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Ozel A, Ozel CS, Yuksel E, Çakmak A, Davutoglu EA, Muhcu M. SARS-CoV-2 in early pregnancy-does it affect the aneuploidy screening markers and cause pregnancy loss? Ir J Med Sci 2024; 193:295-301. [PMID: 37428422 DOI: 10.1007/s11845-023-03454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND It is known that vertical transmission of various infections poses a potential risk to the fetus, especially in early pregnancy. Potential effects of SARS-CoV-2 infection on early pregnancy and placental formation and functions still remain unknown. AIM To determine the alterations of prenatal aneuploidy screening markers in a group of pregnant women who were SARS-CoV-2 positive during the first trimester. The secondary goal was to assess pregnancy loss rates. METHOD The study group consisted of pregnant women who were diagnosed with mild forms of SARS-CoV-2 infection before the screening test at any time in early pregnancy. The control group included pregnant women who were not diagnosed with SARS-CoV-2 infection during their pregnancy. SARS-CoV-2 infection was detected by RT-PCR in the nasopharyngeal swab samples. Multivariate linear regression analysis was performed due to evaluate effect of SARS-CoV-2 infection on NT and serum aneuploidy screening parameters taking maternal age and gestational age which the COVID-19 RT-PCR test result was positive into account. RESULTS We did not find any significant difference between the COVID-19-positive and COVID-negative groups in gestational age at screening, sonographic measurements of CRL, NT, and serum levels of PAPP-A, free hCG, and triple test serum markers even after accounting for maternal age and gestational age which the COVID-19 RT-PCR test result was positive. There was no statistically significant difference in pregnancy loss. CONCLUSIONS We did not find any evidence for unfavorable prenatal biochemical, ultrasound markers of fetal aneuploidy screening tests, and pregnancy loss rates in our study group.
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Affiliation(s)
- Aysegul Ozel
- Department of Obstetrics and Gynecology, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey.
| | - Canan Satır Ozel
- Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ecem Yuksel
- Department of Obstetrics and Gynecology, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Aysegul Çakmak
- Department of Obstetrics and Gynecology, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ebru Alici Davutoglu
- Cerrahpasa Faculty of Medicine, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Muhcu
- Department of Obstetrics and Gynecology, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
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Braga A, Sun SY, Zaconeta ACM, Junior AT, Luz AG, Osanan G, Duarte G, Ramos JGL, Wender MCO, Nomura RMY, Francisco RPV, Borges VTM, Mattar R. Increase in cesarean sections in Brazil - a call to reflection. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:109-112. [PMID: 37105193 PMCID: PMC10166644 DOI: 10.1055/s-0043-1768454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Antonio Braga
- Department of Obstetrics and Gynecology, Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
- Department of Maternal Child, Fluminense Federal University, Niterói, RJ, Brazil
- Vassouras University, Vassouras, RJ, Brazil
| | - Sue Yazaki Sun
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Alberto Trapani Junior
- Departamento de Ginecologia e Obstetrícia, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Adriana Gomes Luz
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Gabriel Osanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - José Geraldo Lopes Ramos
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Celeste Osório Wender
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roseli Mieko Yamamoto Nomura
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Rosiane Mattar
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Atzl C, Dertinger S. COVID-19 und Plazentapathologie: 3 Fälle aus dem Kreißsaal. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1842-6368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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4
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Ayala-Ramírez P, González M, Escudero C, Quintero-Arciniegas L, Giachini FR, Alves de Freitas R, Damiano AE, García-Robles R. Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Pregnancy. A Non-systematic Review of Clinical Presentation, Potential Effects of Physiological Adaptations in Pregnancy, and Placental Vascular Alterations. Front Physiol 2022; 13:785274. [PMID: 35431989 PMCID: PMC9005899 DOI: 10.3389/fphys.2022.785274] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
In December 2019, the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) rapidly spread to become a pandemic. To date, increasing evidence has described the potential negative impact of SARS-CoV-2 infection on pregnant women. Although the pathophysiology of coronavirus disease 2019 (COVID-19) is not entirely understood, there is emerging evidence that it causes a severe systemic inflammatory response associated with vascular alterations that could be of special interest considering some physiological changes in pregnancy. Additionally, these alterations may affect the physiology of the placenta and are associated with pregnancy complications and abnormal histologic findings. On the other hand, data about the vaccine against SARS-CoV-2 are limited, but the risks of administering COVID-19 vaccines during pregnancy appear to be minimal. This review summarizes the current literature on SARSCoV2 virus infection, the development of COVID-19 and its relationship with physiological changes, and angiotensin-converting enzyme 2 (ACE2) function during pregnancy. We have particularly emphasized evidence coming from Latin American countries.
