregnant women with confirmed SARS-CoV-2 infection during pregnancy or childbirth were recruited and donated the milk and blood samples. No SARS-CoV-2 was found in the human breast milk. Immunoglobulin A, G, and M were present in 129/162 (79·6%), 5/163 (3·1%), and 15/76 (19·7%) colostrum samples and in 17/62 (27·42%), 2/62 (3·23%) and 2/62 (3·23%) mature milk samples, respectively. Immunoglobulin A was the predominant immunoglobulin found in breast milk, and its levels were significantly higher in the colostrum than in the mature milk (p-value < 0.001). We did not find that the presence of immunoglobulins in the colostrum was associated with their presence in maternal, the severity of the disease, or the time when the infection had occurred.

CONCLUSIONS

Since anti-SARS-CoV-2 antibodies are found in the colostrum irrespective of the time of infection during pregnancy, but the virus itself is not detected in human breast milk, our study found no indications to withhold breastfeeding, taking contact precautions when there is active disease.

Likely Vertical Transmission of Neonatal SARS CoV-2 Infection

Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can affect placental function, but the possibility of intrauterine transmission has been debated. Several authors have published inclusion criteria for vertical transmission, but few reports exist that are able to meet the suggested requirements. Despite the fact that the majority of fetuses born to infected mothers do well, others become critically ill. We present a case of likely intrauterine transmission of a neonate born to a mother who was recently symptomatic with a positive SARS CoV-2 polymerase chain reaction (PCR). The parturient complained of decreased fetal movement and presented at 31 2/7 weeks' gestation with a biophysical profile score of 2/10 and required an emergency cesarean delivery. The neonate went on to develop severe leukopenia with signs of sepsis with a positive SARS CoV-2 PCR on day 4 of life and an otherwise pan-negative workup. Meeting criteria for transplacental transmission requires timely collection of several diagnostic studies that are not standard of care. Further research is needed to support the notion that intrauterine/transplacental infection is possible. Collection swabs should be obtained soon after delivery to help diagnose neonatal infection because early diagnosis is crucial to help identify opportunities for intervention.

Histological and immunohistochemical features of the placenta associated with COVID-19: a systematic review and meta-analysis

OBJECTIVE

Aim: To make a systematic review and meta-analysis of published data on the study of histological and immunohistochemical features of the placenta in women who had acute coronavirus infection associated with SARS-CoV-2 ("Covid" placentas) during pregnancy.

PATIENTS AND METHODS

Materials and Methods: The search for literature data is based on the PRISMA methodology); the MEDLINE database (PubMed®) was searched using Medical Subject Headings terms from January 2020 to July 2023. The project was registered in the Open Sience Frame (Project Identifier: DOI 10.17605/OSF.IO/GDR3S, Registration DOI: https://doi.org/10.17605/OSF.IO/H2KPU). Preference was given to studies in which the description of placentas met the requirements of the Amsterdam Placental Workshop Group Consensus Statement.

RESULTS

Results: A total of 31 studies were included; the number of participants whose morphological and histological description of the placentas could be subjected to meta-analysis was 2401, respectively, in the group with a "Covid" history and 1910 - conditionally healthy pregnant women. Pathological changes in the placental complex were not detected in 42±19.62% of pregnant women with a history of Covid. Immunohistochemical examination of placentas preferably focuses on the detection of SARS-CoV-2 spike protein or ACE2. According to currently available studies, in the placentas of women who have had COVID-19 during pregnancy, there are no pathognomic histological patterns specific to this infection and direct damage to the placenta is rarely observed. Histological patterns in "covid" placentas are isolated, most often a combination of lesions in both the maternal and fetal malperfusion.

CONCLUSION

Conclusions: According to currently available studies, in the placentas of women who have had COVID-19 during pregnancy, there are no pathognomic histological patterns specific to this infection and direct damage to the placenta is rarely observed. The probability of infection of the intrauterine fetus by the transplacental hematogenous route is the lowest compared to other routes, which, in our opinion, is a possible explanation for the high frequency of MVM without subsequent infection of the fetus.

Impact of fatalistic approaches in the health crisis: COVID-19 example

BACKGROUND

When faced with a health crisis, most people tend to seek solutions through modern or traditional medicine. However, there is a group of people who tend to take a fatalistic approach to health crises and tend not to do what is necessary. When such approaches are exhibited in disadvantaged groups, there may be a chain reaction resulting in much more important problems.

OBJECTIVE

The aim of this study is to determine whether the fatalistic approach is realized during a health crisis period in people 65 years and older, pregnant women, people with chronic diseases, and healthcare workers who are considered disadvantaged. Researchers also examined whether there were sociodemographic characteristics that made a difference in these attitudes among those who were determined to have a fatalistic approach.

METHODS

The research was conducted with a quantitative method. The sample calculation was performed and it was decided to reach 196 people. A self-report scale was used for fatalism.

RESULTS

It was determined that the participants had a moderate level of fatalism. It was seen that there was a difference between the groups in terms of fatalistic behavior. It was observed that women, divorced people, people without alcohol and smoking habits, people who live alone, and people who think their health is poor tend to behave more fatalistic.

CONCLUSION

The tendency to show fatalistic behavior was found to be higher in the group of 65 years and older. Sociodemographic characteristics are associated with fatalistic behavior.

Complications in Pregnant Women and Newborns Before and During the COVID-19 Pandemic

Background

One of the high-risk groups exposed to the coronavirus disease 2019 (COVID-19) pandemic was pregnant women at risk of pregnancy complications due to a weakened immune system and inability to use various drugs to treat COVID-19. Accordingly, this study was conducted to investigate the complications in pregnancy before and during the COVID-19 pandemic.

