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Kyriacou C, Yang W, Kapur S, Maheetharan S, Pikovsky M, Parker N, Barcroft J, Bobdiwala S, Sur S, Stalder C, Gould D, Ofili-Yebovi D, Day A, Unsworth N, Wilkes EH, Tan T, Bourne T. Ambulatory human chorionic gonadotrophin (hCG) testing: a verification of two hCG point of care devices. Clin Chem Lab Med 2024; 62:664-673. [PMID: 37886834 DOI: 10.1515/cclm-2023-0703] [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: 07/05/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Quantitative human chorionic gonadotropin (hCG) measurements are used to manage women classified with a pregnancy of unknown location (PUL). Two point of care testing (POCT) devices that quantify hCG are commercially available. We verified the i-STAT 1 (Abbott) and the AQT 90 FLEX (Radiometer) prior to use in PUL triage. METHODS Tests for precision, external quality assurance (EQA), correlation, hook effect and recovery were undertaken alongside a POCT usability assessment during this prospective multi-center verification. RESULTS Coefficients of variation ranged between 4.0 and 5.1 % for the three i-STAT 1 internal quality control (IQC) solutions and between 6.8 and 7.3 % for the two AQT IQC solutions. Symmetric differences in POCT EQA results when compared with laboratory and EQA stock values ranged between 3.2 and 24.5 % for the i-STAT 1 and between 3.3 and 36.9 % for the AQT. Correlation coefficients (i-STAT 1: 0.96, AQT: 0.99) and goodness of fit curves (i-STAT 1: 0.92, AQT: 0.99) were excellent when using suitable whole blood samples. An hCG hook effect was noted with the i-STAT 1 between 572,194 and 799,089 IU/L, lower than the hook effect noted with the AQT, which was between 799,089 and 1,619,309 IU/L. When hematocrit concentration was considered in sample types validated for use with each device, hCG recovery was 108 % with the i-STAT 1 and 98 % with the AQT. The i-STAT 1 scored lower on usability overall (90/130) than the AQT (121/130, p<0.001, Mann-Whitney). CONCLUSIONS Both hCG POCT devices were verified for use in clinical practice. Practical factors must also be considered when choosing which device to use in each unit.
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Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Dede Ofili-Yebovi
- Early Pregnancy Assessment Unit, Chelsea and Westminster Hospital, London, UK
| | - Andrea Day
- Early Pregnancy Assessment Unit, West Middlesex University Hospital, London, UK
| | - Nick Unsworth
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Edmund H Wilkes
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tricia Tan
- Biochemistry Unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Kyriacou C, Ledger A, Bobdiwala S, Ayim F, Kirk E, Abughazza O, Guha S, Vathanan V, Gould D, Timmerman D, Van Calster B, Bourne T. Updating M6 pregnancy of unknown location risk-prediction model including evaluation of clinical factors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:408-418. [PMID: 37842861 DOI: 10.1002/uog.27515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/19/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Ectopic pregnancy (EP) is a major high-risk outcome following a pregnancy of unknown location (PUL) classification. Biochemical markers are used to triage PUL as high vs low risk to guide appropriate follow-up. The M6 model is currently the best risk-prediction model. We aimed to update the M6 model and evaluate whether performance can be improved by including clinical factors. METHODS This prospective cohort study recruited consecutive PUL between January 2015 and January 2017 at eight units (Phase 1), with two centers continuing recruitment between January 2017 and March 2021 (Phase 2). Serum samples were collected routinely and sent for β-human chorionic gonadotropin (β-hCG) and progesterone measurement. Clinical factors recorded were maternal age, pain score, bleeding score and history of EP. Based on transvaginal ultrasonography and/or biochemical confirmation during follow-up, PUL were classified subsequently as failed PUL (FPUL), intrauterine pregnancy (IUP) or EP (including persistent PUL (PPUL)). The M6 models with (M6P ) and without (M6NP ) progesterone were refitted and extended with clinical factors. Model validation was performed using internal-external cross-validation (IECV) (Phase 1) and temporal external validation (EV) (Phase 2). Missing values were handled using multiple imputation. RESULTS Overall, 5473 PUL were recruited over both phases. A total of 709 PUL were excluded because maternal age was < 16 years or initial β-hCG was ≤ 25 IU/L, leaving 4764 (87%) PUL for analysis (2894 in Phase 1 and 1870 in Phase 2). For the refitted M6P model, the area under the receiver-operating-characteristics curve (AUC) for EP/PPUL vs IUP/FPUL was 0.89 for IECV and 0.84-0.88 for EV, with respective sensitivities of 94% and 92-93%. For the refitted M6NP model, the AUCs were 0.85 for IECV and 0.82-0.86 for EV, with respective sensitivities of 92% and 93-94%. Calibration performance was good overall, but with heterogeneity between centers. Net Benefit confirmed clinical utility. The change in AUC when M6P was extended to include maternal age, bleeding score and history of EP was between -0.02 and 0.01, depending on center and phase. The corresponding change in AUC when M6NP was extended was between -0.01 and 0.03. At the 5% threshold to define high risk of EP/PPUL, extending M6P altered sensitivity by -0.02 to -0.01, specificity by 0.03 to 0.04 and Net Benefit by -0.005 to 0.006. Extending M6NP altered sensitivity by -0.03 to -0.01, specificity by 0.05 to 0.07 and Net Benefit by -0.005 to 0.006. CONCLUSIONS The updated M6 model offers accurate diagnostic performance, with excellent sensitivity for EP. Adding clinical factors to the model improved performance in some centers, especially when progesterone levels were not suitable or unavailable. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Kyriacou
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - A Ledger
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - F Ayim
- Department of Gynaecology, Hillingdon Hospital NHS Trust, London, UK
| | - E Kirk
- Department of Gynaecology, Royal Free NHS Foundation Trust, London, UK
| | - O Abughazza
- Department of Gynaecology, Royal Surrey County Hospital, Guildford, UK
| | - S Guha
- Department of Gynaecology, Chelsea and Westminster NHS Trust, London, UK
| | - V Vathanan
- Department of Gynaecology, Wexham Park Hospital, London, UK
| | - D Gould
- Department of Gynaecology, St Mary's Hospital, London, UK
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Gynecology, University Hospital Leuven, Leuven, Belgium
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - T Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Gynecology, University Hospital Leuven, Leuven, Belgium