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Affiliation(s)
- Paola Ayala-Ramírez
- School of Medicine, Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
- *Correspondence: Paola Ayala-Ramírez,
| | - Marcelo González
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
- Laboratorio de Investigación Materno-Fetal (LIMaF), Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Marcelo González,
| | - Carlos Escudero
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
- Laboratory of Vascular Physiology, Department of Basic Sciences, Faculty of Sciences, Universidad del Bio-Bio, Chillan, Chile
| | - Laura Quintero-Arciniegas
- Perinatal Medicine Seedbed, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Physiological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernanda R. Giachini
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil
| | | | - Alicia E. Damiano
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO)- CONICET- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Cátedra de Biología Celular y Molecular, Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Reggie García-Robles
- Department of Physiological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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5
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Aharon D, Gounko D, Lee JA, Copperman AB, Flisser E. The Impact of the Coronavirus Disease 19 Pandemic on Early Pregnancy Outcomes Among Patients Undergoing In Vitro Fertilization Treatment. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:473-478. [PMID: 34841393 PMCID: PMC8617588 DOI: 10.1089/whr.2021.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/14/2022]
Abstract
Objective: To determine if pregnancy rates (PRs) or pregnancy loss rates (PLRs) were altered in patients undergoing single, euploid frozen-thawed embryo transfer (FET) during the initial peak of the Coronavirus Disease 19 (COVID-19) pandemic. Materials and Methods: This was a retrospective cohort study performed in a single academic center. Patients undergoing single, euploid FET cycles from January to May 2017–2020 were included. Cycles with FET performed in January–May of 2020 (“COVID-surge cohort”) were compared to cycles with FET performed in January–May of 2017–2019 (“pre-COVID cohort”). Pregnancy rate (PR), clinical pregnancy rate (CPR), pregnancy loss rate (PLR), and clinical pregnancy loss rate (CLR) were compared between the cohorts. Results: A total of 2629 single, euploid FET cycles were included: 2070 from January to May, 2017–2019 and 559 from January to May 2020. PR was similar when comparing FET performed from January to May 2020 (COVID-surge) to those performed from January to May, 2017–2019 (pre-COVID) (77.6% vs. 73.7%, p = 0.06), while CPR was higher among the COVID-surge compared to the pre-COVID cohort (65.5% vs. 60.0%, p = 0.02). No differences were seen in PLR and CLR among the COVID-surge and pre-COVID cohorts (28.3% vs. 32.0%, p = 0.08; 15.0% vs. 16.5%, p = 0.50). PR, CPR, PLR, and CLR were similar when comparing individual months between the cohorts. Adjusted analysis showed no differences in PR, CPR, PLR, or CLR when comparing the cohorts overall or when comparing corresponding individual months in the two time periods. Conclusion: PRs and PLRs were not decreased when SARS-CoV-2 transmission was widespread in our geographic area, suggesting that high COVID-19 transmission does not compromise early pregnancy outcomes.
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Affiliation(s)
- Devora Aharon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Reproductive Medicine Associates of New York, New York, New York, USA
| | - Dmitry Gounko
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Joseph A Lee
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Alan B Copperman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Reproductive Medicine Associates of New York, New York, New York, USA
| | - Eric Flisser
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Reproductive Medicine Associates of New York, New York, New York, USA
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6
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Arco-Torres A, Cortés-Martín J, Tovar-Gálvez MI, Montiel-Troya M, Riquelme-Gallego B, Rodríguez-Blanque R. Pharmacological Treatments against COVID-19 in Pregnant Women. J Clin Med 2021; 10:jcm10214896. [PMID: 34768416 PMCID: PMC8584594 DOI: 10.3390/jcm10214896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/05/2021] [Accepted: 10/16/2021] [Indexed: 12/11/2022] Open
Abstract
The recent respiratory virus known as SARS-CoV-2 has caused millions of deaths worldwide, causing great uncertainty due to the lack of a specific treatment, which has been mitigated by the use of various drugs traditionally used against other types of pathologies. Pregnancy presents special physiological conditions that expose the pregnant woman and the foetus to greater risk. Pregnant women are often excluded from trials due to possible risk of toxicity or side effects, resulting in a lack of knowledge about the use of drugs and treatments during pregnancy. The main objective of this review was to compile existing knowledge about currently available drug treatments for COVID-19 in pregnant women. The review report met the criteria of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) review protocol and was registered with the registration number CRD42021251036. The electronic databases searched were Scopus, PubMed, CINAHL and SciELO. Finally, 22 articles were included, resulting in an analysis of drugs with an acceptable safety profile in the treatment of pregnant women with COVID-19.