Material and Methods

This cross-sectional study was performed on all pregnant women in Shahroud, Iran. The time interval from February 18, 2019, to February 17, 2020, was considered before the COVID-19 pandemic and from February 18, 2020, to February 17, 2021, was considered the COVID-19 pandemic. Sampling was conducted by census and included 6851 pregnant women. The required information was extracted from hospitals' health deputy registration system and high-risk pregnancy registration program.

Result

Based on the findings, hypertension disorder, gestational diabetes, placental abruption, pre-eclampsia, cesarean section, hospitalization in neonatal intensive care unit (NICU), preterm birth, and hospitalization in other hospital wards increased by 1.88%, 1.93%, 0.12%, 0.45%, 5.45%, 1.00%, 1.20%, and 1.40%, respectively, in 2020 compared to 2019. A statistically significant difference was also observed between them (p < 0.05). Also, the regression results showed that the chances of high blood pressure, Gestational Diabetes Mellitus (GDM), placental abruption, and cesarean section were increased by 10.91, 1.53, 5.51, and 2.83 times, respectively.

Conclusions

Pregnancy complications have increased during the COVID-19 pandemic. As a result, there is a need to take appropriate health and medical measures to reduce the risks associated with the COVID-19 epidemic for pregnant women and neonates.

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes in a Large Health Maintenance Organization

OBJECTIVE

This study aimed to examine whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy is associated with increased odds of perinatal complications and viral transmission to the infant.

STUDY DESIGN

A retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals (April 6, 2020-February 28, 2021) was performed using data extracted from electronic health records (EHRs). During this time polymerize chain reaction (PCR)-based tests for SARS-CoV-2 was universally offered to all pregnant women at labor and delivery admission, as well as earlier in the pregnancy, if they were displaying symptoms consistent with SARS-CoV-2 infection or a possible exposure to the virus. Adjusted odds ratio (aOR) was used to estimate the strength of associations between positive test results and adverse perinatal outcomes.

RESULTS

Of 35,123 women with a singleton pregnancy, 2,203 (6%) tested positive for SARS-CoV-2 infection with 596 (27%) testing positive during the first or second trimester and 1,607 (73%) during the third trimester. Women testing positive were younger than those who tested negative (29.7 [5.4] vs. 31.1 [5.3] years; mean [standard deviation (SD)]; p < .001). The SARS-CoV-2 infection tended to increase the odds of an abnormal fetal heart rate pattern (aOR: 1.10; 95% confidence interval [CI]: 1.00, 1.21; p = 0.058), spontaneous preterm birth (aOR: 1.28; 95% CI: 1.03, 1.58; p = 0.024), congenital anomalies (aOR: 1.69; 95% CI: 1.15, 2.50; p = 0.008), and maternal intensive care unit admission at delivery (aOR: 7.44; 95% CI: 4.06, 13.62; p < 0.001) but not preeclampsia/eclampsia (aOR: 1.14; 95% CI: 0.98, 1.33; p = 0.080). Eighteen (0.8%) neonates of mothers who tested positive also had a positive SARS-CoV-2 test after 24 hours of birth, but all were asymptomatic during the neonatal period.

CONCLUSION

These findings suggest that prenatal SARS-CoV-2 infection increases the odds of some adverse perinatal outcomes. The likelihood of vertical transmission from the mother to the fetus was low (0.3%), suggesting that pregnancy complications resulting from SARS-CoV-2 infection pose more risk to the baby than transplacental viral transmission.

KEY POINTS

· SARS-CoV-2 infection is associated with increased odds of adverse perinatal outcomes.. · The odds of specific adverse outcomes were greater when a mother was infected earlier in pregnancy.. · The proportion of vertical transmission from mother to fetus was 0.3%.

The clinical manifestations and pregnancy outcomes of COVID-19 infection at a tertiary care hospital

Objective

To evaluate clinical presentation and pregnancy outcomes in pregnant women with Covid-19 infection in our local tertiary care from lower middle-income country.

Methods

A retrospective study was conducted at Obstetrics & Gynecology department, Sheikh Saeed Memorial Hospital (SSMH) of The Indus Hospital and Health Network (IHHN) from March 2020 to August 2021. Data of 422 admitted pregnant women with COVID-19 infection was retrieved for demographic and clinical information, laboratory tests, pregnancy outcome, and neonatal outcomes on RED-Cap and analyzed on SPSS 26. Univariate and multivariable logistic regression analyses were performed to estimate odds ratios (OR) for symptomology with categorical variables and feto-maternal outcome.

Results

Of the total 422 pregnant women, 24.4% were symptomatic, 74.7% exhibiting mild symptoms. Largely reported symptoms were fever (71.8%), cough (36.9%) and body ache (35.0%); while odds of symptomatic COVID-19 infection was less in educated pregnant women (OR 0.3; 95% CI 0.1-0.9) compared to uneducated. Amongst maternal comorbidities, odds of having symptomatic COVID-19 infection were 3.8 times (95% CI 1.1-13.0) in women with chronic hypertension and 5.5 times (95% CI 2.9-10.4) in women with diabetes. Symptomatic women had significantly greater incidence of miscarriages (p= 0.009), PPROM (p= 0.001), preterm birth (p= 0.000), preeclampsia (p= 0.000), placental abruption (p= 0.006) and maternal ICU admission (p= 0.000) than asymptomatic patients. Still birth was higher (6.4% vs 1.3%, p-value= 0.013) in symptomatic group. The odds of having severe maternal outcome were higher (OR=3.5; 95% CI 1.9-6.0) in symptomatic pregnant women.

Conclusion

Majority of pregnant women were asymptomatic. Symptomatic women with COVID-19 infection had an increased risk of adverse feto-maternal outcome.