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Kyriacou C, Kapur S, Jeyapala S, Parker N, Yang W, Pikovsky M, Bobdiwala S, Barcroft J, Maheetharan S, Sur S, Stalder C, Gould D, Syed S, Tan T, Bourne T. Beta-human chorionic gonadotrophin point of care testing for the management of pregnancy of unknown location. Reprod Biomed Online 2024; 48:103643. [PMID: 38262209 DOI: 10.1016/j.rbmo.2023.103643] [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: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 01/25/2024]
Abstract
RESEARCH QUESTION Does a commercially available quantitative beta-human chorionic gonadotrophin (BHCG) point of care testing (POCT) device improve workflow management in early pregnancy by performing comparably to gold standard laboratory methods, and is the performance of a validated pregnancy of unknown location (PUL) triage strategy maintained using POCT BHCG results? DESIGN Women classified with a PUL between 2018 and 2021 at three early pregnancy units were included. The linear relationship of untreated whole-blood POCT and serum laboratory BHCG values was defined using coefficients and regression. Paired serial BHCG values were then incorporated into the validated M6 multinomial logistic regression model to stratify the PUL as at high risk or at low risk of clinical complications. The sensitivity and negative predictive value were assessed. The timings required for equivocal POCT and laboratory care pathways were compared. RESULTS A total of 462 PUL were included. The discrepancy between 571 laboratory and POCT BHCG values was -5.2% (-6.2 IU/l), with a correlation coefficient of 0.96. The 133 PUL with paired 0 and 48 h BHCG values were compared using the M6 model. The sensitivity for high-risk outcomes (96.2%) and negative predictive values (98.5%) was excellent for both. Sample receipt and laboratory processing took 135 min (421 timings), compared with 12 min (91 timings) when using POCT (P < 0.0001). CONCLUSIONS POCT BHCG values correlated well with laboratory testing measurements. The M6 model retained its performance when using POCT BHCG values. Using the model with POCT may improve workflow and patient care without compromising on effective PUL triage.
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Affiliation(s)
- Christopher Kyriacou
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shikha Kapur
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Sobanakumari Jeyapala
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Nina Parker
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Wei Yang
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Margaret Pikovsky
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shabnam Bobdiwala
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jennifer Barcroft
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Shanuja Maheetharan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Shyamaly Sur
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Catriona Stalder
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Deborah Gould
- Gynaecology Emergency Unit, Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College London, London, UK
| | - Shabana Syed
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Hillingdon Hospital, London, UK
| | - Tricia Tan
- Biochemistry unit, Department of Laboratory Diagnostics, Hammersmith Hospital, Imperial College London, London, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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Albakri AA, Alzahrani MM, Alghamdi SH. Medical Imaging in Pregnancy: Safety, Appropriate Utilization, and Alternative Modalities for Imaging Pregnant Patients. Cureus 2024; 16:e54346. [PMID: 38500900 PMCID: PMC10945608 DOI: 10.7759/cureus.54346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/20/2024] Open
Abstract
This article reviews the existing literature on diagnostic and medical imaging of pregnant women, the risks and safety measures of different medical imaging modalities, and alternative modalities for imaging pregnant patients. Different medical imaging modalities such as MRI, CT scan, ultrasound, nuclear medicine, and X-ray imaging help to evaluate women with recognized or unrecognized pregnancies and identify any underlying complications among pregnant patients. Fetuses are more sensitive to radiation and the effects of medical imaging as compared to adults since they have a rapidly developing cell system. During cell proliferation, migration, and differentiation, fetuses suffer greatly from imaging radiation since they are developing under a dynamic system. To ensure safety, pregnant women should discuss the benefits and risks of medical imaging with their physicians. In addition, radiologists should not perform any medical imaging procedure without the patient's consent, unless the patient cannot make any sound decision. Fetal risks of medical imaging include slow growth and development of the fetus, abortion, malformations, impaired brain function, abnormal childhood growth, and neurological development. Diagnostic imaging procedures are necessary when a condition that needs medical evaluation arises during pregnancy such as appendicitis.
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Affiliation(s)
| | | | - Saeed H Alghamdi
- Interventional Radiology, King Fahad General Hospital, Al Baha, SAU
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Gurbuz H, Basol G, Altintas MM, Kuru B. The impact of the first wave of the COVID-19 pandemic on hospital admissions and treatment management of ectopic pregnancy. Turk J Emerg Med 2023; 23:238-243. [PMID: 38024190 PMCID: PMC10664196 DOI: 10.4103/tjem.tjem_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the clinical features and treatment strategies applied to the patients with ectopic pregnancy admitted to our tertiary care center before and during the pandemic. METHODS Women aged 18-45 years, who were admitted to the hospital with a diagnosis of ectopic pregnancy in the pre- and postpandemic periods, were included in this case-control study. RESULTS A total of 173 patients, 116 patients before the pandemic and 57 patients during the pandemic, were included in the study. The rate of admissions from the emergency department was higher during the pandemic than before the pandemic (P = 0.003). The rupture was detected significantly higher during the outbreak (13/116 [11.2%]) than before the pandemic (16/57 [28.1%]) (P = 0.009). While conservative treatment was applied more frequently in the prepandemic period, it was observed that patients were treated surgically more frequently during the pandemic period (P = 0.003). While laparoscopic surgery was preferred before the pandemic, laparotomy was applied to all patients during the pandemic (P < 0.001). CONCLUSIONS In the first wave of the outbreak, there were delays in the diagnosis of ectopic pregnancies, and these patients presented with ruptures more frequently than before the pandemic. Furthermore, surgical treatment methods were used more than conservative therapies during the outbreak.