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Affiliation(s)
- Ana Arco-Torres
- Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (A.A.-T.); (J.C.-M.)
| | - Jonathan Cortés-Martín
- Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (A.A.-T.); (J.C.-M.)
| | - María Isabel Tovar-Gálvez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (M.M.-T.); (B.R.-G.)
- Correspondence:
| | - María Montiel-Troya
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (M.M.-T.); (B.R.-G.)
| | - Blanca Riquelme-Gallego
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (M.M.-T.); (B.R.-G.)
| | - Raquel Rodríguez-Blanque
- Delegación Territorial de Salud y Familias, Grupo de Investigación CTS-1068, 18014 Granada, Spain;
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7
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Bahrami R, Schwartz DA, Karimi-Zarchi M, Javaheri A, Dastgheib SA, Ferdosian F, Noorishadkam M, Mirjalili SR, Neamatzadeh H. Meta-analysis of the frequency of intrauterine growth restriction and preterm premature rupture of the membranes in pregnant women with COVID-19. Turk J Obstet Gynecol 2021; 18:236-244. [PMID: 34580931 PMCID: PMC8480208 DOI: 10.4274/tjod.galenos.2021.74829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022] Open
Abstract
The impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in pregnancy has yet to be determined. Some studies indicate that SARSCoV- 2 infection may be associated with a higher risk of adverse outcomes in pregnant women. Here, we performed a meta-analysis to estimate the frequency of intrauterine growth restriction (IUGR) and preterm premature rupture of the membranes (PPROM) in pregnant women with Coronavirus disease-2019 (COVID-19). A comprehensive search was performed in various databases, such as PubMed, Scopus, SciELO, MedRxiv, and Web of Science, to find all relevant studies published before 10 February 2021. Cross-sectional and consecutive case series reporting the pregnancy outcomes of COVID-19 were included. A total of 24 studies, including 8 studies on IUGR and 16 studies on PPROM, were selected. Pooled data showed that the frequencies of IUGR and PPROM in pregnant women with COVID-19 were 2.6% and 9.9%, respectively. Analyses stratified by ethnicity showed that the frequencies of IUGR in Asian and Caucasian COVID-19-infected pregnant women were 2.9% and 2.0%, respectively. Moreover, the frequencies of PPROM in Asian and Caucasian COVID-19-infected pregnant women were 10.2% and 5.8%, respectively. This meta-analysis showed that the frequencies of IUGR and PPROM in COVID-19-infected pregnant women were 2.6% and 9.9%, respectively. However, well-designed, large-scale and multicenter clinical studies are required to improve and validate these results.
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Affiliation(s)
- Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - David A. Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
| | - Mojgan Karimi-Zarchi
- Department of Obstetrics and Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atiyeh Javaheri
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzad Ferdosian
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmood Noorishadkam
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Reza Mirjalili
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Babarinsa IA, Okunoye GO, Odukoya O. Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-1) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in pregnancy - An overview. Eur J Obstet Gynecol Reprod Biol 2021; 263:171-175. [PMID: 34218204 PMCID: PMC8219955 DOI: 10.1016/j.ejogrb.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 01/15/2023]
Abstract
Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-1) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections, like most other viruses that affect the respiratory tract can cause severe maternal illness and adverse pregnancy outcomes. They are not only highly transmissible (acquired through droplets), but Host reservoirs such as dromedary camels for MERS-CoV and masked palm civet for SARS-CoV-1 are critical links in the onset of outbreaks. Clinically they present with flu-like symptoms and therefore a high index of suspicion is required to ensure timely diagnosis and tailored management. Although there are not many reported series on these infections in pregnancy they seem to be associated with an increased risk of preterm delivery and maternal mortality. Diagnosis is made by PCR from nasopharyngeal swabs. There are currently no effective anti-viral agents for these viruses but following infections various agents have been administered to patients. The most important aspect of management should be early identification of deterioration and intensive support and prevention of transmission. Our understanding of the evidence of the impact of both infections on pregnancies suggests the potential for future repeat outbreaks, hence the importance of maintaining vigilance across healthcare systems.
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Affiliation(s)
- Isaac A Babarinsa
- Women Wellness and Research Centre, Hamad Medial Corporation, Qatar; Qatar University College of Medicine, Qatar.
