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Simbar M, Nazarpour S, Sheidaei A. Evaluation of pregnancy outcomes in mothers with COVID-19 infection: a systematic review and meta-analysis. J OBSTET GYNAECOL 2023; 43:2162867. [PMID: 36651606 DOI: 10.1080/01443615.2022.2162867] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that reported adverse pregnancy outcomes in pregnant women with COVID-19 infection. A literature search was performed in PubMed and Scopus up to 1 September 2022, for retrieving original articles published in the English language assessing the association between COVID-19 infection and adverse pregnancy outcomes. Finally, in this review study, of 1790 articles obtained in the initial search, 141 eligible studies including 1,843,278 pregnant women were reviewed. We also performed a meta-analysis of a total of 74 cohort and case-control studies. In this meta-analysis, both fixed and random effect models were used. Publication bias was also assessed by Egger's test and the trim and fill method was conducted in case of a significant result, to adjust the bias. The result of the meta-analysis showed that the pooled prevalence of preterm delivery, maternal mortality, NICU admission and neonatal death in the group with COVID-19 infection was significantly more than those without COVID-19 infection (p<.01). A meta-regression was conducted using the income level of countries. COVID-19 infection during pregnancy may cause adverse pregnancy outcomes including of preterm delivery, maternal mortality, NICU admission and neonatal death. Pregnancy loss and SARS-CoV2 positive neonates in Lower middle income are higher than in High income. Vertical transmission from mother to foetus may occur, but its immediate and long-term effects on the newborn are unclear.
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Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Nazarpour
- Department of Midwifery, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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2
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Hammad LF, Almutairi AN, Aldahlawi RH. Effect of infection with severe acute respiratory syndrome coronavirus 2 on the fetus in pregnant women who recovered from infection. Ann Saudi Med 2023; 43:213-218. [PMID: 37554020 DOI: 10.5144/0256-4947.2023.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The effect of maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the fetus is unclear, and there is no data from Saudi Arabia. OBJECTIVE Assess the effect of maternal SARS-CoV-2 infection on fetal growth. DESIGN Retrospective case-control SETTING: Tertiary care hospital, Riyadh, Saudi Arabia PATIENTS AND METHODS: We selected pregnant women who underwent an obstetric growth scan and umbilical artery Doppler ultra-sound examination between 28 and 41 weeks of pregnancy. Women with multiple pregnancy, fetal abnormalities, maternal body mass index >30, maternal hypertension, any other chronic diseases that might affect fetal growth or pregnant women suffering from cancer were excluded. Fetal growth parameters assessed included fetal biometry (biparietal diameter, head circumference, abdominal circumference and femur length). We also did an umbilical artery Doppler assessment, which includes the umbilical artery pulsatility index, resistive index and the systolic/diastolic ratio. MAIN OUTCOME MEASURE Fetal biometry and biophysical profile SAMPLE SIZE: 48 SARS-CoV-2; 98 non-SARS-CoV-2 RESULTS: More women who had recovered from SARS-CoV-2 infection had small for gestational age fetuses compared with the control group (P=.001). CONCLUSION Maternal SARS-CoV-2 infection during pregnancy was associated with a higher prevalence of small for gestational age (SGA) fetuses. LIMITATIONS Retrospective, middle cerebral artery and uterine artery Doppler data were not included nor were the effect of tobacco use and socioeconomic status, the relationship between the date of infection with the date of conceiving or the relationship between the severity of infection in the mother and fetal biometry and growth. CONFLICT OF INTEREST None.
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Affiliation(s)
- Lina Fahmi Hammad
- From the Department of Radiological Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ahad Naif Almutairi
- From the Department of Radiological Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Rana Hussain Aldahlawi
- From the Department of Radiological Sciences, King Saud University, Riyadh, Saudi Arabia
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3
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HS. Putra D, Winston K, Renaldy R, Irwandi BB, Sakti A, Martua EH, Wardhana WS, Ilhami LG, Rinaldi I. Pneumonia Deterioration Occurring After C-section in a Preeclamptic Patient: A Case Report. Cureus 2023; 15:e36147. [PMID: 37065353 PMCID: PMC10101510 DOI: 10.7759/cureus.36147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/15/2023] Open
Abstract
Pneumonia is a type of lung infection that can be caused by bacteria, viruses, or fungi. It is a serious condition that can affect people of all ages, but it is more dangerous for certain populations, such as the elderly, young children, and people with weakened immune systems. Pneumonia can cause higher risk in patients undergoing surgery, including C-sections. In this case report, we present a pregnant woman who was scheduled for a C-section due to preeclampsia and was initially suspected of concomitant pneumonia. The patient successfully underwent the C-section, but unfortunately experienced a deterioration in her pneumonia after the surgery. She was later admitted to ICU and placed on mechanical ventilation due to the deterioration. Despite the acknowledged risks, including the possibility of death, the patient's family chose to bring the patient home due to their belief that there had been no improvement in the patient's condition and a feeling of resignation. In conclusion, pregnant patients who have pneumonia may require an emergency C-section due to several conditions such as preeclampsia, and the C-section can be conducted successfully. However, it is important for physicians to be aware of the potential for the worsening of pneumonia postoperatively. Post-operative pneumonia is a serious condition that can have a significant impact on the health of patients who have undergone a C-section.