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Affiliation(s)
- Hande Gurbuz
- Department of Anesthesiology and Reanimation, Bursa City Hospital, University of Health Sciences, Bursa, Turkey
| | - Gulfem Basol
- Department of Obstetrics and Gynecology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Mustafa Altintas
- Department of General Surgery, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Betul Kuru
- Department of Obstetrics and Gynecology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
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Di Girolamo R, Khalil A, Rizzo G, Capannolo G, Buca D, Liberati M, Acharya G, Odibo AO, D'Antonio F. Systematic review and critical evaluation of quality of clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. Am J Obstet Gynecol MFM 2022; 4:100654. [PMID: 35504493 PMCID: PMC9057927 DOI: 10.1016/j.ajogmf.2022.100654] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically identify and critically assess the quality of clinical practice guidelines for the management of SARS-CoV-2 infection in pregnancy. DATA SOURCES Medline, Scopus, and ISI Web of Science databases were searched until February 15, 2022. STUDY ELIGIBILITY CRITERIA Inclusion criteria were clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. The risk of bias and quality assessments of the included clinical practice guidelines were performed using the Appraisal of Guidelines for REsearch and Evaluation II tool, which is considered the gold standard for quality assessment of clinical practice guidelines. To define a clinical practice guideline as of good quality, we adopted the cutoff score proposed by Amer et al: if the overall clinical practice guideline score was >60%, it was recommended. METHODS The following clinical points related to the management of pregnant women with SARS-CoV-2 infection were addressed: criteria for maternal hospitalization, recommendations for follow-up fetal growth scan, specific recommendations against invasive procedures, management of labor, timing of delivery, postpartum care, and vaccination strategy. RESULTS A total of 28 clinical practice guidelines were included. All recommended hospitalization only for severe disease; 46.1% (6/13) suggested a fetal growth scan after SARS-CoV-2 infection, whereas 23.1% (3/13) did not support this practice. Thromboprophylaxis with low-molecular-weight heparin was recommended in symptomatic women by 77.1% (7/9) of the clinical practice guidelines. None of the guidelines recommended administering corticosteroids only for the presence of SARS-CoV-2 infection in preterm gestation, unless specific obstetrical indication exists. Elective induction of labor from 39 weeks of gestation was suggested by 18.1% (2/11) of the clinical practice guidelines included in the present review, whereas 45.4% (5/11) did not recommend elective induction unless other obstetrical indications coexisted. There were 27% (3/11) of clinical practice guidelines that suggested shortening of the second stage of labor, and active pushing was supported by 18.1% (2/11). There was general agreement among the clinical practice guidelines in not recommending cesarean delivery only for the presence of maternal infection and in recommending vaccine boosters at least 6 months after the primary series of vaccination. The Appraisal of Guidelines for REsearch and Evaluation II standardized domain scores for the first overall assessment of clinical practice guidelines had a mean of 50% (standard deviation±21.82%), and 9 clinical practice guidelines scored >60%. CONCLUSION A significant heterogeneity was found in some of the main aspects of the management of SARS-CoV-2 infection in pregnancy, as reported by the published clinical practice guidelines.
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Affiliation(s)
- Raffaella Di Girolamo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, London, United Kingdom (Prof. Khalil)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, Università degli studi di Roma Tor Vergata, Roma, Italy (Prof. Rizzo)
| | - Giulia Capannolo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Danilo Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Marco Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden (Prof. Acharya); Women's Health and Perinatology Research Group, Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway (Prof. Acharya); Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway (Prof. Acharya)
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Prof. Odibo)
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio).
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Strózik M, Szarpak L, Adam I, Smereka J. Determinants of Place of Delivery during the COVID-19 Pandemic-Internet Survey in Polish Pregnant Women. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060831. [PMID: 35744094 PMCID: PMC9229740 DOI: 10.3390/medicina58060831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives: COVID-19 is a pandemic disease, and its unpredictable outcome makes it particularly dangerous, especially for pregnant women. One of the decisions they have to make is where they will give birth. This study aimed to determine the factors influencing the choice of place of delivery and the impact of the COVID 19 pandemic on these factors. Materials and Methods: The study was conducted on 517 respondents from Poland. The research methods comprised the authors’ own survey questionnaire distributed via the Internet from 8 to 23 June 2021. The survey was fully anonymous, voluntary, and addressed to women who gave birth during the pandemic or will give birth shortly. Results: A total of 440 (85.1%) respondents were afraid of SARS-CoV-2 infection. The most frequently indicated factors were fear of complications in the newborn, fear of intrauterine fetal death, and congenital disabilities in a newborn. A total of 74 (14.3%) women considered home delivery. The main factors that discouraged the choice of home birth were the lack of professional medical care 73.1% (N = 378), the lack of anesthesia 23.6% (N = 122), and the presence of indications for caesarean section 23.4% (N = 121). The possibility of mother–child isolation caused the greatest fear about hospital delivery. During the COVID-19 pandemic, pregnant women concerned about SARS-CoV-2 infection were more likely to consider home delivery than those without such fears. The most important factors affecting the choice of the place of delivery included the possibility of a partner’s presence, excellent sanitary conditions and optimal distance from the hospital, and the availability of epidural analgesia for delivery. Conclusions: Our study identifies the determinants of place of delivery during the COVID-19 pandemic. The data we obtained can result in the healthcare system considering patients’ needs in case of similar crisis in the future.
