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Hemati Z, Ameli S, Nikkhoo B, Shahgheibi S, Seyedoshohadaei F, Soufizadeh N, Rahmani K. Comparing the immunogenicity of COVID-19 infection and vaccination in pregnant women as measured by anti-S IgG. BMC Infect Dis 2024; 24:935. [PMID: 39251937 PMCID: PMC11386373 DOI: 10.1186/s12879-024-09853-5] [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: 05/28/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Pregnancy is a critical time for women, making them more susceptible to infectious diseases like COVID-19. This study aims to determine the immunogenicity of COVID-19 in pregnant women who have been infected compared to those who have received the inactive COVID-19 vaccine. MATERIALS AND METHODS In this retrospective cohort study, pregnant women who received the inactivated COVID-19 vaccine (Sinopharm) and those with a history of COVID-19 infection during pregnancy were studied. Participants who had experienced stillbirth, received different COVID-19 vaccines, or had intrauterine fetal death were excluded from the study. Overall, the study included 140 participants. The participants were divided into two groups of 70 participants - pregnant women who received the Sinopharm vaccine and pregnant women who had COVID-19 infection during pregnancy. Before delivery, blood samples were collected from all mothers to evaluate the maternal immunoglobulin G (IgG) level. Blood samples were also taken from the baby's umbilical cord during delivery to measure the newborn's IgG level. Additionally, blood samples were collected from babies whose mothers showed signs of acute infection to measure their IgM levels and evaluate vertical transmission. FINDINGS The study found a significant relationship between the mean level of maternal IgG and umbilical cord IgG within the groups (P < 0.001). The highest levels of maternal IgG (2.50 ± 2.17) and umbilical cord IgG (2.43 ± 2.09) were observed in pregnant women with a previous COVID-19 infection and no history of vaccination (P < 0.001). Only one baby was born with a positive IgM, and this baby was born to a mother who showed signs of COVID-19 infection in the last five days of pregnancy. The mother was 28 years old, with a BMI of 33; it was her first pregnancy, and she gave birth to a male newborn at term. CONCLUSION Administering an inactivated vaccine during pregnancy can generate immunity in both the mother and the child. However, the vaccine's immunity level may not be as potent as that conferred by COVID-19 infection during pregnancy. Nonetheless, the risk of vertical transmission of COVID-19 is considered minimal and can be classified as negligible.
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Affiliation(s)
- Zeinab Hemati
- Associate Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Saeideh Ameli
- Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Bahram Nikkhoo
- Professor in Pathology, Liver and Digestive Research Center, Research Institute for Health 4. Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sholeh Shahgheibi
- Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fariba Seyedoshohadaei
- Associate Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Nasrin Soufizadeh
- Associate Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Khaled Rahmani
- Associate Professor in Epidemiology, Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Shah NM, Charani E, Ming D, Cheah FC, Johnson MR. Antimicrobial stewardship and targeted therapies in the changing landscape of maternal sepsis. JOURNAL OF INTENSIVE MEDICINE 2024; 4:46-61. [PMID: 38263965 PMCID: PMC10800776 DOI: 10.1016/j.jointm.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/30/2023] [Indexed: 01/25/2024]
Abstract
Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide. Moreover, severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis. In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis, the implications for the neonate, as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment. Finally, we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.
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Affiliation(s)
- Nishel M Shah
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Esmita Charani
- Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Damien Ming
- Department of Infectious Diseases, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Fook-Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mark R Johnson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Chelsea and Westminster Hospital, London, UK
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3
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Georgescu T. The role of maternal hormones in regulating autonomic functions during pregnancy. J Neuroendocrinol 2023; 35:e13348. [PMID: 37936545 DOI: 10.1111/jne.13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 11/09/2023]
Abstract
Offspring development relies on numerous physiological changes that occur in a mother's body, with hormones driving many of these adaptations. Amongst these, the physiological functions controlled by the autonomic nervous system are required for the mother to survive and are adjusted to meet the demands of the growing foetus and to ensure a successful birth. The hormones oestrogen, progesterone, and lactogenic hormones rise significantly during pregnancy, suggesting they may also play a role in regulating the maternal adaptations linked to autonomic nervous system functions, including respiratory, cardiovascular, and thermoregulatory functions. Indeed, expression of pregnancy hormone receptors spans multiple brain regions known to regulate these physiological functions. This review examines how respiratory, cardiovascular, and thermoregulatory functions are controlled by these pregnancy hormones by focusing on their action on central nervous system circuits. Inadequate adaptations in these systems during pregnancy can give rise to several pregnancy complications, highlighting the importance in understanding the mechanistic underpinnings of these changes and potentially identifying ways to treat pregnancy-associated afflictions using hormones.