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Kyathanahalli C, Snedden M, Hirsch E. Is human labor at term an inflammatory condition?†. Biol Reprod 2023; 108:23-40. [PMID: 36173900 PMCID: PMC10060716 DOI: 10.1093/biolre/ioac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/20/2023] Open
Abstract
Parturition at term in normal pregnancy follows a predictable sequence of events. There is some evidence that a state of inflammation prevails in the reproductive tissues during labor at term, but it is uncertain whether this phenomenon is the initiating signal for parturition. The absence of a clear temporal sequence of inflammatory events prior to labor casts doubt on the concept that normal human labor at term is primarily the result of an inflammatory cascade. This review examines evidence linking parturition and inflammation in order to address whether inflammation is a cause of labor, a consequence of labor, or a separate but related phenomenon. Finally, we identify and suggest ways to reconcile inconsistencies regarding definitions of labor onset in published research, which may contribute to the variability in conclusions regarding the genesis and maintenance of parturition. A more thorough understanding of the processes underlying normal parturition at term may lead to novel insights regarding abnormal labor, including spontaneous preterm labor, preterm premature rupture of the fetal membranes, and dysfunctional labor, and the role of inflammation in each.
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Affiliation(s)
- Chandrashekara Kyathanahalli
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Madeline Snedden
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Emmet Hirsch
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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Baltaji S, Noronha SF, Patel S, Kaura A. Obstetric Emergencies. Crit Care Nurs Q 2023; 46:66-81. [PMID: 36415068 DOI: 10.1097/cnq.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Human gestation and birthing result in many deviations from usual physiology that are nonetheless normal to be seen. However, on occasion, certain complications in the obstetric patient can be life-threatening to both mother and fetus. Timely recognition of these disorders and allocation of the appropriate resources are especially important. These conditions often require an intensive care unit admission for closer monitoring and supportive care. They can affect an array of physiological systems and can lead to significant morbidity. Such complications are discussed in greater detail in this article.
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Affiliation(s)
- Stephanie Baltaji
- Division of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania (Drs Baltaji and Patel); and Division of Pulmonary and Critical Care Medicine, West Penn Hospital, Pittsburgh, Pennsylvania (Drs Noronha and Kaura)
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Ashby T, Staiano P, Najjar N, Louis M. Bacterial pneumonia infection in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85:26-33. [PMID: 35970746 DOI: 10.1016/j.bpobgyn.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
Bacterial pneumonia in pregnancy is the most common fatal non-obstetrical infection and is associated with poorer maternal and fetal outcomes. Risk factors include normal physiological and anatomic changes that occur during pregnancy. In this review, we will discuss the etiological pathogens of bacterial pneumonias in pregnancy and its common complications, including both maternal and fetal outcomes. We will also review the diagnosis and management of bacterial pneumonia in the outpatient and inpatient setting and highlight the major pregnancy and lactation considerations when choosing antibiotic therapies.
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Affiliation(s)
- Tracy Ashby
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA
| | - Peter Staiano
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA
| | - Nimeh Najjar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA
| | - Mariam Louis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA.
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7
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Kosmidou P, Karamatzanis I, Tzifas S, Vervenioti A, Gkentzi D, Dimitriou G. Hearing Outcomes of Infants Born to Mothers With Active COVID-19 Infection. Cureus 2022; 14:e25571. [PMID: 35784961 PMCID: PMC9249119 DOI: 10.7759/cureus.25571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/05/2022] Open
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Lucovnik M, Druskovic M, Vidmar Simic M, Verdenik I, Mesaric V, Kosir R, Kornhauser Cerar L, Tojner Bregar A, Steblovnik L, Kavsek G, Premru Srsen T. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls. J Perinat Med 2022; 50:253-260. [PMID: 34881547 DOI: 10.1515/jpm-2021-0313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare perinatal outcomes in women with vs. without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS Perinatal outcomes in SARS-CoV-2 positive pregnant women who delivered at our institution between October 27th 2020 and January 31st 2021 were compared to SARS-CoV-2 negative pregnancies (contemporary controls) and historical 2019 controls matched by maternal age, pre-pregnancy body mass index and parity. Testing was performed based on symptoms or close contact at any time during pregnancy and as part of universal screening at hospital admission. Multivariable log-linear regression models were used adjusting for potential confounders (p < 0.05 statistically significant). RESULTS One thousand three hundred seventeen women delivered at our institution during the study period. 1,124 (85%) tested negative and 193 (15%) positive for SARS-CoV-2. 189 (98%) were infected during third trimester. 19 (10%) were asymptomatic, 171 (89%) had mild to moderate coronavirus disease 2019 (COVID-19), and 3 (2%) were critically ill with one case of maternal death. There were no significant differences in preterm birth, small-for-gestational-age birth weight, congenital anomalies, operative delivery, intrapartum hypoxia, and perinatal mortality in SARS-CoV-2 positive pregnancies compared to contemporary reference group or historical controls from pre-COVID-19 period. Labor was more commonly induced in SARS-CoV-2 positive women compared to reference SARS-CoV-2 negative group (68 [35%] vs. 278 [25%], adjusted odds ratio 1.62; 95% confidence interval 1.14-2.28). CONCLUSIONS SARS-CoV-2 infection in pregnancy was not strongly associated with adverse perinatal outcomes. While the majority of SARS-CoV-2 positive women had no or mild/moderate symptoms, 2% were critically ill, with one case of maternal death.