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Affiliation(s)
- Mateusz Strózik
- Department of Emergency Medical Service, Wroclaw Medical University, 50-367 Wroclaw, Poland;
- Correspondence: ; Tel.: +48-692-486-793
| | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-001 Warsaw, Poland;
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia;
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 50-367 Wroclaw, Poland;
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Estrada-Chiroque LM, Orostegui-Arenas M, Burgos-Guanilo MDP, Amau-Chiroque JM. Características clínicas y resultado materno perinatal en mujeres con diagnóstico confirmado por COVID-19 en un hospital de Perú. Estudio de cohorte retrospectivo. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2022; 73:28-38. [PMID: 35503299 PMCID: PMC9090281 DOI: 10.18597/rcog.3776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/01/2022] [Indexed: 11/24/2022]
Abstract
Objetivos: describir las características clínicas, sociodemográficas y la frecuencia de complicaciones maternas y perinatales en mujeres gestantes con diagnóstico confirmado de COVID-19 atendidas en un hospital de alta complejidad en Perú. Materiales y métodos: estudio de cohorte retrospectivo descriptivo. Se incluyeron mujeres con 20 semanas o más de gestación con diagnóstico de infección por COVID-19 atendidas en un hospital de referencia nacional del Seguro Social del Perú entre marzo y diciembre del 2020; se excluyeron mujeres cuya gestación no culminó en la institución participante. Las variables medidas fueron: características sociodemográficas y obstétricas de la gestante, nexo epidemiológico, severidad de la infección por COVID-19, síntomas y datos de laboratorio, morbi-mortalidad materna, presencia de anticuerpos en el recién nacido, peso, adaptación y mortalidad perinatal. El análisis fue descriptivo. El protocolo fue aprobado por el comité de ética en investigación del Instituto de Evaluación de Tecnologías en Salud e Investigación de EsSalud. Resultados: los criterios de inclusión y exclusión fueron cumplidos por 322 mujeres. La población de estudio se caracterizó por ser predominantemente mujeres menores de 35 años, con educación superior. El 95% de las gestantes presentó síntomas leves o imperceptibles. Los síntomas predominantes fueron fiebre (85%), tos (52%) y cefalea (18%); se documentó leucocitosis (31%), linfopenia (24%) y trombocitopenia (5%). Se registraron 2 muertes maternas (0,6%) y 22 (7,2%) defunciones perinatales. El 0,9% de los neonatos exhibieron una prueba reactiva positiva para COVID-19. Conclusiones: durante la gestación, la infección producida por el SARS-CoV-2 suele ser asintomática o leve. En las gestantes con infección moderada y severa se presentaron más frecuentemente complicaciones maternas y perinatales. Se requieren más estudios que analicen el impacto materno fetal de la infección por COVID-19 durante la gestación en la región.
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Thamer E, Al-Rawaf S. Hematological Changes and Pregnancy Outcome in COVID-19 Pregnant Patients: A Case–Control Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Viral infections during pregnancy are associated with adverse maternal as well as fetal outcomes such as higher rates of miscarriage, perinatal mortality, restriction of fetal growth and preterm delivery. Aim of the study: to explore maternal outcomes and hematological alterations in a sample of Iraqi pregnant women. Patients and methods: The current cross sectional study was carried out in Obstetric department in Al Imamain Al-Kadhimain Medical City, Baghdad, Iraq, including a total of 55 full term pregnant women who were grouped into 25 women with SARS-Cov-2 and 30 control pregnant women, starting from January 2021 through December 2021. Results: Fever was the most common symptom, which was reported in 12 cases (48.0 %), and it was followed by cough that was seen in 9 cases (36.0 %). Gastrointestinal symptoms in the form of nausea, vomiting and diarrhea were seen in 2 cases (8.0 %). Leaking liquor was seen in a single case of COVID-19 women. Pregnancy induced hypertension, antepartum hemorrhage and diabetes mellitus were seen in 2 cases of COVID-19 women for each event; with no significant difference between groups. The rate of cesarean section was higher in COVID-19 group in comparison with control group, 19 (76.0 %) versus 13 (43.3 %), respectively and the difference was significant (p = 0.014). Conclusion: COVID-19 at time of pregnancy is accompanied by higher rate of cesarean section because of fetal distress with no significant increase in fetal or maternal mortality rates and the main hematological changes are leukopenia and lymphopenia.
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Bourne T, Kyriacou C, Shah H, Ceusters J, Preisler J, Metzger U, Landolfo C, Lees C, Timmerman D. Experiences and well-being of healthcare professionals working in the field of ultrasound in obstetrics and gynaecology as the SARS-CoV-2 pandemic were evolving: a cross-sectional survey study. BMJ Open 2022; 12:e051700. [PMID: 35121598 PMCID: PMC8819548 DOI: 10.1136/bmjopen-2021-051700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Assess experience of healthcare professionals (HCPs) working with ultrasound in obstetrics and gynaecology during the evolving SARS-CoV-2 pandemic, given the new and unprecedented challenges involving viral exposure, personal protective equipment (PPE) and well-being. DESIGN Prospective cross-sectional survey study. SETTING Online international survey. Single-best, open box and Hospital Anxiety and Depression Scale (HADS) questions. PARTICIPANTS The survey was sent to 35 509 HCPs in 124 countries and was open from 7 to 21 May 2020. 2237/3237 (69.1%) HCPs from 115 countries who consented to participate completed the survey. 1058 (47.3%) completed the HADS. PRIMARY OUTCOME MEASURES Overall prevalence of SARS-CoV-2, depression and anxiety among HCPs in relation to country and PPE availability. ANALYSES Univariate analyses were used to investigate associations without generating erroneous causal conclusions. RESULTS Confirmed/suspected SARS-CoV-2 prevalence was 13.0%. PPE provision concerns were raised by 74.1% of participants; highest among trainees/resident physicians (83.9%) and among HCPs in Spain (89.7%). Most participants worked in self-perceived high-risk areas with SARS-CoV-2 (67.5%-87.0%), with proportionately more trainees interacting with suspected/confirmed infected patients (57.1% vs 24.2%-40.6%) and sonographers seeing more patients who did not wear a mask (33.3% vs 13.9%-7.9%). The most frequent PPE combination used was gloves and a surgical mask (22.3%). UK and US respondents reported spending less time self-isolating (8.8 days) and lower satisfaction with their national pandemic response (37.0%-43.0%). 19.8% and 8.8% of respondents met the criteria for moderate to severe anxiety and depression, respectively. CONCLUSIONS Reported prevalence of SARS-CoV-2 in HCPs is consistent with literature findings. Most respondents used gloves and a surgical mask, with a greater SARS-CoV-2 prevalence compared with those using 'full' PPE. HCPs with the least agency (trainees and sonographers) were not only more likely to see high-risk patients but also less likely to be protected. A fifth of respondents reported moderate to severe anxiety.