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Affiliation(s)
- T Georgescu
- Centre for Neuroendocrinology and Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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4
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Arena A, Miller E. Respiratory Acid-Base Disorders. Emerg Med Clin North Am 2023; 41:863-875. [PMID: 37758429 DOI: 10.1016/j.emc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Respiratory acid-base disorders are often not thought of as frequently as their metabolic cousins, which occur more frequently in the emergency department. Although most respiratory and acid-base disturbances are driven by lung pathology, central nervous system and other organ systems can and do play a role as well. Although managing the airway and appropriate mechanical ventilation may be necessary, it is akin to placing a band-aid on a large wound. It is crucial for the emergency clinician to discover the etiology of the disturbance as management depends on treating the underlying etiology to prevent worsening acid-base status.
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Affiliation(s)
- Alexander Arena
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7736, San Antonio, TX 78229-3900, USA.
| | - Emily Miller
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7736, San Antonio, TX 78229-3900, USA
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5
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Francis AP, Alshowaikh K, Napoleon M, Al-Khan A, Kayaalp E. Venous Thromboembolism Risk Assessment Models in Obstetrics: A Review of Current Practices and Future Directions. Am J Perinatol 2023; 40:1509-1514. [PMID: 35235956 DOI: 10.1055/a-1785-8948] [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: 11/01/2022]
Abstract
Pregnancy is a major risk factor for venous thromboembolism (VTE) and its associated complications. The hypercoagulable state in both the antenatal and postnatal periods contributes to thromboembolism and continues to be a leading cause of maternal morbidity and mortality worldwide. The non-specific signs and symptoms of VTE in pregnancy and the lack of specific Risk Assessment Models (RAMs) propose a diagnostic challenge in the obstetric population. This review aims to discuss and compare existing RAMs and highlights the important challenges of using established RAMs in obstetric patients. It also emphasizes the importance of enhancing and individualizing RAMs in obstetrics to improve maternal healthcare. KEY POINTS: · VTE is a major complication of pregnancy, associated with increased maternal morbidity and mortality.. · VTE RAMs lack sensitivity and specificity in stratifying VTE risk in pregnancy.. · Validating VTE RAMs in the obstetric population aims to improve maternal outcomes..
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Affiliation(s)
- Antonia P Francis
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Khadija Alshowaikh
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Melissa Napoleon
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Abdulla Al-Khan
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Emre Kayaalp
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
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Zhou X, Zhong Y, Pan Z, Zhang J, Pan J. Physiology of pregnancy and oral local anesthesia considerations. PeerJ 2023; 11:e15585. [PMID: 37404472 PMCID: PMC10315135 DOI: 10.7717/peerj.15585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Background Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients. Methodology An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment. Results Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied. Conclusions Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.
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Affiliation(s)
- Xueer Zhou
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yunyu Zhong
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zijian Pan
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiankang Zhang
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Chengdu Advanced Medical Science Center, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jian Pan
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Chengdu Advanced Medical Science Center, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Mihajlovic S, Trifunovic Kubat J, Nikolic D, Santric-Milicevic M, Milicic B, Dimic N, Lackovic M. Risk Factors of Adverse Maternal Outcome among SARS-CoV-2 Infected Critically Ill Pregnant Women in Serbia. J Clin Med 2023; 12:3902. [PMID: 37373597 DOI: 10.3390/jcm12123902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES During the COVID-19 pandemic, Serbia has faced devastating losses related to increased mortality rates among men and women of all ages. With 14 registered cases of maternal death in 2021, it became obvious that pregnant women are faced with a serious threat that jeopardises their life as well as the life of their unborn child. Studying the consequences of the COVID-19 pandemic on maternal outcomes is vivifying and stimulating for many professionals and decision-makers, and knowing the contextual characteristics can facilitate the application of literature findings in practice. Therefore, the aim of this study was to present findings of maternal mortality in Serbia associated with SARS-CoV-2 infected and critically ill pregnant women. METHODS Clinical status and pregnancy-related features were analysed for a series of 192 critically ill pregnant women with confirmed SARS-CoV-2 infection. According to the treatment outcome, pregnant women were divided in two study groups: a group of survivors and a group of deceased patients. RESULTS A lethal outcome was recorded in seven cases. Pregnant women in the deceased group were presenting at admission more commonly with X-ray-confirmed pneumonia, a body temperature of >38 °C, cough, dyspnea, and fatigue. They were more likely to have a progression of the disease, to be admitted to intensive care unit, and be dependent from mechanical ventilation, as well as to have nosocomial infection, pulmonary embolism, and postpartum haemorrhage. On average, they were in their early third trimester of pregnancy, presenting more commonly with gestational hypertension and preeclampsia. CONCLUSIONS Initial clinical manifestations of SARS-CoV-2 infection, such as dyspnea, cough, fatigue, and fever, could be a potent factors in risk stratification and outcome prediction. Prolonged hospitalization, ICU admission, and associated risk of hospital-acquired infections require strict microbiological surveillance and should be a constant reminder of rational antibiotics use. Understanding and identification of risk factors associated with poor maternal outcomes among pregnant women infected with SARS-CoV-2 should warn medical professionals of potentially unwanted outcomes and can be used for organising an individualised treatment for a pregnant patient's specific needs, including a guide to necessary consultations with medical specialists in various fields.