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Affiliation(s)
- Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druskovic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Marijana Vidmar Simic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Vita Mesaric
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Renata Kosir
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Andreja Tojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lili Steblovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Gorazd Kavsek
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tanja Premru Srsen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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9
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Critical Care in Obstetrics. Best Pract Res Clin Anaesthesiol 2022; 36:209-225. [DOI: 10.1016/j.bpa.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/20/2022]
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10
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Barbagallo M, Schiappa E. MOF in Pregnancy and Its Relevance to Eclampsia. POSTINJURY MULTIPLE ORGAN FAILURE 2022:205-239. [DOI: 10.1007/978-3-030-92241-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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11
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Abstract
Macrolides such as azithromycin are commonly prescribed antibiotics during pregnancy. The good oral bioavailability and transplacental transfer of azithromycin make this drug suitable for the treatment of sexually transmitted diseases, toxoplasmosis, and malaria. Moreover, azithromycin is useful both in the management of preterm pre-labor rupture of membranes and in the adjunctive prophylaxis for cesarean delivery. The aim of this comprehensive narrative review is to critically analyze and summarize the available literature on the main aspects of azithromycin use in pregnant women, with a special focus on adverse offspring outcomes associated with prenatal exposure to the drug. References for this review were identified through searches of MEDLINE, PubMed, and EMBASE. Fetal and neonatal outcomes following prenatal azithromycin exposure have been investigated in several studies, yielding conflicting results. Increased risks of spontaneous miscarriage, major congenital malformations, cardiovascular malformations, digestive system malformations, preterm birth, and low birth weight have been reported in some studies but not in others. Currently, there is no conclusive evidence to support that azithromycin use by pregnant women causes adverse outcomes in their offspring. Therefore, this agent should only be used during pregnancy when clinically indicated, if the benefits of treatment are expected to outweigh the potential risks.
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12
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Chow EJ, Beigi RH, Riley LE, Uyeki TM. Clinical Effectiveness and Safety of Antivirals for Influenza in Pregnancy. Open Forum Infect Dis 2021; 8:ofab138. [PMID: 34189160 DOI: 10.1093/ofid/ofab138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/19/2021] [Indexed: 11/14/2022] Open
Abstract
Seasonal influenza epidemics result in substantial health care burden annually. Early initiation of antiviral treatment of influenza has been shown to reduce the risk of complications and duration of illness. Pregnant and postpartum women may be at increased risk for influenza-associated complications; however, pregnant women have been generally excluded from clinical trials of antiviral treatment of influenza. In this review, we summarize the available evidence on the clinical effectiveness and safety of antiviral treatment of pregnant women with influenza. Observational data show a reduction of severe outcomes when pregnant and postpartum women are treated with oseltamivir and other neuraminidase inhibitors without increased risk of adverse maternal, fetal, or neonatal outcomes. Due to lack of safety and efficacy data for baloxavir treatment of pregnant and postpartum women, baloxavir is currently not recommended for use in these populations.
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Affiliation(s)
- Eric J Chow
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Richard H Beigi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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PrabhuDas M, Piper JM, Jean-Philippe P, Lachowicz-Scroggins M. Immune Regulation, Maternal Infection, Vaccination, and Pregnancy Outcome. J Womens Health (Larchmt) 2021; 30:199-206. [PMID: 33232632 PMCID: PMC8020511 DOI: 10.1089/jwh.2020.8854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
About 12.5% of all maternal deaths in the United States are due to infectious causes. This proportion, although stable during the past three decades, represents an increase in infectious causes of mortality, as the overall mortality rate in U.S. pregnant women had increased steadily during that same period. During healthy pregnancies, a delicate immunological balance-in which a mother's immune system tolerates the semi-allogeneic fetus yet maintains immune competency against infectious agents-is achieved and maintained. This immunological paradigm, however, results in increased susceptibility to infectious diseases during pregnancy, particularly in later stages and during the early postpartum period. The inflammatory process induced by these infectious insults, as well as some noninfectious insults, occurring during pregnancy can disrupt this carefully achieved balance and, in turn, lead to a state of rampant inflammation, immune activation, and dysregulation with deleterious health outcomes for the mother and fetus. Elucidating mechanisms contributing to the disruption of this immunologic homeostasis, and its disruption by infectious pathogens, might offer opportunities for interventions to reduce maternal and fetal morbidity and mortality.