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Affiliation(s)
- Tom Bourne
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Christopher Kyriacou
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Harsha Shah
- Early Pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Jolien Ceusters
- Department of Oncology, Laboratory of Tumour Immunology and Immunotherapy, KU Leuven, Leuven, Belgium
| | - Jessica Preisler
- Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago de Chile, Chile
- Facultad de Medicina, Clínica Alemana, Hospital Clínico de la Universidad de Chile José Joaquín Aguirre, Santiago, Chile
| | - Ulrike Metzger
- Département d'échographie en Gynécologie et Obstétrique, Centre d'Échographie de l'Odéon, Paris, France
| | - Chiara Landolfo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Christoph Lees
- Centre for Fetal Care, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, KU Leuven University Hospitals Leuven, Leuven, Belgium
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Kyriacou C, Cooper N, Robinson E, Parker N, Barcroft J, Kundu S, Letchworth P, Sur S, Gould D, Stalder C, Bourne T. Ultrasound characteristics, serum biochemistry and outcome of ectopic pregnancies presenting during COVID-19 pandemic. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:909-915. [PMID: 34605083 PMCID: PMC8661840 DOI: 10.1002/uog.24793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe and compare the characteristics of ectopic pregnancies (EPs) in the year prior to vs during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This was a retrospective analysis of women diagnosed with an EP on transvaginal sonography conducted at a center in London, UK, providing early-pregnancy assessment, between 1 January 2019 and 31 December 2020. Women were identified via the Astraia ultrasound reporting system using coded and non-coded outcomes of EP or pregnancy outside the uterine cavity. Data related to predefined outcomes were collected using Astraia and Cerner electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. RESULTS There were 22 683 consultations over the 2-year period. Following consultation, a similar number and proportion of EPs were diagnosed in 2019 (141/12 657 (1%)) and 2020 (134/10 026 (1%)). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at the first transvaginal sonography scan and at diagnosis were similar, and no difference in location, size or morphology of EP was found between the two cohorts. Serum human chorionic gonadotropin (hCG) levels at the time of EP diagnosis were higher in 2020 than in 2019 (1005 IU/L vs 665 IU/L; P = 0.03). The proportions of women according to type of final EP management were similar, but the rate of failed first-line management was higher during vs before the pandemic (16% vs 6%; P = 0.01). The rates of blood detected in the pelvis (hemoperitoneum) on ultrasound (23% vs 26%; P = 0.58) and of ruptured EP confirmed surgically (9% vs 3%; P = 0.07) were similar in 2019 vs 2020. CONCLUSIONS No difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of EP between women diagnosed before vs during the COVID-19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first-line conservative management measures were higher during the pandemic. Our findings suggest that women continued to access appropriate care for EP during the COVID-19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome in our population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Kyriacou
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - N. Cooper
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - E. Robinson
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - N. Parker
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - J. Barcroft
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - S. Kundu
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - P. Letchworth
- St Mary's Hospital, Department of Obstetrics and GynaecologyImperial College LondonLondonUK
| | - S. Sur
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - D. Gould
- St Mary's Hospital, Department of Obstetrics and GynaecologyImperial College LondonLondonUK
| | - C. Stalder
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - T. Bourne
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
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Mate A, Reyes-Goya C, Santana-Garrido Á, Sobrevia L, Vázquez CM. Impact of maternal nutrition in viral infections during pregnancy. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166231. [PMID: 34343638 PMCID: PMC8325560 DOI: 10.1016/j.bbadis.2021.166231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Abstract
Other than being a physiological process, pregnancy is a condition characterized by major adaptations of maternal endocrine and metabolic homeostasis that are necessary to accommodate the fetoplacental unit. Unfortunately, all these systemic, cellular, and molecular changes in maternal physiology also make the mother and the fetus more prone to adverse outcomes, including numerous alterations arising from viral infections. Common infections during pregnancy that have long been recognized as congenitally and perinatally transmissible to newborns include toxoplasmosis, rubella, cytomegalovirus, and herpes simplex viruses (originally coined as ToRCH infections). In addition, enterovirus, parvovirus B19, hepatitis virus, varicella-zoster virus, human immunodeficiency virus, Zika and Dengue virus, and, more recently, coronavirus infections including Middle Eastern respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) infections (especially the novel SARS-CoV-2 responsible for the ongoing COVID-19 pandemic), constitute relevant targets for current research on maternal-fetal interactions in viral infections during pregnancy. Appropriate maternal education from preconception to the early postnatal period is crucial to promote healthy pregnancies in general and to prevent and/or reduce the impact of viral infections in particular. Specifically, an adequate lifestyle based on proper nutrition plans and feeding interventions, whenever possible, might be crucial to reduce the risk of virus-related gestational diseases and accompanying complications in later life. Here we aim to provide an overview of the emerging literature addressing the impact of nutrition in the context of potentially harmful viral infections during pregnancy.