Neonatal outcomes of maternal prenatal coronavirus infection

The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

Effects of novel coronavirus Omicron variant infection on pregnancy outcomes: a retrospective cohort study from Guangzhou

Objective

Since 2022, Omicron has been circulating in China as a major variant of the novel coronavirus, but the effects of infection with Omicron variants on pregnant women and newborns are unknown. The purpose of this study was to determine the clinical characteristics of Omicron infection during pregnancy and its effect on pregnancy outcomes.

Methods

This study retrospectively analyzed the data of 93 confirmed cases of novel coronavirus infection and 109 non-infected patients admitted to the isolation ward of Guangdong Maternal and Child Health Hospital from December 1, 2022 to January 31, 2023, and statistically analyzed the clinical features of Omicron variant infection during pregnancy and its impact on pregnancy outcomes. Further effects of underlying diseases on Omicron infection in pregnant women were analyzed.

Results

The incubation period of COVID-19 infection was 0.99±0.86 days, 94.38% of patients had fever or other respiratory symptoms, the lymphocyte count in the infected group was lower than that in the uninfected group, and the lymphocyte count was further reduced in the patients with pregnancy complications or complications. Compared with the uninfected group, APTT and PT were prolonged, platelet count and fibrinogen were decreased in the infected group, all of which had statistical significance. COVID-19 infection during pregnancy increased the rate of cesarean section compared to uninfected pregnant patients, and COVID-19 infection in gestational diabetes resulted in a 4.19-fold increase in cesarean section rate. There was no statistically significant difference in gestational age between the two groups. The incidence of intrauterine distress, turbidity of amniotic fluid and neonatal respiratory distress were higher in the infection group. No positive cases of neonatal COVID-19 infection have been found.

Conclusion

The patients infected with omicron during pregnancy often have febrile respiratory symptoms with lymphocyopenia, but the incidence of severe disease is low. Both Omicron infection and gestational diabetes further increase the incidence of cesarean section, and this study found no evidence of vertical transmission of Omicron.

A review on sterilization methods of environmental decontamination to prevent the coronavirus SARS-CoV-2 (COVID-19 virus): A new challenge towards eco-friendly solutions

In recent years, the COVID-19 pandemic is currently wreaking havoc on the planet. SARS-CoV-2, the Severe Acute Respiratory Syndrome Coronavirus, is the current term for this outbreak. Reports about this novel coronavirus have been presented since the pandemic's breakout, and they have demonstrated that it transmits rapidly from person to person, primarily by droplets in the air. Findings have illustrated that SARS-CoV-2 can survive on surfaces from hours to days. Therefore, it is essential to find practical solutions to reduce the virus's impact on human health and the environment. This work evaluated common sterilization methods that can decontaminate the environment and items. The goal is that healthcare facilities, disease prevention organizations, and local communities can overcome the new challenge of finding eco-friendly solutions. Further, a foundation of information encompassing various sterilization procedures and highlighting their limits to choose the most appropriate method to stop disease-causing viruses in the new context has been presented. The findings of this crucial investigation contribute to gaining insight into the comprehensive sterilization approaches against the coronavirus for human health protection and sustainable environmental development.

A retrospective observational study on maternal and neonatal outcomes of COVID-19: Does the mild SARS-CoV-2 infection affect the outcome?

Background

Currently, several SARS-CoV-2 variants, including Omicron, are still circulating globally. This underscores the necessity for a comprehensive understanding of their impact on obstetric and neonatal outcomes in pregnant women, even in cases of mild infection.

Methods

We conducted a retrospective, single-center observational study to investigate the association between gestational SARS-CoV-2 infection and maternal-fetal outcomes in the Chinese population. The study enrolled 311 pregnant patients with SARS-CoV-2 infection (exposure group) and 205 uninfected pregnant patients (control group). We scrutinized the hospital records to collect data on demographics, clinical characteristics, and maternal and neonatal outcomes for subsequently comparison.

Results

Similar characteristics were observed in both groups, including maternal age, height, BMI, gravidity, parity, and comorbidities (p > 0.05). A majority (97.4%) of pregnant women in the exposure group with COVID-19 experienced mild clinical symptoms, with fever (86.5%) and cough (74.3%) as the primary symptoms. The exposure group exhibited significantly higher incidences of cesarean section and fetal distress compared to the control group (p < 0.05). Furthermore, pregnant women in the exposure group showed reduced levels of hemoglobin and high-sensitivity C-reactive protein, while experiencing significantly increased levels of lymphocytes, prothrombin time, alanine aminotransferase, and aspartate aminotransferase (p < 0.05). Notably, recent SARS-CoV-2 infection prior to delivery appeared to have an adverse impact on liver function, blood and coagulation levels in pregnant women. When comparing the two groups, there were no significant differences in the postpartum hemorrhage rate, premature birth rate, birth weight, neonatal asphyxia rate, neonatal department transfer rate, and neonatal pneumonia incidence.

Conclusions

Our study suggests that mild COVID-19 infection during pregnancy does not have detrimental effects on maternal and neonatal outcomes. However, the increased risks of events such as fetal distress and cesarean section, coupled with potential alterations in physical function, reveal the consequences of SARS-CoV-2 infection during pregnancy, even in mild cases. These findings emphasize the importance of proactive management and monitoring of pregnant individuals with COVID-19.