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9
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Abstract
Ein besonderes Augenmerk bei der durch das Severe-acute-respiratory-syndrome-Coronavirus‑2 (SARS-CoV-2) hervorgerufenen Coronaviruskrankheit 2019 (COVID-19) wurde von Beginn an auf die Gruppe der Schwangeren gelegt. Nach einer Einführung zur Immunabwehr der Plazenta und viralen plazentaren Infektionen, beschreiben wir die morphologischen Veränderungen der Plazenta bei SARS-CoV-2-Infektion der Mutter, ziehen Vergleiche zur SARS-Epidemie und diskutieren die Frage der vertikalen Transmission von SARS-CoV‑2 von der Mutter auf das Neugeborene. Die häufigsten pathologischen Befunde der Plazenta bestehen in Zeichen der maternalen und auch fetalen Malperfusion sowie immunologisch bzw. thromboinflammatorisch vermittelten Veränderungen. Es finden sich Infarkte, deziduale Vaskulopathie sowie Thromben im fetalen Kreislauf und Vermehrung avaskulärer Villi. Daneben zeigen sich in einigen Fällen Entzündungsreaktionen mit Villitis und Intervillositis sowie eine Vaskulitis fetaler Gefäße. Zudem konnte der Nachweis erbracht werden, dass SARS-CoV‑2 die Plazenta direkt infizieren kann. Somit ist auch eine vertikale Transmission möglich. Ein COVID-19-spezifisches Schädigungsmuster der Plazenta liegt bislang nicht vor, obwohl der Nachweis von fetaler Thrombovaskulitis, Villitis und Intervillositis sowie einer fetalen und maternalen Malperfusion in Analogie zu der bereits bekannten allgemeinen Pathophysiologie von COVID-19 (Entzündungsreaktion und Mikrozirkulationsstörung) interpretiert werden könnte. Der Nachweis viraler RNA in den fetalen Kompartimenten der Plazenta/der Nabelschnur zeugt von der vertikalen SARS-CoV‑2 Transmission.
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10
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Crowther S, Maude R, Zhao IY, Bradford B, Gilkison A. New Zealand maternity and midwifery services and the COVID-19 response: A systematic scoping review. Women Birth 2021; 35:213-222. [PMID: 34215539 PMCID: PMC8179056 DOI: 10.1016/j.wombi.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022]
Abstract
Problem COVID-19 guidance from professional and health organisations created uncertainty leading to professional and personal stress impacting on midwives providing continuity of care in New Zealand (NZ). The COVID-19 pandemic resulted in massive amounts of international and national information and guidance. This guidance was often conflicting and not suited to New Zealand midwifery. Aim To examine and map the national and international guidance and information provided to midwifery regarding COVID-19 and foreground learnt lessons for future similar crises. Methods A systematic scoping review informed by Arksey and O’Malley’s five-stage framework. A range of sources from grey and empirical literature was identified and 257 sources included. Findings Four categories were identified and discussed: (1) guidance for provision of maternity care in the community; (2) guidance for provision of primary labour and birth care; (3) Guidance for midwifery care to women/wāhine with confirmed/suspected COVID-19 infection, including screening processes and management of neonates of infected women/wāhine (4) Guidance for midwives on protecting self and own families and whānau (extended family) from COVID-19 exposure. Conclusion Guidance was mainly targeted and tailored for hospital-based services. This was at odds with the NZ context, where primary continuity of care underpins practice. It is evident that those providing continuity of care constantly needed to navigate an evolving situation to mitigate interruptions and restrictions to midwifery care, often without fully knowing the personal risk to themselves and their own families. A key message is the need for a single source of evidence-based guidance, regularly updated and timestamped to show where advice changes over time.
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Affiliation(s)
- Susan Crowther
- Faculty of Health and Environmental Sciences, Center for Midwifery and Women's Health Research, Auckland University of Technology, Auckland, New Zealand.
| | - Robyn Maude
- School of Nursing, Midwifery and Health Practice, Te Herenga Waka Victoria University of Wellington, New Zealand.
| | - Ivy Y Zhao
- WHO Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Billie Bradford
- School of Nursing, Midwifery and Health Practice, Te Herenga Waka Victoria University of Wellington, New Zealand.
| | - Andrea Gilkison
- Faculty of Health and Environmental Sciences, Center for Midwifery and Women's Health Research, Auckland University of Technology, Auckland, New Zealand.