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Affiliation(s)
- Alfonso Mate
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain.
| | - Claudia Reyes-Goya
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain
| | - Álvaro Santana-Garrido
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Luis Sobrevia
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), São Paulo State University (UNESP), Brazil; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands
| | - Carmen M Vázquez
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
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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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Montagnoli C, Zanconato G, Ruggeri S, Cinelli G, Tozzi AE. Restructuring maternal services during the covid-19 pandemic: Early results of a scoping review for non-infected women. Midwifery 2021; 94:102916. [PMID: 33412360 PMCID: PMC7832106 DOI: 10.1016/j.midw.2020.102916] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE The novel coronavirus outbreak has caused substantial changes in societal norms as well as adjustments in health systems worldwide. To date the impact of these pandemic-related variations has yet to be fully understood also in the field of maternal health for which continuity of care is a proven life-saving preventive measure. DESIGN Following the PRISMA guidelines for reviews, a literature search was carried out to assess different approaches that combine quality of maternal care with the imposed social-distancing rules. Nine studies were included in the scoping review. FINDINGS Reduction of in-person visits is the preferred overall solution. Yet, fewer consultations can still guarantee essential services and appropriate care through integration with telemedicine. Referral to epidemic-free community centres is an alternative option and new paths need to include the interdisciplinary contribution of medical consultants and IT experts, among others. In this context, delaying access for symptomatic expectant mothers is still debated since it carries the potential risk of untimely detection of pregnancy complications. KEY CONCLUSIONS Preliminary experiences provide an overview of the different attempts put in place to reshape health services to contain the pandemic hazards. IMPLICATIONS FOR PRACTICE These early prototypes may inspire future innovative health solutions compatible with local resources and specific population preferences and needs.
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Affiliation(s)
- Caterina Montagnoli
- Verona University Hospital, Verona, Italy; Department of Midwifery, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, 47, av. de Champel, Switzerland.
| | - Giovanni Zanconato
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, Verona, Italy.
| | | | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy; School of Specialization in Food Sciences, University of Rome Tor Vergata, Rome Italy.
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
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Martinez‐Portilla RJ, Gil MM, Poon LC. Scientific effort in combating COVID-19 in obstetrics and gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:189-194. [PMID: 33428290 PMCID: PMC8013175 DOI: 10.1002/uog.23584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- R. J. Martinez‐Portilla
- Clinical Research DivisionNational Institute of Perinatology “Isidro Espinosa de los Reyes”, Mexico CityMexico
- Iberoamerican Research Network in ObstetricsGynecology and Translational MedicineMexico CityMexico
- Fetal Medicine Research Center, BCNatalBarcelona Center for Maternal–Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de BarcelonaBarcelonaCataloniaSpain
| | - M. M. Gil
- Obstetrics and Gynecology DepartmentHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
- School of Health SciencesUniversidad Francisco de Vitoria (UFV), Pozuelo de AlarcónMadridSpain
| | - L. C. Poon
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong Kong SAR
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Martinez-Portilla RJ, Sotiriadis A, Chatzakis C, Torres-Torres J, Espino Y Sosa S, Sandoval-Mandujano K, Castro-Bernabe DA, Medina-Jimenez V, Monarrez-Martin JC, Figueras F, Poon LC. Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:224-231. [PMID: 33320401 DOI: 10.1002/uog.23575] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There are limited, unmatched data reporting low complication rates in pregnant women with coronavirus disease 2019 (COVID-19). The aim of this study was to compare COVID-19-related outcomes between pregnant and non-pregnant women after adjusting for potential risk factors for severe outcomes. METHODS Data were obtained from the COVID-19 National Data Registry of Mexico, which is an ongoing prospective cohort of people of any age with clinically suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and admitted to 475 monitoring hospitals. This study included pregnant and non-pregnant women of reproductive age (15-45 years) with COVID-19 confirmed by reverse transcription polymerase chain reaction. To adjust for underlying risk factors, propensity score matching was conducted for chronic obstructive pulmonary disease, asthma, smoking, hypertension, cardiovascular disease, obesity, diabetes, chronic renal disease, immunosuppression, age, language, nationality and level of health insurance. The primary outcome was death. Secondary outcomes were pneumonia, intubation and intensive care unit (ICU) admission. RESULTS The cohort comprised 5183 pregnant and 175 905 non-pregnant women with COVID-19. The crude (unmatched) rates of death, pneumonia, intubation and ICU admission in pregnant compared with non-pregnant women were 1.5% vs 1.5%, 9.9% vs 6.5%, 8.1% vs 9.9% and 13.0% vs 6.9%, respectively. After propensity score matching (5183 pregnant and 5183 non-pregnant matched women), pregnant women had a higher odds of death (odds ratio (OR), 1.84; 95% CI, 1.26-2.69), pneumonia (OR, 1.86; 95% CI, 1.60-2.16) and ICU admission (OR, 1.86; 95% CI, 1.41-2.45) than non-pregnant women, but similar odds of intubation (OR, 0.93; 95% CI, 0.70-1.25). CONCLUSION After adjusting for background demographic and medical factors, pregnancy is a risk factor for death, pneumonia and ICU admission in SARS-CoV-2-infected women of reproductive age. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R J Martinez-Portilla
- Clinical Research Division, National Institute of Perinatology (Isidro Espinosa de lo Reyes), Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - A Sotiriadis
- Second Department of Obstetrics and Gynaecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Chatzakis
- Second Department of Obstetrics and Gynaecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Torres-Torres
