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Banerjee A, Ivan M, Nazarenko T, Solda R, Bredaki EF, Casagrandi D, Tetteh A, Greenwold N, Zaikin A, Jurkovic D, Napolitano R, David AL. Prediction of spontaneous preterm birth in women with previous full dilatation cesarean delivery. Am J Obstet Gynecol MFM 2024; 6:101298. [PMID: 38278178 DOI: 10.1016/j.ajogmf.2024.101298] [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: 01/04/2024] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND A previous term (≥37 weeks' gestation), full-dilatation cesarean delivery is associated with an increased risk for a subsequent spontaneous preterm birth. The mechanism is unknown. We hypothesized that the cesarean delivery scar characteristics and scar position relative to the internal cervical os may compromise cervical function, thereby leading to shortening of the cervical length and spontaneous preterm birth. OBJECTIVE This study aimed to determine the relationship of cesarean delivery scar characteristics and position, assessed by transvaginal ultrasound, in pregnant women with previous full-dilatation cesarean delivery with the risk of shortening cervical length and spontaneous preterm birth. STUDY DESIGN This was a single-center, prospective cohort study of singleton pregnant women (14 to 24 weeks' gestation) with a previous term full-dilatation cesarean delivery who attended a high-risk preterm birth surveillance clinic (2017-2021). Women underwent transvaginal ultrasound assessment of cervical length, cesarean delivery scar distance relative to the internal cervical os, and scar niche parameters using a reproducible transvaginal ultrasound technique. Spontaneous preterm birth prophylactic interventions (vaginal cervical cerclage or vaginal progesterone) were offered for short cervical length (≤25 mm) and to women with a history of spontaneous preterm birth or late miscarriage after full-dilatation cesarean delivery. The primary outcome was spontaneous preterm birth; secondary outcomes included short cervical length and a need for prophylactic interventions. A multivariable logistic regression analysis was used to develop multiparameter models that combined cesarean delivery scar parameters, cervical length, history of full-dilatation cesarean delivery, and maternal characteristics. The predictive performance of models was examined using the area under the receiver operating characteristics curve and the detection rate at various fixed false positive rates. The optimal cutoff for cesarean delivery scar distance to best predict a short cervical length and spontaneous preterm birth was analyzed. RESULTS Cesarean delivery scars were visualized in 90.5% (220/243) of the included women. The spontaneous preterm birth rate was 4.1% (10/243), and 12.8% (31/243) of women developed a short cervical length. A history- (n=4) or ultrasound-indicated (n=19) cervical cerclage was performed in 23 of 243 (9.5%) women; among those, 2 (8.7%) spontaneously delivered prematurely. A multiparameter model based on absolute scar distance from the internal os best predicted spontaneous preterm birth (area under the receiver operating characteristics curve, 0.73; 95% confidence interval, 0.57-0.89; detection rate of 60% for a fixed 25% false positive rate). Models based on the relative anatomic position of the cesarean delivery scar to the internal os and the cesarean delivery scar position with niche parameters (length, depth, and width) best predicted the development of a short cervical length (area under the receiver operating characteristics curve, 0.79 [95% confidence interval, 0.71-0.87]; and 0.81 [95% confidence interval, 0.73-0.89], respectively; detection rate of 73% at a fixed 25% false positive rate). Spontaneous preterm birth was significantly more likely when the cesarean delivery scar was <5.0 mm above or below the internal os (adjusted odds ratio, 6.87; 95% confidence interval, 1.34-58; P =.035). CONCLUSION In pregnancies following a full-dilatation cesarean delivery, cesarean delivery scar characteristics and distance from the internal os identified women who were at risk for spontaneous preterm birth and developing short cervical length. Overall, the spontaneous preterm birth rate was low, but it was significantly increased among women with a scar located <5.0 mm above or below the internal cervical os. Shortening of cervical length was strongly associated with a low scar position. Our novel findings indicate that a low cesarean delivery scar can compromise the functional integrity of the internal cervical os, leading to cervical shortening and/or spontaneous preterm birth. Assessment of the cesarean delivery scar characteristics and position seem to have use in preterm birth clinical surveillance among women with a previous, full-dilatation cesarean delivery and could better identify women who would benefit from prophylactic interventions.