COVID-19: A Challenge to the Safety of Assisted Reproduction

There is an increased risk of becoming pregnant through fertility treatments using assisted reproductive technology (ART) during the COVID-19 pandemic. The aim of this review is to gather comprehensive data from the existing literature on the potential risks of fertility management during the pandemic period, and outline strategies to mitigate them, with a focus on the hormonal and surgical procedures of ART. A comprehensive search of the scientific literature on COVID-19 in relation to fertility was conducted in the PubMed database using the keywords "coronavirus," "COVID-19," "SARS-CoV-2" and "pregnancy," "fertility," "urogenital system," "vertical transmission," "assisted human reproduction," "controlled ovarian stimulation," "oocyte retrieval," "in vitro fertilization," "hormones," "surgical procedures," "embryos," "oocytes," "sperm," "semen," "ovary," "testis," "ACE-2 receptor," "immunology," "cytokine storm," and "coagulation," from January 2020-July 2022. Published data on pregnancy and COVID-19, and the interaction of the urogenital system and SARS-CoV-2 is reported. The immunologic and prothrombotic profiles of patients with COVID-19, and their increased risks from controlled ovarian stimulation (COS) and ART surgeries, and how these procedures could facilitate COVID-19 and/or contribute to the severity of the disease by enhancing the cytokine storm are summarized. Strategies to prevent complications during COS that could increase the risks of the disease in pre-symptomatic patients are considered. The impact of SARS-CoV-2 on pre-symptomatic infertile patients presents a challenge to find ways to avoid the increased hormonal, immunologic, and prothrombotic risks presented by the use of COS in ART protocols during the COVID-19 outbreak. Safe ART procedures and recommendations are highlighted.

Evaluation of pregnancy outcomes in mothers with COVID-19 infection: a systematic review and meta-analysis

Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that reported adverse pregnancy outcomes in pregnant women with COVID-19 infection. A literature search was performed in PubMed and Scopus up to 1 September 2022, for retrieving original articles published in the English language assessing the association between COVID-19 infection and adverse pregnancy outcomes. Finally, in this review study, of 1790 articles obtained in the initial search, 141 eligible studies including 1,843,278 pregnant women were reviewed. We also performed a meta-analysis of a total of 74 cohort and case-control studies. In this meta-analysis, both fixed and random effect models were used. Publication bias was also assessed by Egger's test and the trim and fill method was conducted in case of a significant result, to adjust the bias. The result of the meta-analysis showed that the pooled prevalence of preterm delivery, maternal mortality, NICU admission and neonatal death in the group with COVID-19 infection was significantly more than those without COVID-19 infection (p<.01). A meta-regression was conducted using the income level of countries. COVID-19 infection during pregnancy may cause adverse pregnancy outcomes including of preterm delivery, maternal mortality, NICU admission and neonatal death. Pregnancy loss and SARS-CoV2 positive neonates in Lower middle income are higher than in High income. Vertical transmission from mother to foetus may occur, but its immediate and long-term effects on the newborn are unclear.

Maternal Characteristics and Outcomes Affected by COVID-19 Pandemic in Indonesia

Aim

Compare the impact of the intervention on the outcome of pregnancy of patients receiving obstetric care with and non-COVID-19 diagnosis at a tertiary referral hospital located in the region of East Java, Indonesia.

Methods

This was a cross-sectional analysis of 694 pregnant women. These patients' information was acquired based on the medical data obtained from the hospital. The Mann-Whitney test was used to analyze the disparities among the factors examined in this research investigation.

Results

There was a statistically significant difference in length of stay (LOS). It has been shown that individuals diagnosed with COVID-19 often exhibit a longer length of stay (LOS) in healthcare facilities compared to those who do not have the infection. More than fifty percent of patients gave birth by cesarean section, 83 in COVID-19 group and 283 in non-COVID-19 group. The most prevalent complications among COVID-19 patients were maternal infectious and parasitic diseases (1.3 vs 0%), prolonged labor (12.3 vs 9.6%) and puerperal complications (0.6 vs 0%). In 40.9% of COVID-19 patients, acute respiratory distress syndrome (ARDS) was encountered. Infection due to COVID-19 had no discernible impact on the outcomes of pregnancy.

Conclusion

Numerous interventions, including cesarean delivery in COVID-19 and non-COVID-19 patients, require reevaluation. It is imperative to undertake a comprehensive reassessment of the health care delivery system, with particular emphasis on enhancing the efficacy of the referral system.

Navigation of Knowledge: the Impact of COVID-19 on Pregnancy-a Bibliometric Analysis

Since the outbreak of COVID-19, countries around the world have faced huge economic and social burdens. SARS-COV-2 may exist in nature for a long time due to the diversity of its different variants. Pregnant women and newborns as vulnerable groups will suffer serious health threats. Bibliometrics as a method of summarizing publications can be used to extract important achievements and hot topics in this field. We search the target publications from the Web of Science Core collection database, and then use Microsoft Office Excel, CiteSpace, R, Scimago, and VOSviewer for visual analysis. Finally, we included 1709 publications from 2998 institutions in 104 countries. The number of publications has exploded since the COVID-19 pandemic in 2019. Among them, the USA, China, Britain, and Italy have higher quantity and quality. We identified important journals, authors, keywords, and references in this field. Anxiety, stress, risk of pregnancy complications, and vaccine safety and acceptance have received extensive attention from scholars during the COVID-19 pandemic and will continue to be urgent issues to be addressed in the future. Most of the current studies fall into the category of case reports and clinical data analysis. COVID-19 has been linked to serious pregnancy complications and mental illness, and vaccination during pregnancy is recommended to protect both mother and fetus. Further large-scale cohort studies and discovery of molecular mechanisms are needed in this field.

Association of Late Radiographic Assessment of Lung Edema Score with Clinical Outcome in Patients with Influenza-Associated Acute Respiratory Distress Syndrome

Background: Influenza virus infection leads to acute pulmonary injury and acute respiratory distress syndrome (ARDS). The Radiographic Assessment of Lung Edema (RALE) score has been proposed as a reliable tool for the evaluation of the opacity of chest X-rays (CXRs). This study aimed to examine the RALE scores and outcomes in patients with influenza-associated ARDS. Methods: Patients who were newly diagnosed with influenza-associated ARDS from December 2015 to March 2016 were enrolled. Two independent reviewers scored the CXRs obtained on the day of ICU admission and on days 2 and 7 after intensive care unit (ICU) admission. Results: During the study, 47 patients had influenza-associated ARDS. Five died within 7 days of ICU admission. Of the remaining 42, non-survivors (N = 12) had higher Sequential Organ Failure Assessment scores (SOFA) at ICU admission and higher day 7 RALE scores than survivors (N = 30). The day 7 RALE score independently related to late in-hospital mortality (aOR = 1.121, 95% CI: 1.014-1.240, p = 0.025). Conclusions: The RALE score for the evaluation of opacity on CXRs is a highly reproducible tool. Moreover, RALE score on day 7 was an independent predictor of late in-hospital mortality in patients with influenza-associated ARDS.