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Affiliation(s)
- Sladjana Mihajlovic
- Department of Obstetrics and Gynecology, University Hospital "Dragisa Misovic", 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Trifunovic Kubat
- Department of Obstetrics and Gynecology, University Hospital "Dragisa Misovic", 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children's Hospital, 11000 Belgrade, Serbia
| | - Milena Santric-Milicevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Faculty of Medicine, School of Public Health and Health Management, University of Belgrade, 11000 Belgrade, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nemanja Dimic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Anesthesiology and Intensive Care, University Hospital "Dragisa Misovic", 11000 Belgrade, Serbia
| | - Milan Lackovic
- Department of Obstetrics and Gynecology, University Hospital "Dragisa Misovic", 11000 Belgrade, Serbia
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8
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Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment. Semin Fetal Neonatal Med 2023; 28:101426. [PMID: 36964118 PMCID: PMC9990893 DOI: 10.1016/j.siny.2023.101426] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Pregnancy-related acute respiratory distress syndrome (ARDS) is fast becoming a growing and clinically relevant subgroup of ARDS amidst global outbreaks of various viral respiratory pathogens that include H1N1-influenza, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS), and the most recent COVID-19 pandemic. Pregnancy is a risk factor for severe viral-induced ARDS and commonly associated with poor maternal and fetal outcomes including fetal growth-restriction, preterm birth, and spontaneous abortion. Physiologic changes of pregnancy further compounded by mechanical and immunologic alterations are theorized to impact the development of ARDS from viral pneumonia. The COVID-19 sub-phenotype of ARDS share overlapping molecular features of maternal pathogenicity of pregnancy with respect to immune-dysregulation and endothelial/microvascular injury (i.e., preeclampsia) that may in part explain a trend toward poor maternal and fetal outcomes seen with severe COVID-19 maternal infections. To date, current ARDS diagnostic criteria and treatment management fail to include and consider physiologic adaptations that are unique to maternal physiology of pregnancy and consideration of maternal-fetal interactions. Treatment focused on lung-protective ventilation strategies have been shown to improve clinical outcomes in adults with ARDS but may have adverse maternal-fetal interactions when applied in pregnancy-related ARDS. No specific pharmacotherapy has been identified to improve outcomes in pregnancy with ARDS. Adjunctive therapies aimed at immune-modulation and anti-viral treatment with COVID-19 infection during pregnancy have been reported but data in regard to its efficacy and safety is currently lacking.
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Affiliation(s)
- Michelle J Lim
- UC Davis School of Medicine, UC Davis Children's Hospital, Department of Pediatrics, Division of Critical Care and Neonatology, Sacramento, CA, USA.