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Affiliation(s)
- Mercy PrabhuDas
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Jeanna M. Piper
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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Han Y, Ma H, Suo M, Han F, Wang F, Ji J, Ji J, Yang H. Clinical manifestation, outcomes in pregnant women with COVID-19 and the possibility of vertical transmission: a systematic review of the current data. J Perinat Med 2020; 48:912-924. [PMID: 33068387 DOI: 10.1515/jpm-2020-0431] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/01/2020] [Indexed: 12/22/2022]
Abstract
Objectives To assess perinatal outcomes of COVID-19 infections during pregnancy and the possibility of vertical transmission. Methods An analysis was performed using Stata 15.0, and Q-test was used to evaluate the heterogeneity of the included studies. Results The most common symptoms were found to be fever (64.78%), cough (59.81%) and shortness of breath or dyspnea (23.86%). Of this 88.73% patients demonstrated typical COVID-19 signs on chest CT or X-ray. Intubation was carried out in 35.87% of patients, and 4.95% of mothers were admitted to the intensive care unit, where the rate of maternal death was <0.01% and that of premature delivery was 25.32%. The rate of the birth weight being <2,500 g was 30.65% and that of Neonatal intensive care unit (NICU) admission was 24.41%. Positive nasopharynx swabs or sputum from newborns was <0.01%. Conclusions Pregnant patients with COVID-19 most commonly presented with fever, cough, shortness of breath and dyspnea, most of which possessed imaging manifestations. The risk of intubation and admission to intensive care unit were high. The risk of premature delivery was higher, leading to a high risk of NICU admission and low neonatal birthweight. Vertical transmission of SARS-CoV-2 from mother to child was found to be unlikely.
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Affiliation(s)
- Yu Han
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, P.R. China
| | - Huijing Ma
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Mingli Suo
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Fang Han
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Fang Wang
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Jingru Ji
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Jing Ji
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Hailan Yang
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
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Chamseddine RS, Wahbeh F, Chervenak F, Salomon LJ, Ahmed B, Rafii A. Pregnancy and Neonatal Outcomes in SARS-CoV-2 Infection: A Systematic Review. J Pregnancy 2020; 2020:4592450. [PMID: 33062333 PMCID: PMC7542507 DOI: 10.1155/2020/4592450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Abstract
With the emergence of SARS-CoV-2 and its rapid spread, concerns regarding its effects on pregnancy outcomes have been growing. We reviewed 245 pregnancies complicated by maternal SARS-CoV-2 infection across 48 studies listed on PubMed and MedRxiv. The most common clinical presentations were fever (55.9%), cough (36.3%), fatigue (11.4%), and dyspnea (12.7%). Only 4.1% of patients developed respiratory distress. Of all patients, 89.0% delivered via cesarean section (n = 201), with a 33.3% rate of gestational complications, a 35.3% rate of preterm delivery, and a concerning 2.5% rate of stillbirth delivery or neonatal death. Among those tested, 6.45% of newborns were reported positive for SARS-CoV-2 infection. Relative to known viral infections, the prognosis for pregnant women with SARS-CoV-2 is good, even in the absence of specific antiviral treatment. However, neonates and acute patients, especially those with gestational or preexisting comorbidities, must be actively managed to prevent the severe outcomes being increasingly reported in the literature.