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Affiliation(s)
- Amrita Banerjee
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David); Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David)
| | - Maria Ivan
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David); Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David)
| | - Tatiana Nazarenko
- Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David); Department of Mathematics, University College London, London, United Kingdom (Dr Nazarenko and Prof Zaikin)
| | - Roberta Solda
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David)
| | - Emmanouella F Bredaki
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David)
| | - Davide Casagrandi
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David); Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David)
| | - Amos Tetteh
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David)
| | - Natalie Greenwold
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David)
| | - Alexey Zaikin
- Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David); Department of Mathematics, University College London, London, United Kingdom (Dr Nazarenko and Prof Zaikin)
| | - Davor Jurkovic
- Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David); Department of Gynecology, Elizabeth Garrett Anderson Wing, University College London Hospital NHS Foundation Trust, London, United Kingdom (Prof Jurkovic)
| | - Raffaele Napolitano
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David); Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David)
| | - Anna L David
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, United Kingdom (Drs Banerjee, Ivan, Solda, Bredaki, Casagrandi Tetteh, Greenwold, Napolitano and Prof David); Research Department of Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Drs Banerjee, Ivan, Nazarenko, Casagrandi, Napolitano and Profs Zaikin, Jurkovic, and David); National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, London, United Kingdom (Prof David).
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Chapman-Hatchett N, Chittenden N, Arattu Thodika FMS, Williams EE, Harris C, Dassios T, Arasu A, Johnson K, Greenough A. Risk assessment of survival and morbidity of infants born at <24 completed weeks of gestation. Early Hum Dev 2023; 185:105852. [PMID: 37659264 DOI: 10.1016/j.earlhumdev.2023.105852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Infants born at the threshold of viability have a high risk of mortality and morbidity. The British Association of Perinatal Medicine (BAPM) provided updated guidance in 2019 advising a risk-based approach to balancing decisions about active versus redirected care at birth. AIMS To determine survival and morbidity of infants born between 22 and 24 completed weeks of gestation. To develop a scoring system to categorise infants at birth according to risk for mortality or severe adverse outcome. METHODS A retrospective, single centre observational study of infants who received neonatal care from 2011 to 2021. Data were collected on mortality, morbidity and two-year neurodevelopmental outcomes. Each infant was risk categorised utilising the proposed tools in the BAPM (2019) framework. A composite adverse score for either dying or surviving with severe impairment was created. RESULTS Four infants born at 22 weeks, 49 at 23 weeks and 105 at 24 weeks of gestation were included. The mortality rate was 23.4 %. Following risk categorisation there were 8 (5.1 %) extremely high risk, 44 (27.8 %) high risk and 106 (67.1 %) moderate risk infants. The rate of dying or surviving with severe impairment for extremely high risk, high risk and moderate risk were 100 %, 88.9 % and 53 % respectively. The proportions with the composite adverse outcome differed significantly according to the risk category (p < 0.001). CONCLUSIONS When applying a scoring system to risk categorise infants at birth, high rates of dying or surviving with severe impairment were found in infants born at 22 or 23 weeks of gestation.
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Affiliation(s)
| | | | - Fahad M S Arattu Thodika
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RS, United Kingdom; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom.
| | - Emma E Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RS, United Kingdom.
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RS, United Kingdom; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom.
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RS, United Kingdom; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom.
| | - Anusha Arasu
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom.
| | | | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, SE5 9RS, United Kingdom.
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Hirsch M, Reisel D, Saridogan E, David AL. Endoscopic transabdominal cervical cerclage replacement after recurrent late miscarriage. BMJ Case Rep 2022; 15:e247757. [PMID: 35228241 PMCID: PMC8886391 DOI: 10.1136/bcr-2021-247757] [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] [Accepted: 01/25/2022] [Indexed: 11/03/2022] Open
Abstract
Transabdominal cerclage (TAC) is a recognised treatment for recurrent spontaneous late miscarriage or preterm birth due to cervical weakness. This can be performed via an open procedure before and during pregnancy, or a laparoscopic technique preconception. Complications include cerclage failure and suture migration. We present a case highlighting these complications where laparoscopic removal of an open TAC and replacement led to two successful term deliveries. A woman in her thirties with a fibroid uterus, adenomyosis and a history of three spontaneous mid-trimester losses, had an open TAC at 13 weeks of gestation. Preterm premature rupture of the membranes occurred shortly after and at 18 weeks of gestation she underwent surgical evacuation of the uterus. Subsequent hysteroscopy confirmed migration of the cerclage through the cervical canal. We demonstrate the application of endoscopic gynaecological surgery to remove and replace the TAC with two successful term births by Caesarean section in the ensuing pregnancies.