| | - Satyan Lakshminrusimha
- UC Davis School of Medicine, UC Davis Children's Hospital, Department of Pediatrics, Division of Critical Care and Neonatology, Sacramento, CA, USA
| | - Herman Hedriana
- UC Davis School of Medicine, UC Davis Medical Center, Department of Obstetrics and Gynecology, Sacramento, CA, USA
| | - Timothy Albertson
- UC Davis School of Medicine, UC Davis Medical Center, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Sacramento, CA, USA
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9
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Thomson B, Velusamy R, Martin A. Severe tachypnoea and dyspnoea due to physiological hyperventilation in pregnancy. Obstet Med 2023; 16:69-71. [PMID: 37139508 PMCID: PMC10150302 DOI: 10.1177/1753495x211037885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
Physiological hyperventilation and dyspnoea in pregnancy are well-established phenomena and commonly lead to a chronic respiratory alkalosis with compensatory renal excretion of bicarbonate. However, the underlying mechanism of dyspnoea during normal pregnancy remains largely undefined. Increasing progesterone levels are a primary factor leading to increased respiratory drive to ensure the rising metabolic demands of the pregnancy are met. Dyspnoea symptoms typically begin in the first or second trimester, are mild, and do not interfere with activities of daily living. We report the case of a 35-year-old female with severe physiological hyperventilation of pregnancy presenting with profound dyspnoea, tachypnoea, and presyncope from 18 weeks of gestation until delivery. Subsequent investigations revealed no identifiable underlying pathology. There remain limited reports of such severe physiological hyperventilation of pregnancy. This case highlights interesting questions regarding the respiratory physiology of pregnancy and underlying mechanisms.
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Affiliation(s)
- Brady Thomson
- Albury Wodonga Health, Albury, Australia
- Royal Melbourne Hospital, Melbourne, Australia
| | - Ragani Velusamy
- Albury Wodonga Health, Albury, Australia
- Royal Melbourne Hospital, Melbourne, Australia
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Hua Z, Ijaz I, Shahzad MN, Yi D, Hu GY, Dong FX. Multidisciplinary Antenatal Management of a Late Pregnancy Complicated With Advanced Stage Breast Burkitt Lymphoma - Case Report and a Review of the Literature. Cureus 2023; 15:e34950. [PMID: 36938187 PMCID: PMC10018230 DOI: 10.7759/cureus.34950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 02/16/2023] Open
Abstract
The multidisciplinary team (MDT) plays a pivotal role in establishing the diagnosis and tailoring treatment for challenging, complicated, rare obstetrical cases. At 28 weeks of gestation, a lady presented with an unresolved unilateral proptosis and sustained severe mastitis. MDT managed the patient at a tertiary care hospital for primary breast Burkitt lymphoma (PBBL). It is a rare and highly malignant condition requiring an aggressive therapeutic approach. Antenatal chemotherapy (ANC) with an aggressive regimen of R-hyper-CVAD/MA was started. A healthy baby was vaginally delivered after completing the second therapy cycle at 32+ weeks, weighing 1.6kg with a good Apgar score. Postnatally, the central nervous system (CNS) prophylaxis was added; after completing eight chemo cycles, our patient remained stabilized for nine months. Unfortunately, due to the refractory and aggressive nature of malignancy, it relapsed, giving an overall survival (OS) of two years. MDT care should be considered at the earliest possible period to expedite the entire process. Positive results can be achieved with timely aggressive treatment and early management of such cases.
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Affiliation(s)
- Zhong Hua
- Department of Obstetrics, Luzhou Medical College Affiliated Hospital, Luzhou, CHN
| | - Iqra Ijaz
- Sichuan Provincial Center for Gynecological and Breast Diseases, Southwest Medical University, Luzhou, CHN
- Department of Obstetrics and Gynecology, Holy Family Hospital, Rawalpindi, PAK
| | - Muhammad N Shahzad
- Department of Hematology, Luzhou Medical College Affiliated Hospital, Luzhou, CHN
- Internal Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Duan Yi
- Department of Pathology, Luzhou Medical College Affiliated Hospital, Luzhou, CHN
| | - Gao Y Hu
- Department of Radiology, Luzhou Medical College Affiliated Hospital, Luzhou, CHN
| | - Fu X Dong
- Department of Obstetrics, Luzhou Medical College Affiliated Hospital, Luzhou, CHN
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11