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Affiliation(s)
| | - Farah Wahbeh
- Genetic Intelligence Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Frank Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell-Lenox Hill Hospital, New York, USA
| | - Laurent J. Salomon
- Maternité, Médecine, Chirurgie et Imagerie Fœtales, Hôpital Universitaire Necker Enfants Malades, Université de Paris and EA FETUS, Affiliate of Institute Imagine, Paris, France
| | | | - Arash Rafii
- Genetic Intelligence Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medicine, New York, USA
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16
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Lai YJ, Chang CM, Lin CK, Yang YP, Chien CS, Wang PH, Chang CC. Severe acute respiratory syndrome coronavirus-2 and the deduction effect of angiotensin-converting enzyme 2 in pregnancy. J Chin Med Assoc 2020; 83:812-816. [PMID: 32902940 PMCID: PMC7434025 DOI: 10.1097/jcma.0000000000000362] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
The 2019 novel coronavirus (2019-nCoV, later named SARS-CoV-2) is a pandemic disease worldwide. The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is continuing at a rapid speed. Till May 4, 2020, there have been 3,407,747 confirmed cases and 238,198 deaths globally. The common symptoms in pregnant women are fever, cough, and dyspnea. Angiotensin-converting enzyme 2 (ACE2) has transient overexpression and increased activity during pregnancy, which is now confirmed as the receptor of SARS-CoV-2 and plays essential roles in human infection and transmission. There is no evidence that pregnant women are more susceptible to SARS-CoV-2. To date, there is no valid medication or vaccination. The immune suppression or modulation during pregnancy increases the risk of severe pneumonia. Remdesivir is an antiviral medication targeting ribonucleic acid (RNA) synthesis that has clinical improvement in the treatment of SARS-CoV-2. Chloroquine is controversial in its effectiveness and safety to treat SARS-CoV-2. Remdesivir is safe in pregnancy. Chloroquine has not been formally assigned to a pregnancy category by the Food and Drug Administration (FDA). The management strategy includes monitoring fetal heart rate and uterine contractions; early oxygenation if O2 saturation is less than 95%; empiric antibiotics for prevention of secondary infection; corticosteroid to treat maternal SARS-CoV-2 disease routinely is not suggested, only for fetal lung maturation in selected cases; and consideration of delivery is according to the obstetric indication, gestational age, and severity of the disease. During epidemics, delivery at 32-34 weeks is considered. The indication for the Cesarean section should be flexible to minimize the risk of infection during the delivery. The newborn should be in isolation ward immediately after birth; breastfeeding is not contraindicated but should avoid direct transmission infection.
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Affiliation(s)
- Yu-Ju Lai
- Department of Obstetrics and Gynecology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Ming Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chi-Kung Lin
- Department of Obstetrics and Gynecology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Ping Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chian-Shiu Chien
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
| | - Cheng-Chang Chang
- Department of Obstetrics and Gynecology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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17
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Chen L, Jiang H, Zhao Y. Pregnancy with COVID-19: Management considerations for care of severe and critically ill cases. Am J Reprod Immunol 2020; 84:e13299. [PMID: 32623810 PMCID: PMC7361145 DOI: 10.1111/aji.13299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 01/08/2023] Open
Abstract
Pregnant women are a potentially highly vulnerable population due to anatomical, physiological, and immunological changes under the COVID‐19 pandemic. Issues related to pregnancy with COVID‐19 attracted widespread attention from researchers. A large number of articles were published aiming to elaborate clinical characteristics and outcomes of pregnant women infected with COVID‐19, in order to provide evidence for management. The existing data suggest that the overall prognosis of pregnancy with COVID‐19 is promising when compared with that of other previous coronaviruses. There is still maternal morbidity and mortality related to COVID‐19 reported. However, the optimal management of severe and critically ill cases of COVID‐19–infected pregnancy is poorly clarified. The possibility of postpartum exacerbation in pregnancy with COVID‐19 is also worthy of attention for obstetricians. This review makes further elaboration of the above issues.
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Affiliation(s)
- Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,National Center for Healthcare Quality Management in Obstetrics, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, China
| | - Hai Jiang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,National Center for Healthcare Quality Management in Obstetrics, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,National Center for Healthcare Quality Management in Obstetrics, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, China
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18
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Maternal Infection in Pregnancy and Childhood Leukemia: A Systematic Review and Meta-analysis. J Pediatr 2020; 217:98-109.e8. [PMID: 31810630 PMCID: PMC7605597 DOI: 10.1016/j.jpeds.2019.10.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To summarize the published evidence regarding the association between maternal infection during pregnancy and childhood leukemia. STUDY DESIGN In this systematic review and meta-analysis (PROSPERO number, CRD42018087289), we searched PubMed and Embase to identify relevant studies. We included human studies that reported associations of at least one measure of maternal infection during pregnancy with acute lymphoblastic leukemia (ALL) or all childhood leukemias in the offspring. One reviewer extracted the data first using a standardized form, and the second reviewer independently checked the data for accuracy. Two reviewers used the Newcastle-Ottawa Scale to assess the quality of included studies. We conducted random effects meta-analyses to pool the ORs of specific type of infection on ALL and childhood leukemia. RESULTS This review included 20 studies (ALL, n = 15; childhood leukemia, n = 14) reported in 32 articles. Most (>65%) included studies reported a positive association between infection variables and ALL or childhood leukemia. Among specific types of infection, we found that influenza during pregnancy was associated with higher risk of ALL (pooled OR, 3.64; 95% CI, 1.34-9.90) and childhood leukemia (pooled OR, 1.77; 95% CI, 1.01-3.11). Varicella (pooled OR, 10.19; 95% CI, 1.98-52.39) and rubella (pooled OR, 2.79; 95% CI, 1.16-6.71) infections were also associated with higher childhood leukemia risk. CONCLUSIONS Our findings suggest that maternal infection during pregnancy may be associated with a higher risk of childhood leukemia.