- Clinical Research Division, National Institute of Perinatology (Isidro Espinosa de lo Reyes), Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | - S Espino Y Sosa
- Clinical Research Division, National Institute of Perinatology (Isidro Espinosa de lo Reyes), Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | - K Sandoval-Mandujano
- Clinical Research Division, National Institute of Perinatology (Isidro Espinosa de lo Reyes), Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | - D A Castro-Bernabe
- Clinical Research Division, National Institute of Perinatology (Isidro Espinosa de lo Reyes), Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | - V Medina-Jimenez
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
- State Center for Timely Prenatal Screening (CETO), Leon Guanajuato, Mexico
| | - J C Monarrez-Martin
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | - F Figueras
- Fetal Medicine Research Center, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - L C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Effects of the COVID-19 pandemic on timely care for extrauterine pregnancies: A retrospective analysis. LANCET REGIONAL HEALTH-EUROPE 2021; 2:100026. [PMID: 34173625 PMCID: PMC7804379 DOI: 10.1016/j.lanepe.2021.100026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The COVID-19 pandemic may have taken a toll upon the rate of extrauterine pregnancy (EUP)-related admissions and emergent surgeries. Methods This retrospective study compared current and past visits to the emergency services of a large metropolitan university-affiliated medical center in Tel-Aviv, Israel. Data on EUP-related and regular early pregnancy care-related presentations to the emergency department (ED) during the COVID-19 pandemic were collected and compared to a historical control group admitted during 2018-2019. The primary outcome was the rate of ruptured EUP. Secondary outcomes included the rate of EUPs requiring surgery, symptoms, blood products, blood loss, embryonic heart rate, β-HCG levels, and intensive care unit transfer. Findings During the COVID-19 pandemic there was a 28.3% reduction in women seeking early pregnancy and emergent gynecological medical care. ED visits due to suspected EUP were similar: After exclusion, the study group comprised of 100 women and the combined control group from previous years included 208 women with confirmed EUP. Baseline maternal characteristics were similar between the groups. The rate of ruptured EUP's was significantly more common during the COVID-19 pandemic than in previous years [odds ratio (OR) 2•403 (1•272-4•539), p = 0•006]. Moreover, during the pandemic patients admitted due to EUP were significantly more symptomatic [OR 1•815 (1•072-3•074), p = 0•017] and had more blood loss demonstrated as substantial hemoglobin decline [OR 2•441 (1•07-5•565), p = 0•028] as well as hemoperitoneum during surgery [OR 2•672 (1•095-6•52), p = 0•035] The number of women receiving blood products was higher in the study group yet not reaching statistical significance [7% vs 3•4%, OR 2•161 (0•737-6•339) p = 0•128]. The overall rate of surgically treated EUP was similar between the groups [OR 1•070 (0•660-1•734), p = 0•439] and there was no significant difference in non-surgical management. Interpretation The COVID-19 pandemic has a toll on early pregnancy emergent care due to EUP with a significantly higher risk of tubal rupture and morbidity. Physicians should expect delayed presentation of symptomatic EUP and act accordingly. Funding This research received no funding.
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Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, Critchley HOD. Pregnancy and COVID-19. Physiol Rev 2021; 101:303-318. [PMID: 32969772 PMCID: PMC7686875 DOI: 10.1152/physrev.00024.2020] [Citation(s) in RCA: 309] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
There are many unknowns for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe SARS-CoV-2 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation. These may have positive or negative effects on COVID-19 disease progression. The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management. Besides the direct impacts of the disease, a plethora of indirect consequences of the pandemic adversely affect maternal health, including reduced access to reproductive health services, increased mental health strain, and increased socioeconomic deprivation. In this review, we explore the current knowledge of COVID-19 in pregnancy and highlight areas for further research to minimize its impact for women and their children.
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Affiliation(s)
- Elizabeth A N Wastnedge
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sara R van Boeckel
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah J Stock
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona C Denison
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacqueline A Maybin
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Hilary O D Critchley
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Antolín E, Herrero B, Rodríguez R, Illescas T, Duyos I, Gimeno A, Sotillo L, Abascal A, Orensanz I, Hernández A, Bartha JL. [How to organize a Fetal Medicine Unit in the context of COVID-19 pandemic. Safe measures for obstetric scans and equipment cleaning]. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021; 48:3-13. [PMID: 32836610 PMCID: PMC7328539 DOI: 10.1016/j.gine.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022]
Abstract
During a pandemic, the three basic principles are. to prioritize medical resources, ensure patients' lockdown in order to avoid community transmission and prevent healthcare collapse, and keep the number of visits to an absolute minimum to avoid patient exposure and safeguard healthcare workers. Antenatal care must be maintained during a health crisis, regardless of the COVID-19 state of alert. Routine and specialist obstetric ultrasound scans are essential for clinical decision-making during pregnancy, as it has a direct impact on the management of mothers and fetuses and on the perinatal outcome. In an attempt to minimize in-person visits, these will be organized according to the established ultrasound schedule. Based on scientific evidence, and on existing main national and international guidelines, this document has been prepared, in which proposals and options are provided for managing pregnant women in the context of the SARS-CoV-2 pandemic. It includes how a Fetal Medicine Unit facing this health crisis should be restructured, what safety measures should be followed in the performance of obstetric scans and invasive procedures, and how ultrasound rooms, equipment and transducers should be cleaned and disinfected. These recommendations should be adapted to different units based on their resources and infrastructure.