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Righini M, Robert-Ebadi H, Cremonesi A, Elias A, Sanchez O, Le Moigne E, Schmidt J, Le Gall C, Cornuz J, Aujesky D, Roy PM, Chauleur C, Rouyer F, Poletti PA, Moreau C, Le Gal G. Risk of neonatal hypothyroidism in newborns from mothers exposed to CTPA during pregnancy: Ancillary data from a prospective outcome study. J Thromb Haemost 2022; 20:2550-2555. [PMID: 35950611 DOI: 10.1111/jth.15843] [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: 04/13/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neonatal hypothyroidism is often raised as a potential concern for the use of computed tomography pulmonary angiography (CTPA) in pregnant women with suspected pulmonary embolism (PE). OBJECTIVES To assess the incidence of neonatal hypothyroidism among newborns from mothers exposed to CTPA. PATIENTS/METHODS Pregnant women with clinically suspected PE were included in a multicenter, multinational prospective diagnostic management outcome study, based on pretest clinical probability assessment, high-sensitivity D-dimer testing, bilateral lower limb venous compression ultrasonography, and CTPA. Results of Guthrie tests were systematically collected for newborns of all women who required CTPA as part of the diagnostic strategy. A thyroid-stimulating hormone (TSH) level above 15 U/ml was used to define hypothyroidism. RESULTS Out of the 166 women included in the Swiss participating centers, 149 underwent a CTPA including 14 with twin pregnancies. Eight women suffered a pregnancy loss and results of the Guthrie test could not be retrieved for four newborns. All TSH levels were reported as being below 15 U/ml. The incidence of neonatal hypothyroidism was 0/151 (0.0%, 95% confidence interval: 0.0%-2.5%). CONCLUSIONS We did not identify any cases of neonatal hypothyroidism in our cohort of 149 pregnant women investigated for suspected PE using a CTPA. Along with previous literature data, this provides further reassuring data regarding the use of CTPA in this indication.
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Affiliation(s)
- Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alessio Cremonesi
- Division of Clinical Biochemistry and Swiss Newborn Screening, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antoine Elias
- Médecine Vasculaire, Centre Hospitalier de Toulon, Toulon, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM UMR S 1140, Paris, France
- F-CRIN INNOVTE, Saint-Etienne, France
| | | | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Jacques Cornuz
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pierre-Marie Roy
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
| | - Céline Chauleur
- INSERM U1059, Saint-Etienne, France
- University of Lyon, Saint-Etienne, France
- Department of Gynecology and Obstetrics, University Hospital, Saint-Etienne, France
| | - Frédéric Rouyer
- Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Grégoire Le Gal
- EA3878 GETBO, Université de Brest, Brest, France
- Department of Hematology, Ottawa Health Research Institute, Ottawa, Ontario, Canada
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12
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[Translated article] Term Pregnancy in a Patient With Severe Pulmonary Emphysema Associated With Pi*ZZ Alpha-1 Antitrypsin Deficiency. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Liu A, Raja xavier J, Singh Y, Brucker SY, Salker MS. Molecular and Physiological Aspects of SARS-CoV-2 Infection in Women and Pregnancy. Front Glob Womens Health 2022; 3:756362. [PMID: 35284910 PMCID: PMC8908006 DOI: 10.3389/fgwh.2022.756362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/01/2022] [Indexed: 01/08/2023] Open
Abstract
Whilst scientific knowledge about SARS-CoV-2 and COVID-19 is rapidly increasing, much of the effects on pregnant women is still unknown. To accommodate pregnancy, the human endometrium must undergo a physiological transformation called decidualization. These changes encompass the remodeling of endometrial immune cells leading to immunotolerance of the semi-allogenic conceptus as well as defense against pathogens. The angiotensin converting enzyme 2 (ACE2) plays an important regulatory role in the renin-angiotensin-system (RAS) and has been shown to be protective against comorbidities known to worsen COVID-19 outcomes. Furthermore, ACE2 is also crucial for decidualization and thus for early gestation. An astounding gender difference has been found in COVID-19 with male patients presenting with more severe cases and higher mortality rates. This could be attributed to differences in sex chromosomes, hormone levels and behavior patterns. Despite profound changes in the female body during pregnancy, expectant mothers do not face worse outcomes compared with non-pregnant women. Whereas mother-to-child transmission through respiratory droplets during labor or in the postnatal period is known, another question of in utero transmission remains unanswered. Evidence of placental SARS-CoV-2 infection and expression of viral entry receptors at the maternal-fetal interface suggests the possibility of in utero transmission. SARS-CoV-2 can cause further harm through placental damage, maternal systemic inflammation, and hindered access to health care during the pandemic. More research on the effects of COVID-19 during early pregnancy as well as vaccination and treatment options for gravid patients is urgently needed.