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19
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Bridwell RE, Carius BM, Long B, Oliver JJ, Schmitz G. Sepsis in Pregnancy: Recognition and Resuscitation. West J Emerg Med 2019; 20:822-832. [PMID: 31539341 PMCID: PMC6754194 DOI: 10.5811/westjem.2019.6.43369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/23/2019] [Accepted: 06/16/2019] [Indexed: 12/29/2022] Open
Abstract
The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.
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Affiliation(s)
- Rachel E Bridwell
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Brandon M Carius
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Joshua J Oliver
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Gillian Schmitz
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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20
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Rac H, Gould AP, Eiland LS, Griffin B, McLaughlin M, Stover KR, Bland CM, Bookstaver PB. Common Bacterial and Viral Infections: Review of Management in the Pregnant Patient. Ann Pharmacother 2018; 53:639-651. [PMID: 30556401 DOI: 10.1177/1060028018817935] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review the treatment of common bacterial and viral infections occurring in the pregnant patient. DATA SOURCES A literature search of MEDLINE was performed (inception to October 2018). The Centers for Disease Control and Prevention website was utilized for additional information. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies and those conducted in humans were considered. DATA SYNTHESIS β-Lactams alone or in combination are the preferred treatment for many common infections in pregnancy, such as urinary tract infections, pelvic inflammatory disease (PID), gonococcal infections, syphilis, chancroid, upper- and lower-respiratory-tract infections, certain gastrointestinal infections, Group B Streptococcus, listeriosis, and intrauterine inflammation or infection. Macrolides, particularly azithromycin, are also utilized for the treatment of PID, chlamydia, gonococcal infections, chancroid, community-acquired pneumonia, and certain gastrointestinal infections. Other antibiotics or antivirals such as vancomycin, aminoglycosides, metronidazole, nitrofurantoin, fosfomycin, acyclovir, valacyclovir, and oseltamivir are included in the preferred therapy for some common bacterial and viral infections in pregnant patients as well. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence of treatments of common infections in pregnancy and provides a concise summary to guide clinicians on empirical treatment during pregnancy. CONCLUSIONS There are limited data on clinical outcomes in pregnant patients with common bacterial and viral infections. Empirical management decisions require balance of benefit and risk to both mother and infant. Although few clinical practice guidelines have quality evidence for strong recommendations in this population, clinicians should weigh antimicrobial dosing, pharmacokinetics, safety, and established effectiveness to optimize antimicrobial therapy in pregnancy.
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Affiliation(s)
- Hana Rac
- 1 University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Lea S Eiland
- 3 Auburn University Harrison School of Pharmacy, Meridian, MS, USA
| | - Brooke Griffin
- 4 Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Milena McLaughlin
- 4 Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Kayla R Stover
- 5 University of Mississippi School of Pharmacy, Jackson, MS, USA
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21
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van Riel D, Mittrücker HW, Engels G, Klingel K, Markert UR, Gabriel G. Influenza pathogenicity during pregnancy in women and animal models. Semin Immunopathol 2016; 38:719-726. [PMID: 27387428 PMCID: PMC7101682 DOI: 10.1007/s00281-016-0580-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
Pregnant women are at the highest risk to develop severe and even fatal influenza. The high vulnerability of women against influenza A virus infections during pregnancy was repeatedly highlighted during influenza pandemics including the pandemic of this century. In 2009, mortality rates were particularly high among otherwise healthy pregnant women. However, our current understanding of the molecular mechanisms involved in severe disease development during pregnancy is still very limited. In this review, we summarize the knowledge on the clinical observations in influenza A virus-infected pregnant women. In addition, knowledge obtained from few existing experimental infections in pregnant animal models is discussed. Since clinical data do not provide in-depth information on the pathogenesis of severe influenza during pregnancy, adequate animal models are urgently required that mimic clinical findings. Studies in pregnant animal models will allow the dissection of involved molecular disease pathways that are key to improve patient management and care.
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Affiliation(s)
- Debby van Riel
- Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Geraldine Engels
- Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
- Department of Obstetrics and Fetal Medicine, Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Karin Klingel
- Department of Molecular Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Udo R Markert
- Department of Obstetrics and Gynecology, University Hospital Jena, Jena, Germany
| | - Gülsah Gabriel
- Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany.
- University of Lübeck, Lübeck, Germany.