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Affiliation(s)
- Martin Hirsch
- Oxford Endometriosis CaRe Centre, Oxford University, Oxford, UK
| | - Dan Reisel
- Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- EGA Institute for Women's Health, University College London, London, UK
| | - Ertan Saridogan
- Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- EGA Institute for Women's Health, University College London, London, UK
| | - Anna L David
- EGA Institute for Women's Health, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
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4
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Affiliation(s)
- Andrei S Morgan
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM U1153 EPOPé, INRA, Paris, France
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- Department of Neonatal Medicine, Maternité Port-Royal, Association Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Marina Mendonça
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Nicole Thiele
- European Foundation for Care of the Newborn Infant, Munich, Germany
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK
- National Institute for Health Research, University College London Hospital Biomedical Research Centre, London, UK
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Papapanou M, Papaioannou M, Petta A, Routsi E, Farmaki M, Vlahos N, Siristatidis C. Maternal and Neonatal Characteristics and Outcomes of COVID-19 in Pregnancy: An Overview of Systematic Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E596. [PMID: 33445657 PMCID: PMC7828126 DOI: 10.3390/ijerph18020596] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022]
Abstract
(1) Background: A considerable number of systematic reviews, with substantial heterogeneity regarding their methods and included populations, on the impact of COVID-19 on infected pregnant women and their neonates, has emerged. The aim was to describe the obstetric-perinatal and neonatal outcome of infected pregnant women and their newborns during the COVID-19 pandemic; (2) Methods: Three bibliographical databases were searched (last search: September 10, 2020). Quality assessment was performed using the AMSTAR-2 tool. Primary outcomes included mode of delivery, preterm delivery/labor, premature rupture of membranes (PROM/pPROM) and abortions/miscarriages. Outcomes were mainly presented as ranges. A separate analysis, including only moderate and high-quality systematic reviews, was also conducted. The protocol was registered with PROSPERO (CRD42020214447); (3) Results: Thirty-nine reviews were analyzed. Reported rates, regarding both preterm and term gestations, varied between 52.3 and 95.8% for cesarean sections; 4.2-44.7% for vaginal deliveries; 14.3-63.8% specifically for preterm deliveries and 22.7-32.2% for preterm labor; 5.3-12.7% for PROM and 6.4-16.1% for pPROM. Maternal anxiety for potential fetal infection contributed to abortion decisions, while SARS-CoV-2-related miscarriages could not be excluded. Maternal ICU admission and mechanical ventilation rates were 3-28.5% and 1.4-12%, respectively. Maternal mortality rate was <2%, while stillbirth, neonatal ICU admission and mortality rates were <2.5%, 3.1-76.9% and <3%, respectively. Neonatal PCR positivity rates ranged between 1.6% and 10%. After accounting for quality of studies, ranges of our primary outcomes remained almost unchanged, while among our secondary outcomes, maternal ICU admission (3-10%) and mechanical ventilation rates (1.4-5.5%) were found to be relatively lower; (4) Conclusions: Increased rates of cesarean sections and preterm birth rates were found, with iatrogenic reasons potentially involved. In cases of symptomatic women with confirmed infection, high maternal and neonatal ICU admission rates should raise some concerns. The probability of vertical transmission cannot be excluded. Further original studies on women from all trimesters are warranted.
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Affiliation(s)
- Michail Papapanou
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Maria Papaioannou
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Aikaterini Petta
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (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; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Maria Farmaki
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (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; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (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; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (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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6
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Ewington LJ, Quenby S. Full Dilatation Caesarean Section and the Risk of Preterm Delivery in a Subsequent Pregnancy: A Historical Cohort Study. J Clin Med 2020; 9:jcm9123998. [PMID: 33321784 PMCID: PMC7763432 DOI: 10.3390/jcm9123998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
Full dilatation caesarean sections (CS) have increased risk of uterine extensions, which leads to cervical trauma that has been associated with an increased risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy. The aim of this study was to determine if CS at full dilatation increased the risk of sPTB in a subsequent pregnancy in our unit. A historical cohort study was performed on women delivered by emergency CS between 2008–2015 (n = 5808) in a university hospital who had a subsequent pregnancy in this time frame (n = 1557). Women were classified into two exposure groups; those who were 6–9 cm and those fully dilated at index CS. The reference group was CS at 0–5 cm dilated. The primary outcome was sPTB < 37 weeks’ gestation. CS at 6–9 cm or fully dilated did not significantly increase the odds of sPTB in a subsequent pregnancy (aOR 1.64, 95% CI: 0.83–3.28, p = 0.158; aOR 1.86, 95% CI: 0.91–3.83; p = 0.090, respectively). However, a short interpregnancy interval of <1 year significantly increased the odds of sPTB in a subsequent pregnancy (aOR 3.10, 95% CI: 1.71–5.61). This study has found a short interpregnancy interval following a CS conferred a higher risk of sPTB than full dilatation CS. This finding highlights postnatal contraception and increased surveillance of women with short interpregnancy interval post CS as possible interventions to reduce sPTB.