Does COVID-19 Infection during Pregnancy Increase the Appearance of Congenital Gastrointestinal Malformations in Neonates?

BACKGROUND

COVID-19 was an infection that was capable of bringing the entire world to a standstill position within a period of days to months. Despite the advancements in the medical sector, the contagion was difficult to control and costed the lives of millions of people worldwide. Many short- and long-term effects are witnessed even to date in people that contracted the disease. Pregnant females had to suffer not only the devastating effects of the virus, but also the psycho-social impact of the lockdown. The impact of COVID-19 infection during pregnancy causing decreased antenatal care or hypoxemic episodes due to severe respiratory distress and whether it could lead to the appearance of congenital gastrointestinal malformation in neonates is still unclear. The aim of our study was to analyze if COVID-19 infection during pregnancy could increase the incidence of gastric malformations in neonates born from these women.

MATERIALS AND METHODS

We sifted the files of all neonates admitted into our hospital between January 2022 and December 2022, and based on inclusion and exclusion criteria, we included the cases having gastrointestinal congenital malformations during the COVID-19 pandemic. We performed a single-center, retrospective, observational descriptive study. We further divided the patients based on the anatomical location of the malformation. We also took down details of the evolution of pregnancy and whether the mother had contracted a SARS-CoV-2 infection during the pregnancy. Details regarding the Apgar score, days of intensive care admission, sex, and nutrition were the key findings studied.

RESULTS

A total of 47 neonates were found to have digestive anomalies, among which, based on the anatomical locations, the number of malformation cases found at the level of the esophagus were 15, while 16 occurred at the level of the pylorus; we found 12 cases of malformation of the duodenum, and four cases had malformation of the rectum. Out of these 47 neonates, 38.3% were females and 61.7% were males. A total of 58% were preemies, among which 9% had intra-uterine growth retardation (IUGR), and 42% were full-term newborns, among which 4% had intra-uterine growth retardation (IUGR). A total of 45% of the births were primiparous pregnancies and 55% were from multiparous females. A total of 14 mothers were found to have tested positive for COVID-19 during the course of pregnancy (p-value = 0.23); many had mild symptoms but were not tested.

CONCLUSIONS

COVID-19 can affect the wellbeing of the pregnant female and their fetus. Larger studies can help gain extensive knowledge as to whether COVID-19 also has the potential to result in congenital gastrointestinal anomalies in children born from COVID-19 positive mothers. In our study, only a few infants born with this pathology were found to be born from COVID-19 positive mothers. Hence, it is difficult to conclude or exclude a direct correlation between the infection and the congenital malformations.

Impact of the COVID-19 Pandemic on Births, Vaginal Deliveries, Cesarian Sections, and Maternal Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study

Purpose

The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in healthcare. The primary objective of the study was to assess the impact of the COVID-19 pandemic on birth, vaginal delivery, and cesarian section (c-section) rates. The secondary objective was to compare the maternal mortality before and after the pandemic.

Patients and Methods

Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software.

Results

There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: -24.0-33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9-23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53-6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.

Conclusion

Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial.

Pregnancy and SARS-CoV-2 infection with a focus on its vertical transmission, breastfeeding, cord blood banking, and vaccination during COVID-19 infection

The SARS-CoV-2 outbreak led to a health crisis worldwide. This infection can infect individuals, particularly pregnant women. In this review, we tried to find the possibility of vertical transmission of COVID-19 and investigate the effects of COVID-19 on pregnancy, breastfeeding, cord blood banking, and the effects of recommended vaccines on pregnant and lactating women. Keywords include COVID-19, congenital infection, SARS-CoV-2, pregnancy, and COVID-19 vaccines. Vertical transmission of SARS-CoV-2 was searched in scientific databases, such as PubMed, Google Scholar, and Scopus. The criteria for including studies in this article are the study of SARS-CoV-2 infection in pregnant women, fetuses, and neonates during pregnancy and while breastfeeding, and also the effect of COVID-19 vaccines on them. There are several conflicting results in the transmission of SARS-CoV-2 from the maternal-fetal interface. Since many neonates born from COVID-19-infected mothers had no signs of this infection, the possibility of SARS-CoV-2 congenital transmission cannot be confirmed. Also, SARS-CoV-2-infected women can breastfeed their babies if they have mild symptoms. Up till now, no adverse effect of COVID-19 vaccines has been identified on mothers, infants, and the fertility of men or women. Even so, more investigations are needed on the long-term effects of COVID-19 vaccines.

The COVID-19 Pandemic and Psychopathological symptoms in pregnant women in Spain

BACKGROUND

During the COVID-19 pandemic, pregnant women are exposed to potentially harmful stressors that might affect their health. The direct consequences that SARS-CoV-2 may have on perinatal mental health are still unknown.

OBJECTIVE

The present study aimed to explore the impact of the COVID-19 pandemic on psychopathological symptoms in a sample of Spanish pregnant women.

METHODS

A sample of 186 pregnant women was assessed using the revised Symptoms Check List-90 during the first lockdown in Spain.

RESULTS

The results showed clinical scores on the obsession and compulsion, anxiety and phobic anxiety subscales, as well as on the severity indexes. Phobic anxiety was the only variable that was inversely correlated with age and the number of previous miscarriages. A linear regression model showed that age was inversely associated with phobic anxiety scores. A younger age was associated with higher levels of phobic anxiety symptoms.