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22
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Lapinsky SE, Nelson-Piercy C. The Lungs in Obstetric and Gynecologic Diseases. MURRAY AND NADEL'S TEXTBOOK OF RESPIRATORY MEDICINE 2016. [PMCID: PMC7152064 DOI: 10.1016/b978-1-4557-3383-5.00096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Fischer T, Grab D, Grubert T, Hantschmann P, Kainer F, Kästner R, Kentenich C, Klockenbusch W, Lammert F, Louwen F, Mylonas I, Pildner von Steinburg S, Rath W, Schäfer-Graf UM, Schleußner E, Schmitz R, Steitz HO, Verlohren S. Maternale Erkrankungen in der Schwangerschaft. FACHARZTWISSEN GEBURTSMEDIZIN 2016. [PMCID: PMC7158353 DOI: 10.1016/b978-3-437-23752-2.00017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Kim OS, Yoon SW. [Current state of influenza vaccination and factors affecting vaccination rate among pregnant women]. J Korean Acad Nurs 2015; 44:534-41. [PMID: 25381784 DOI: 10.4040/jkan.2014.44.5.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to examine the actual state of influenza vaccination among pregnant women and factors affecting vaccination rate. METHODS Data were collected using self-report questionnaires. Participants were pregnant women who participated in a prenatal education program at an acute care hospital in 2013. Data collected from 218 pregnant women were analyzed using the SPSS 18.0 Program. RESULTS Only 48.6% of the pregnant women had received vaccination when the influenza was prevalent. Statistically significant factors affecting the influenza vaccination rate among pregnant women were vaccination experience in the previous year, knowledge and attitude about vaccination, and gestation period. CONCLUSION Results indicate that the influenza vaccination rate among pregnant women is lower than that of elders, healthcare workers, and patients with chronic diseases, who have been considered to be the mandatory vaccination recipients. Therefore, it is necessary to develop programs and policies which provide information including safety of vaccines for pregnant women and to induce positive attitudes towards vaccination for these women, in order to ultimately improve the vaccination rate.
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Affiliation(s)
- Og Son Kim
- Department of Nursing Science, Sangji University, Wonju, Korea
| | - Sung Won Yoon
- Department of Nursing, Chungwoon University, Hongseong, Korea.
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25
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Mehta N, Chen K, Hardy E, Powrie R. Respiratory disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:598-611. [PMID: 25997564 DOI: 10.1016/j.bpobgyn.2015.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/16/2022]
Abstract
Many physiological and anatomical changes of pregnancy affect the respiratory system. These changes often affect the presentation and management of the various respiratory illnesses in pregnancy. This article focuses on several important respiratory issues in pregnancy. The management of asthma, one of the most common chronic illnesses in pregnancy, remains largely unchanged compared to the nonpregnant state. Infectious respiratory illness, including pneumonia and tuberculosis, are similarly managed in pregnancy with antibiotics, although special attention may be needed for antibiotic choices with more pregnancy safety data. When mechanical ventilation is necessary, consideration should be given to the maternal hemodynamics of pregnancy and fetal oxygenation. Maintaining maternal oxygen saturation above 95% is recommended to sustain optimal fetal oxygenation. Cigarette smoking has known risks in pregnancy, and current practice guidelines recommend offering cognitive and pharmacologic interventions to pregnant women to assist in smoking cessation.
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Affiliation(s)
- Niharika Mehta
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Kenneth Chen
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Erica Hardy
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Raumond Powrie
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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26
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Arany ZP, Walker CM, Wang L. Case records of the Massachusetts General Hospital. Case 22-2014. A 40-year-old woman with postpartum dyspnea and hypoxemia. N Engl J Med 2014; 371:261-9. [PMID: 25014691 DOI: 10.1056/nejmcpc1304163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Inchingolo R, Smargiassi A, Mormile F, Marra R, De Carolis S, Lanzone A, Valente S, Corbo GM. Look at the lung: can chest ultrasonography be useful in pregnancy? Multidiscip Respir Med 2014; 9:32. [PMID: 24936303 PMCID: PMC4059469 DOI: 10.1186/2049-6958-9-32] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/20/2014] [Indexed: 01/28/2023] Open
Abstract
Background This study aimed to evaluate the clinical value of chest ultrasound (US) in the detection, diagnosis and follow-up of pathologic processes of both peripheral lung parenchyma and pleural space in pregnant women. Findings Pregnant women admitted to Obstetric Pathology Hospital Department for respiratory diseases were enrolled. Chest US examination was performed when there was a respiratory disease highly suggestive of pneumonia and/or pleural effusion and chest X-ray (CXR) should have been obtained. Three chest US patterns were identified: lung consolidation (LC), pleural effusion (PE) and focal sonographic interstitial syndromes (SIS). When chest US pathologic signs were reported, one or more subsequent chest US examinations were performed to follow-up the patient until their complete resolution. Sixteen inpatients underwent 54 chest US evaluations. We identified: 9 LCs, 6 PEs and 11 SISs. Total number of CXRs was 7 (10 females avoided X-rays exposure and one underwent 2 CXR evaluations on the advice of Gynecologist). Chest US follow-up, during and after therapy, showed complete resolution of echographic patterns previously described. Conclusions Chest US evaluation during pregnancy is a useful diagnostic tool to detect and monitor respiratory diseases, avoiding excessive X-rays exposure.