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11
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Pountoukidou A, Potamiti-Komi M, Sarri V, Papapanou M, Routsi E, Tsiatsiani AM, Vlahos N, Siristatidis C. Management and Prevention of COVID-19 in Pregnancy and Pandemic Obstetric Care: A Review of Current Practices. Healthcare (Basel) 2021; 9:467. [PMID: 33920781 PMCID: PMC8071177 DOI: 10.3390/healthcare9040467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Constant accumulation of data results in continuous updates of guidelines and recommendations on the proper management of pregnant women with COVID-19. This study aims to summarize the up-to-date information about the prevention and management of suspected/confirmed SARS-CoV-2 infection in obstetric patients and obstetric care during prenatal, intrapartum, and postpartum periods. We conducted a comprehensive literature search in PubMed for relevant English-written full-text reviews. We also included relevant guidelines and recommendations. In women with a low risk for infection and uncomplicated pregnancy, elective and non-urgent appointments should be postponed or completed through telehealth. Vaccination should be discussed and distance and personal hygiene preventive measures should be recommended. Routine ultrasound examinations should be adjusted in order to minimize exposure to the virus. Standardized criteria should evaluate the need for admission. Women with moderate/high-risk for infection should be isolated and tested with RT-PCR. The mode and timing of delivery should follow routine obstetric indications. In case of infection, glucocorticoids are recommended in critically ill pregnant women, after individualized evaluation. During labor and concomitant infection, the duration of the first two stages should be reduced as possible to decrease aerosolization, while minimization of hemorrhage is essential during the third stage. Close maternal monitoring and adequate oxygenation when necessary always remain a prerequisite. Discharge should be considered on the first or second day postpartum, also depending on delivery mode. Breastfeeding with protective equipment is recommended, as its benefits outweigh the risks of neonatal infection. Recommendations are currently based on limited available data. More original studies on infected pregnant women are needed to establish totally evidence-based protocols of care for these patients.
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Affiliation(s)
- Argyro Pountoukidou
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
| | - Maria Potamiti-Komi
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
| | - Vrisiis Sarri
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
| | - Michail Papapanou
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
| | - Eleni Routsi
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
| | - Anna Maria Tsiatsiani
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece
| | - Charalampos Siristatidis
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (A.P.); (M.P.-K.); (V.S.); (M.P.); (E.R.); (A.M.T.); (N.V.)
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece
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Hui L, Ghidini A. 40 years of prenatal diagnosis in 2020. Prenat Diagn 2020; 40:1623-1626. [PMID: 33373073 DOI: 10.1002/pd.5867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alessandro Ghidini
- Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, Virginia, USA
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Menter T, Mertz KD, Jiang S, Chen H, Monod C, Tzankov A, Waldvogel S, Schulzke SM, Hösli I, Bruder E. Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion. Pathobiology 2020; 88:69-77. [PMID: 32950981 PMCID: PMC7573905 DOI: 10.1159/000511324] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
Since the outbreak of coronavirus disease 2019 (COVID-19), there has been a debate whether pregnant women are at a specific risk for COVID-19 and whether it might be vertically transmittable through the placenta. We present a series of five placentas of SARS coronavirus 2 (SARS-CoV-2)-positive women who had been diagnosed with mild symptoms of COVID-19 or had been asymptomatic before birth. We provide a detailed histopathologic description of morphological changes accompanied by an analysis of presence of SARS-CoV-2 in the placental tissue. All placentas were term deliveries (40th and 41st gestational weeks). One SARS-CoV-2-positive patient presented with cough and dyspnoea. This placenta showed prominent lymphohistiocytic villitis and intervillositis and signs of maternal and foetal malperfusion. Viral RNA was present in both placenta tissue and the umbilical cord and could be visualized by in situ hybridization in the decidua. SARS-CoV-2 tests were negative at the time of delivery of 3/5 women, and their placentas did not show increased inflammatory infiltrates. Signs of maternal and/or foetal malperfusion were present in 100% and 40% of cases, respectively. There was no transplacental transmission to the infants. In our cohort, we can document different time points regarding SARS-CoV-2 infection. In acute COVID-19, prominent lymphohistiocytic villitis may occur and might potentially be attributable to SARS-CoV-2 infection of the placenta. Furthermore, there are histopathological signs of maternal and foetal malperfusion, which might have a relationship to an altered coagulative or microangiopathic state induced by SARS-CoV-2, yet this cannot be proven considering a plethora of confounding factors.
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Affiliation(s)
- Thomas Menter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Sizun Jiang
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Han Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Cécile Monod
- Department of Obstetrics and Antenatal Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Salome Waldvogel
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Sven M. Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Irene Hösli
- Department of Obstetrics and Antenatal Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Elisabeth Bruder
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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