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Affiliation(s)
- E Antolín
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
- Red de Salud Materno Infantil y del Desarrollo (SAMID), España
| | - B Herrero
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - R Rodríguez
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - T Illescas
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - I Duyos
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Gimeno
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - L Sotillo
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Abascal
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - I Orensanz
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - A Hernández
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - J L Bartha
- Sección de Ecografía y Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
- Red de Salud Materno Infantil y del Desarrollo (SAMID), España
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20
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Odibo AO. UOG now and beyond! ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:7-8. [PMID: 33387409 DOI: 10.1002/uog.23567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Abstract
BACKGROUND The risk of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Positive reverse-transcription polymerase chain reaction (RT-PCR) test results for SARS-CoV-2 infection in neonates and placental tissue have been reported, and immunoglobulin M antibodies have been detected in neonates born to mothers with infection. CASES The first case is a woman at 22 3/7 weeks of gestation with coronavirus disease 2019 (COVID-19) who was admitted to the intensive care unit. In the second case, the patient remained at home with mild symptoms, starting at 20 weeks of gestation. In both cases, fetal skin edema was observed on ultrasound examination while maternal SARS-COV-2 RT-PCR test results were positive and resolved when maternal SARS-COV-2 RT-PCR test results became negative. The RT-PCR test result for SARS-CoV-2 in amniotic fluid was negative in both cases. The two pregnancies are ongoing and uneventful. CONCLUSION Transient fetal skin edema noted in these two patients with COVID-19 in the second trimester may represent results of fetal infection or altered fetal physiology due to maternal disease or may be unrelated to the maternal illness.
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22
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Vivanti AJ, Deruelle P, Picone O, Guillaume S, Roze JC, Mulin B, Kochert F, De Beco I, Mahut S, Gantois A, Barasinski C, Petitprez K, Pauchet-Traversat AF, Droy A, Benachi A. Follow-up for pregnant women during the COVID-19 pandemic: French national authority for health recommendations. J Gynecol Obstet Hum Reprod 2020; 49:101804. [PMID: 32407897 PMCID: PMC7212959 DOI: 10.1016/j.jogoh.2020.101804] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations concerning follow-up of pregnant women during the COVID-19 outbreak. METHODS A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.
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Affiliation(s)
- Alexandre J Vivanti
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92140 Clamart, France.
| | - Philippe Deruelle
- Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France; Service de Gynécologie Obstétrique, Hôpital de Hautepierre, Faculté de Médecine de Strasbourg, 67000 Strasbourg, France
| | - Olivier Picone
- Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France; Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris University, IAME INSERM U1137, APHP (Paris, France) GRIG (Groupe de Recherche sur les Infections pendant la Grossesse), 92700 Colombes
| | - Sophie Guillaume
- Collège National des Sages-Femmes de France, 75015 Paris, France
| | | | - Blandine Mulin
- French Federation of Perinatal Health Networks, 31000 Toulouse, France
| | - Fabienne Kochert
- French Association of Ambulatory Paediatrics, 33400 Talence, France
| | | | - Sophie Mahut
- College of General Medicine, 75017 Paris 8, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France, 75015 Paris, France
| | - Chloé Barasinski
- Collège National des Sages-Femmes de France, 75015 Paris, France; Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F63000 ClermontFerrand, France
| | - Karine Petitprez
- Guidelines Department, French National Authority for Health, 93200 Saint-Denis, France
| | | | - Alcyone Droy
- Guidelines Department, French National Authority for Health, 93200 Saint-Denis, France
| | - Alexandra Benachi
- Service de Gynécologie Obstétrique, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92140 Clamart, France; Collège National des Gynécologues Obstétriciens Français, 75002 Paris, France
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23
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Bourne T, Leonardi M, Kyriacou C, Al-Memar M, Landolfo C, Cibula D, Condous G, Metzger U, Fischerova D, Timmerman D, van den Bosch T. ISUOG Consensus Statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:879-885. [PMID: 32267984 PMCID: PMC7262398 DOI: 10.1002/uog.22047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- T Bourne
- Early pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - M Leonardi
- Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, Sydney Medical School Nepean, University of Sydney Nepean Hospital, Penrith, Sydney, Australia
| | - C Kyriacou
- Early pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - M Al-Memar
- Early pregnancy and Acute Gynaecology Unit, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - C Landolfo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - D Cibula
- Gynaecological Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - G Condous
- Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, Sydney Medical School Nepean, University of Sydney Nepean Hospital, Penrith, Sydney, Australia
| | - U Metzger
- Centre d'Échographie de l'Odéon, Paris, France
| | - D Fischerova
- Gynaecological Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Timmerman
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - T van den Bosch
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
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Poon L.C, Yang H, Dumont S, Lee JCS, Copel JA, Danneels L, Wright A, Costa FDS, Leung TY, Zhang Y, Chen D, Prefumo F. ISUOG Interim Guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium: information for healthcare professionals - an update. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:848-862. [PMID: 32356590 PMCID: PMC7267438 DOI: 10.1002/uog.22061] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- L. . C. Poon
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong Kong SAR
| | - H. Yang
- Department of Obstetrics and GynecologyPeking University First HospitalBeijingChina
| | - S. Dumont
- Department of Gynaecology and ObstetricsUniversity Hospitals Leuven, Leuven, Belgium; and Department of GynaecologyAZ Delta, RoeselareBelgium
| | - J. C. S. Lee
- Division of Obstetrics and GynaecologyKK Women's and Children's HospitalSingapore
| | - J. A. Copel
- Department of Obstetrics, Gynecology & Reproductive SciencesYale School of MedicineNew HavenCTUSA
| | - L. Danneels
- Department of Gynaecology, AZ DeltaRoeselareBelgium
| | - A. Wright
- Department of Obstetrics and GynaecologyRoyal Free Teaching Hospital Foundation TrustLondonUK
| | - F. Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; and Department of Obstetrics and GynaecologyMonash UniversityMelbourneAustralia
| | - T. Y. Leung
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong Kong SAR
| | - Y. Zhang
- Department of Obstetrics and GynaecologyZhongnan Hospital of Wuhan UniversityWuhanChina
| | - D. Chen
- Department of Obstetrics and GynaecologyThe Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - F. Prefumo
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
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