CONCLUSIONS

Our results indicated that younger pregnant women and women in the first trimester of pregnancy were more vulnerable to the effects of stress and concerns about COVID-19.

Neonatal Outcomes of Premature Infants Born to Women with the Novel Coronavirus (SARS-CoV-2) Infection: A Case Control Study

OBJECTIVE

Novel coronavirus disease 2019 (COVID-19) is a disease associated with atypical pneumonia caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The first cases of COVID-19 were reported in Wuhan at the end of 2019. Transmission usually occurs via infected droplets and close personal contact; the possibility of vertical transmission is still under debate. This retrospective study aimed to analyze clinical characteristics of premature infants born to mothers with symptomatic COVID-19 disease.

STUDY DESIGN

This case control study compared the clinical and laboratory data of 20 premature infants born to mothers infected with SARS-CoV-2 with sex and gestational age-matched historical controls.

RESULTS

The median gestational age and birth weight in both groups were similar. Respiratory distress developed in 11 (55.5%) infants in study group and 19 (47.5%) infants in control group. Mechanical ventilation and endotracheal surfactant administration rates were similar. Median duration of hospitalization was 8.5 (2-76) days in study group and 12 days in historical controls. Real-time reverse-transcription polymerase chain reaction tests (RT-PCR) of nasopharyngeal swab samples for SARS-CoV-2 were found to be negative twice, in the first 24 hours and later at 24 to 48 hours of life. No neutropenia or thrombocytopenia was detected in the study group. Patent ductus arteriosus, bronchopulmonary dysplasia, and necrotizing enterocolitis rates were similar between groups. No mortality was observed in both groups.

CONCLUSION

To the best of our knowledge, this is one of the few studies evaluating the clinical outcomes of premature infants born to SARS-CoV-2 infected mothers. There was no evidence of vertical transmission of SARS-CoV-2 from symptomatic SARS-CoV-2-infected women to the neonate in our cohort. The neonatal outcomes also seem to be favorable with no mortality in preterm infants.

KEY POINTS

· SARS-CoV-2 pandemic is a challenge for pregnant women.. · Neonatal outcomes of premature infants born to mothers infected with SARS-CoV-2 not well defined.. · SARS-CoV-2 infection seems to have no adverse effect on mortality and morbidity in premature infants..

Viruses and Human Milk: Transmission or Protection?

Human milk (HM) is considered the best source of nutrition for infant growth and health. This nourishment is unique and changes constantly during lactation to adapt to the physiological needs of the developing infant. It is also recognized as a potential route of transmission of some viral pathogens although the presence of a virus in HM rarely leads to a disease in an infant. This intriguing paradox can be explained by considering the intrinsic antiviral properties of HM. In this comprehensive and schematically presented review, we have described what viruses have been detected in HM so far and what their potential transmission risk through breastfeeding is. We have provided a description of all the antiviral compounds of HM, along with an analysis of their demonstrated and hypothesized mechanisms of action. Finally, we have also analyzed the impact of HM pasteurization and storage methods on the detection and transmission of viruses, and on the antiviral compounds of HM. We have highlighted that there is currently a deep knowledge on the potential transmission of viral pathogens through breastfeeding and on the antiviral properties of HM. The current evidence suggests that, in most cases, it is unnecessarily to deprive an infant of this high-quality nourishment and that the continuation of breastfeeding is in the best interest of the infant and the mother.

The Emotional Experience of Mexican Women with SARS-CoV-2 during Pregnancy-A Qualitative Study

Pregnant women have been considered a high-risk group for SARS-CoV-2 infection; the impact of the disease on the health of a mother and her child is still being studied. The emotional impact of the pandemic on pregnant women has been extensively studied. Emotional distress is proposed as a perspective to explain the emotional manifestations in women during this stage as something common rather than pathological. The objective of this study was to explore the emotional experience of women who tested positive for SARS-CoV-2 towards the end of their pregnancy, during the first and second waves of COVID-19 in Mexico. A qualitative study was carried out: 18 pregnant women with COVID-19 were interviewed. A thematic analysis of the data was performed, resulting in 3 main themes and 14 subthemes. The COVID-19-infected mothers-to-be experienced mild to moderate emotional distress. It was more intense for those with comorbidities. This distress was aggravated during obstetrical complications and comorbidities, as well as during COVID-19 and postpartum. The emotional distress was appeased by both the perception of medical care and social support. The emotional distress of pregnant women with COVID-19 requires emotional support to reduce its impact.

Intrauterine transmission of SARS-CoV-2 to and prenatal ultrasound abnormal findings in the fetus of a pregnant woman with mild COVID-19

BACKGROUND

Whether intrauterine transmission of COVID-19 occurs remains uncertain, and it remains unclear whether the disease affects fetuses. We present a case of intrauterine transmission of SARS-CoV-2 infection and the prenatal ultrasonographic findings of the fetus in a pregnant woman with mild COVID-19.

CASE PRESENTATION

A 30-year-old woman was admitted to our hospital for ultrasound examination in January 2023 at 26+ 3 weeks' gestation. Twenty-one days prior, her COVID-19 nucleic acid test was positive, and she had mild symptoms, including fever (38.3 °C), headache, chills, ankle pain and cough. After receiving symptomatic treatment, she fully recovered. Prenatal ultrasound revealed that the placenta was diffusely distributed with punctate echogenic foci, hepatomegaly, and the volume of bilateral lungs decreased significantly, with enhanced echo. In addition, we found that the surface of the fetal brain demonstrated widened gyri with a flattened surface. The prenatal MRI confirmed these fetal abnormalities. Amniotic fluid was tested for SARS-CoV-2, and the sample tested was positive for the virus. After careful consideration, the pregnant woman decided to terminate the pregnancy.