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Affiliation(s)
- Riccardo Inchingolo
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Andrea Smargiassi
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy.,Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Flaminio Mormile
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Roberta Marra
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Sara De Carolis
- Obstetric Pathology Department, University Hospital "A. Gemelli", Rome, Italy
| | - Antonio Lanzone
- Obstetric Pathology Department, University Hospital "A. Gemelli", Rome, Italy
| | - Salvatore Valente
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
| | - Giuseppe M Corbo
- Pulmonary Medicine Department, University Hospital "A. Gemelli", Rome, Italy
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28
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Kitsantas P, Christopher KE. Smoking and respiratory conditions in pregnancy: associations with adverse pregnancy outcomes. South Med J 2013; 106:310-5. [PMID: 23644639 DOI: 10.1097/smj.0b013e318290c6e8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Acute and chronic respiratory conditions affect a large segment of pregnant women. The purpose of the current study was to examine the concomitant effects of respiratory conditions and smoking during pregnancy on gestational age, birth weight, fetal distress, infant mortality, premature rupture of membranes, placenta abruption, and mode of delivery. METHODS This study used data (n = 1,064,969) from the North Carolina linked birth/infant death files from 1999 to 2007. Logistic regression was used to compute odds ratios and 95% confidence intervals (CIs) in assessing risk of adverse pregnancy outcomes. RESULTS We found that women with respiratory conditions/smoking status were significantly more likely than nonsmokers with no respiratory conditions to have a low-birth-weight infant, an infant with fetal distress, and experience preterm birth and an infant's death. Adjusted odds ratios also revealed that smokers with respiratory conditions were 2.37 (95% CI 1.69-3.32) times more likely than women with no respiratory conditions/nonsmoking status to have placenta abruption and 2.20 (95% CI 1.85-2.61) times more likely to have premature rupture of membranes. Regardless of smoking status, women with respiratory conditions were less likely to have a vaginal delivery. CONCLUSIONS These findings underscore the need for clinical and public health programs to educate women, particularly those with respiratory diseases, of the immense array of adverse outcomes that may occur as a consequence of active maternal smoking during gestation. It is important for interventions to target mothers with respiratory conditions early on to ensure favorable birth outcomes.
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Affiliation(s)
- Panagiota Kitsantas
- College of Health and Human Services, George Mason University, Fairfax, Virginia 22030, USA.
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29
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Recomendaciones para el diagnóstico, tratamiento y prevención de la neumonía adquirida en la comunidad en adultos inmunocompetentes. INFECTIO 2013. [DOI: 10.1016/s0123-9392(13)70019-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Chen YH, Keller J, Wang IT, Lin CC, Lin HC. Pneumonia and pregnancy outcomes: a nationwide population-based study. Am J Obstet Gynecol 2012; 207:288.e1-7. [PMID: 23021691 PMCID: PMC7093888 DOI: 10.1016/j.ajog.2012.08.023] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/15/2012] [Accepted: 08/14/2012] [Indexed: 12/14/2022]
Abstract
Objective Using 2 nationwide population-based datasets, this study aimed to assess the risk of adverse pregnancy outcomes, including low birthweight (LBW), preterm birth, small for gestational age (SGA), cesarean section (CS), lower Apgar score, and preeclampsia/eclampsia, between women with and without pneumonia. Study Design This study included 1462 women who had been hospitalized with pneumonia during pregnancy and used 7310 matched women without pneumonia as a comparison group. Results Compared to women without pneumonia, conditional logistic regression analyses showed that the adjusted odds ratios for LBW, preterm birth, SGA, CS, Apgar scores <7 at 5 minutes, and preeclampsia/eclampsia in women with pneumonia were 1.73 (95% confidence interval [CI], 1.41–2.12), 1.71 (95% CI, 1.42–2.05), 1.35 (95% CI, 1.17–1.56), 1.77 (95% CI, 1.58–1.98), 3.86 (95% CI, 1.64–9.06), and 3.05 (95% CI, 2.01–4.63), respectively. Conclusion Women with pneumonia during pregnancy had significantly higher risk of LBW, preterm birth, SGA, low Apgar scores infants, CS, and preeclampsia/eclampsia, compared to unaffected women.
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Affiliation(s)
- Yi-Hua Chen
- School of Public Health, Taipei Medical University Hospital, Taipei, Taiwan
| | - Joseph Keller
- School of Public Health, Taipei Medical University Hospital, Taipei, Taiwan
| | - I-Te Wang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ching-Chun Lin
- School of Health Care Administration, Taipei Medical University Hospital, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University Hospital, Taipei, Taiwan
- Reprints: Herng-Ching Lin, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan
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