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Affiliation(s)
- Lauren Jade Ewington
- Division of Biomedical Sciences, University of Warwick, Coventry CV2 2DX, UK;
- Department of Women and Children, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK
- Correspondence: ; Tel.: +44-24-7696-8702
| | - Siobhan Quenby
- Division of Biomedical Sciences, University of Warwick, Coventry CV2 2DX, UK;
- Department of Women and Children, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, UK
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7
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Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul‐Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. Int J Gynaecol Obstet 2020; 151:7-16. [PMID: 32816307 PMCID: PMC9087651 DOI: 10.1002/ijgo.13329] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women represent a potentially high-risk population in the COVID-19 pandemic. OBJECTIVE To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID-19. SEARCH STRATEGY Relevant databases were searched up until May 29, 2020. SELECTION CRITERIA Case series/reports of hospitalized pregnant women with laboratory-confirmed COVID-19. DATA COLLECTION AND ANALYSIS PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools. MAIN RESULTS Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory-confirmed SARS-CoV-2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D-dimer and interleukin-6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID-19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. CONCLUSIONS Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D-dimer and interleukin-6 levels are predictive of poor pregnancy outcomes in COVID-19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.
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Affiliation(s)
- Ozlem Turan
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
| | - Amir Hakim
- National Heart and Lung InstituteImperial College LondonLondonUK
- Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Pradip Dashraath
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Wong Jing Lin Jeslyn
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Alison Wright
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
| | - Rezan Abdul‐Kadir
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
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8
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Philip RK, Purtill H, Reidy E, Daly M, Imcha M, McGrath D, O'Connell NH, Dunne CP. Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a 'natural experiment' allowing analysis of data from the prior two decades. BMJ Glob Health 2020; 5:e003075. [PMID: 32999054 PMCID: PMC7528371 DOI: 10.1136/bmjgh-2020-003075] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/10/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland's response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants. METHODS Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020. RESULTS Poisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500-600 range. CONCLUSION An unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.
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Affiliation(s)
- Roy K Philip
- Division of Neonatology, Department of Paediatrics, University of Limerick School of Medicine, Limerick, Ireland
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Elizabeth Reidy
- Midwifery and Neonatal Nursing, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance (INHA), Dublin, Ireland
| | - Mendinaro Imcha
- Obstetrics and Gynaecology, University Maternity Hospital Limerick (UMHL), Limerick, Ireland
| | - Deirdre McGrath
- Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick School of Medicine, Limerick, Ireland
| | - Nuala H O'Connell
- Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick School of Medicine, Limerick, Ireland
- Clinical Microbiology, University Hospital Limerick (UHL), Dooradoyle, Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick School of Medicine, Limerick, Ireland
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Lacey L, Daulton E, Wicaksono A, Covington JA, Quenby S. Volatile organic compound analysis, a new tool in the quest for preterm birth prediction-an observational cohort study. Sci Rep 2020; 10:12153. [PMID: 32699319 PMCID: PMC7376243 DOI: 10.1038/s41598-020-69142-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/01/2020] [Indexed: 01/26/2023] Open
Abstract
Preterm birth is the leading cause of death worldwide in children under five years. Due to its complex multifactorial nature, prediction is a challenge. Current research is aiming to develop accurate predictive models using patient history, ultrasound and biochemical markers. Volatile organic compound (VOC) analysis is an approach, which has good diagnostic potential to predict many disease states. Analysis of VOCs can reflect both the microbiome and host response to a condition. We aimed to ascertain if VOC analysis of vaginal swabs, taken throughout pregnancy, could predict which women go on to deliver preterm. Our prospective observational cohort study demonstrates that VOC analysis of vaginal swabs, taken in the midtrimester, is a fair test (AUC 0.79) for preterm prediction, with a sensitivity of 0.66 (95%CI 0.56–0.75) and specificity 0.89 (95%CI 0.82–0.94). Using vaginal swabs taken closest to delivery, VOC analysis is a good test (AUC 0.84) for the prediction of preterm birth with a sensitivity of 0.73 (95%CI 0.64–0.81) and specificity of 0.90 (95%CI 0.82–0.95). Consequently, VOC analysis of vaginal swabs has potential to be used as a predictive tool. With further work it could be considered as an additional component in models for predicting preterm birth.
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Affiliation(s)
- Lauren Lacey
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. .,Department of Obstetrics and Gynaecology, University Hospitals Coventry and Warwickshire, Coventry, CV2 2DX, UK.
| | - Emma Daulton
- School of Engineering, University of Warwick, Coventry, CV4 7AL, UK
| | - Alfian Wicaksono
- School of Engineering, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Siobhan Quenby
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Department of Obstetrics and Gynaecology, University Hospitals Coventry and Warwickshire, Coventry, CV2 2DX, UK
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