CONCLUSION

The intrauterine transmission of COVID-19 is certain. Moreover, the intrauterine transmission of COVID-19 may cause abnormalities in various organs of the fetus.

Impacts of pregnancy and menopause on COVID-19 severity: a systematic review and meta-analysis of 4.6 million women

BACKGROUND

Corona Virus Disease 2019 (COVID-19) pandemic is still a public health emergency of international concern. However, whether pregnancy and menopause impact the severity of COVID-19 remain unclear.

AIM

This study is performed to investigate the truth.

DESIGN

Study appraisal and synthesis follows PRISMA guideline. Meta-analysis is performed in random-effects model.

METHODS

PubMed, Embase, Cochrane database, Central, CINAHL, ClinicalTrials.gov, WHO COVID-19 database and WHO-ICTRP are searched until 28 March 2023.

RESULTS

In total, 57 studies (4 640 275 COVID-19 women) were analyzed. Pregnant women were at a lower risk of severe COVID-19, intensive care unit (ICU) admission and disease mortality compared to those nonpregnant women with comparable comorbidities. In contrast, pregnant women with more prepregnancy comorbidities were at a higher risk of severe COVID-19, ICU admission and invasive mechanical ventilation (IMV). In addition, pregnant women with pregnancy complications had a significantly increased risk of severe COVID-19 and ICU admission. Menopause increased COVID-19 severity, IMV requirement and disease mortality. Hormone replacement therapy inhibited COVID-19 severity in postmenopausal women. Premenopausal and postmenopausal women had a lower chance of severe illness than age-matched men. The impact of pregnancy on COVID-19 severity was significant in Americans and Caucasians, whereas the effect of menopause on COVID-19 severity was only significant in Chinese.

CONCLUSIONS

Pregnancy and menopause are protective and risk factors for severe COVID-19, respectively. The protective role of pregnancy on COVID-19 is minimal and could be counteracted or masked by prepregnancy or pregnancy comorbidities. The administration of estrogen and progesterone may prevent severe COVID-19.

Comprehensive molecular expression profiling of SARS-CoV-associated factors in the endometrium across the menstrual cycle and elevated susceptibility in women with recurrent pregnancy loss

Objective: To evaluate the dynamic expression profiling alterations of SARS-CoV-2-associated molecules within the fertile human endometrium throughout the menstrual cycle. Furthermore, to explore the inherent vulnerability of the endometrium to SARS-CoV-2 infection among women experiencing recurrent pregnancy failure, including both recurrent implantation failures (RIF) and recurrent pregnancy losses (RPL). Method: The present study employed multiple datasets to investigate the expression patterns of SARS-CoV-2-associated genes. Firstly, a single-cell RNA-sequencing dataset comprising endometrial samples from 19 healthy women across the menstrual cycle was utilized. Additionally, two microarray datasets encompassing 24 women with RIF, and 24 women with RPL during the peri-implantation phase were included. To complement these analyses, immunohistochemical (IHC) staining was performed on endometrial samples collected from 30 women with RIF, 30 women with RPL, and 20 fertile controls recruited specifically during the implantation period. Results: The investigation revealed a moderate expression percentage of CTSL (22%), TMPRSS4 (15%), FURIN (16%) and MX1 (9%) in endometrium. Conversely, the expression percentages of ACE2 (1%) and TMPRSS2 (4%) were relatively low. Notably, the expression of BSG exhibited an increment towards the window of implantation, reaching its peak during the middle secretary phase. Furthermore, a significant reduction (p < 0.05) in TMPRSS2 expression was observed in the RIF group compared to the control group. While the expression of BSG was significantly increased (p < 0.05) in the RPL group, findings that were corroborated by the IHC staining results. Conclusion: The findings of this study indicate a noteworthy upregulation of BSG expression in the endometrium of women with RPL. These results suggest an augmented susceptibility of endometrium to SARS-CoV-2 infection, potentially contributing to unfavorable pregnancy outcomes.

Role of Lactate Dehydrogenase and Lymphocyte Count as Predictors of Poor Perinatal Outcomes in COVID-19-Infected Pregnancies Requiring Hospitalization and Delivery: A Retrospective Cohort Study

INTRODUCTION

Physiological, hormonal, or biochemical changes may be related to the increased morbidity of COVID-19 during pregnancy. Our knowledge remains limited about which pregnant women will worsen and develop complications. The aim was to evaluate the maternal, fetal, and neonatal outcomes in hospitalized pregnant women who delivered while infected with acute COVID-19 and to investigate the possible predictors of poor prognosis in a tertiary pandemic center.

METHODS

A retrospective cohort study was conducted on pregnant women who required termination or delivery during a COVID-19 infection in a tertiary hospital. Serum markers were analyzed to determine any possible association and the predictive value of these markers to show poor maternal, fetal, and/or neonatal outcomes.

RESULTS

Out of 45 patients, 12 had maternal complications (Group 1) and 33 had no maternal complications (Group 2). The mean lymphocyte at hospital admission was measured as 1,175.83 ± 362.0 and 1,735.30 ± 746.1 in Groups 1 and 2, respectively (p=0.02). The lymphocyte count measured at hospital admission showed significance in predicting poor maternal outcome, with an area under the curve (AUC) of 0.737 (95% CI:0.578 to 0.897) and a cut-off value of 1,110 mcL with 82% sensitivity and 67% specificity. Nineteen of the 45 women had fetal complications. Receiver operating characteristic analysis showed maternal lactate dehydrogenase as a significant predictor for poor fetal outcome with a cut-off value of 213 U/L (AUC:0.719; 95% CI:0.566 to 0.872) with 85% sensitivity and 60% specificity.

CONCLUSION

The lymphocyte count can be used as a predictor of poor maternal outcome and lactate dehydrogenase demonstrates poor fetal outcome during hospitalization.

The influence of SARS-CoV-2 on the immune system elements and on the placental structure. Clinical, histological and immunohistochemical study

BACKGROUND

The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy remain relatively unknown.

AIM

We present this original paper where we analyzed 60 parturients, at term, 30 without associated infection (C-) and 30 with associated infection (C+), present at birth.

METHODS

We analyzed the blood count and placental microscopic structure through classical and immunohistochemical staining and observed the placental areas affected by the presence of SARS-CoV-2.

RESULTS

SARS-CoV-2 infection was accompanied by a decrease in the number of lymphocytes, the number of platelets and the presence of placental structural changes, identifying extensive areas of amyloid deposits, placental infarcts, vascular thrombosis, syncytial knots, with a decrease in placental vascular density and the presence of infection in the cells located at decidual level, at syncytiotrophoblast level and at the level of the cells of the chorionic plate, still without overcoming this barrier and without causing any fetal infection in the analyzed cases.

CONCLUSIONS

This study shows that the invasion of SARS-CoV-2 in the placenta can produce significant structural changes, with a decrease in placental vascular density that can have significant implications on proper fetal perfusion. Also, the presence of immunoreactivity at the level of decidua, the placental villi, as well as the chorionic plate proves that the virus can overcome the maternal-fetal barrier. However, in the analyzed cases there were no fetal infections at birth, which may show that local placental factors can be a protective filter for the fetus.

Histological Alterations in Placentas of Pregnant Women with SARS-CoV-2 Infection: A Single-Center Case Series

This study aimed to investigate the histopathological changes associated with SARS-CoV-2 infection in placentas. A case series of anatomopathological analysis was conducted on the placentas of pregnant women with SARS-CoV-2 who delivered between March and December 2020 at Santo Amaro Hospital (HSA) in Salvador, Brazil. Out of the 29 placentas examined, the median weight was 423.0 (IQR: 385.0-521.0) g. Among them, 58.3% (n = 14) had inadequate weight relative to the newborn's weight. The histopathological findings revealed that 86.2% (n = 25) of the placentas had poorly defined lobes, and the fetal and maternal surface color was normal in 89.7% (n = 26) and 93.1% (n = 27), respectively. Additionally, 51.7% (n = 15) of the umbilical cords displayed hypercoiling. The most frequent microscopic finding was infarction, present in 35.3% (n = 6) of the cases, followed by 11.8% (n = 2) for each of chorioamnionitis, chronic villitis, focal perivillositis, and laminar necrosis. Analysis of the umbilical cords identified 23.5% (n = 4) cases of intervillous thrombosis, while amnion analysis showed 13.8% (n = 4) cases of squamous metaplasia. Extraplacental membrane examination revealed fibrin deposition in 93.1% (n = 27) of the cases, necrosis in 62.0% (n = 18), calcifications in 51.7% (n = 15), cysts in 37.9% (n = 11), neutrophilic exudate in 17.2% (n = 5), thrombosis in 13.7% (n = 4), and delayed placental maturation in 6.9% (n = 2). All analyzed placentas exhibited histopathological changes, primarily vascular and inflammatory, which indicate SARS-CoV-2 infection in term pregnancies. These alterations could be associated with impaired placental function, fetal growth restriction, preeclampsia, and prematurity. However, further prospective studies are required to validate the type, prevalence, and prognosis of each of these changes.

History, origin, transmission, genome structure, replication, epidemiology, pathogenesis, clinical features, diagnosis, and treatment of COVID-19: A review

In December, 2019, pneumonia triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surfaced in Wuhan, China. An acute respiratory illness named coronavirus disease 2019 (COVID-19) is caused by a new coronavirus designated as SARS-CoV-2. COVID-19 has surfaced as a major pandemic in the 21st century as yet. The entire world has been affected by this virus. World Health Organization proclaimed COVID-19 pandemic as a public health emergency of international concern on January 30, 2020. SARS-CoV-2 shares the same genome as coronavirus seen in bats. Therefore, bats might be its natural host of this virus. It primarily disseminates by means of the respiratory passage. Evidence revealed human-to-human transmission. Fever, cough, tiredness, and gastrointestinal illness are the manifestations in COVID-19-infected persons. Senior citizens are more vulnerable to infections which can lead to dangerous consequences. Various treatment strategies including antiviral therapies are accessible for the handling of this disease. In this review, we organized the most recent findings on COVID-19 history, origin, transmission, genome structure, replication, epidemiology, pathogenesis, clinical features, diagnosis, and treatment strategies.

Pattern-recognition receptors (PRRs) in SARS-CoV-2

Pattern recognition receptors (PRRs) are specific sensors that directly recognize various molecules derived from viral or bacterial pathogens, senescent cells, damaged cells, and apoptotic cells. These sensors act as a bridge between nonspecific and specific immunity in humans. PRRs in human innate immunity were classified into six types: toll-like receptors (TLR), C-type lectin receptors (CLRs), nucleotide-binding and oligomerization domain (NOD)-like receptors (NLRs), absent in melanoma 2 (AIM2)-like receptors (ALRs), retinoic acid-inducible gene I (RIG-I)-like receptors (RLRs), and cyclic GMP-AMP (cGAMP) synthase (cGAS). Numerous types of PRRs are responsible for recognizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which is immensely effective in prompting interferon responses. Detection of SARS-CoV-2 infection by PRRs causes the initiation of an intracellular signaling cascade and subsequently the activation of various transcription factors that stimulate the production of cytokines, chemokines, and other immune-related factors. Therefore, it seems that PRRs are a promising potential therapeutic approach for combating SARS-CoV-2 infection and other microbial infections. In this review, we have introduced the current knowledge of various PRRs and related signaling pathways in response to SARS-CoV-2.