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Affiliation(s)
- Anna Liu
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
| | - Janet Raja xavier
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
| | - Yogesh Singh
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
- Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, Tübingen, Germany
| | - Sara Y. Brucker
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
| | - Madhuri S. Salker
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
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14
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Zakaria ZZ, Al-Rumaihi S, Al-Absi RS, Farah H, Elamin M, Nader R, Bouabidi S, Suleiman SE, Nasr S, Al-Asmakh M. Physiological Changes and Interactions Between Microbiome and the Host During Pregnancy. Front Cell Infect Microbiol 2022; 12:824925. [PMID: 35265534 PMCID: PMC8899668 DOI: 10.3389/fcimb.2022.824925] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
In recent years, it has become clear that microbiome play a variety of essential roles in human metabolism, immunity, and overall health and that the composition of these microbiome is influenced by our environment, diet, weight, hormones, and other factors. Indeed, numerous physiological and pathological conditions, including obesity and metabolic syndrome, are associated with changes in our microbiome, referred to as dysbiosis. As a result, it is not surprising that such changes occur during pregnancy, which includes substantial weight gain and significant changes in metabolism and immune defenses. The present review relates physiological changes during pregnancy to alterations in the microbial composition at various sites, including the gut, oral cavity, and vagina. Pregnancy has been linked to such microbial changes, and we believe that, in contrast to certain disease states, these microbial changes are vital for a healthy pregnancy, probably through their influence on the mother’s immunological, endocrinological, and metabolic status.
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Affiliation(s)
- Zain Zaki Zakaria
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
- Biomedical Research Center, Qatar University (QU), Doha, Qatar
| | - Shouq Al-Rumaihi
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Rana S. Al-Absi
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University (QU), Doha, Qatar
| | - Huda Farah
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Muram Elamin
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Rahaf Nader
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Salma Bouabidi
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Sara Elgaili Suleiman
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Shahd Nasr
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | - Maha Al-Asmakh
- Department of Biomedical Sciences, College of Health Sciences, Qatar University (QU) Health, Qatar University, Doha, Qatar
- Biomedical Research Center, Qatar University (QU), Doha, Qatar
- *Correspondence: Maha Al-Asmakh,
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15
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Embarazo a término de una paciente con enfisema pulmonar grave asociado a déficit grave (PI*ZZ) de alfa-1 antitripsina. Arch Bronconeumol 2022; 58:427-428. [DOI: 10.1016/j.arbres.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
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16
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Determining the Clinical Course of Asthma in Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:793-802.e10. [PMID: 34656801 DOI: 10.1016/j.jaip.2021.09.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease affecting pregnancy, and poor asthma control has been associated with adverse pregnancy outcomes. However, the trajectory of asthma control during pregnancy is not well understood or characterized. OBJECTIVE To identify and characterize trajectories of gestational asthma control in a US-based prospective pregnancy cohort. METHODS A k-means algorithm for joint longitudinal data was used to cluster pregnant women with and without asthma into gestational asthma control trajectories on the basis of daily activity limitation, nighttime symptoms, inhaler use, and respiratory symptoms. RESULTS Among 308 women with asthma, 2 trajectories of gestational asthma control were identified and labeled "same" (n = 184; 59.5%) or "worse" (n = 124; 40.5%). Contrary to previous studies, we did not observe women with better asthma control in pregnancy. Women belonging to the "worse" trajectory experienced frequent and stable activity limitation and inhaler use, as well as frequent and increasing nighttime symptoms (∼3 d/gestational week) and respiratory symptoms (∼5 times/wk). Women belonging to the "same" trajectory experienced infrequent and stable activity limitation, inhaler use, and respiratory symptoms, as well as infrequent and slightly increasing (∼1 d/gestational week) nighttime symptoms. Results from pregnant women without asthma (n = 107) suggest that pregnancy alone was not responsible for changes in symptoms over time. CONCLUSIONS In this US-based obstetric cohort receiving care according to standard clinical practice, gestational asthma control worsened for about 40% of women.
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17
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Corbach N, Berlier C, Lichtblau M, Schwarz EI, Gautschi F, Groth A, Schüpbach R, Krähenmann F, Saxer S, Ulrich S. Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension. Front Med (Lausanne) 2021; 8:689764. [PMID: 34291063 PMCID: PMC8287120 DOI: 10.3389/fmed.2021.689764] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 01/31/2023] Open
Abstract
Introduction: Since pregnancy in women with pulmonary arterial hypertension (PAH) is associated with a high risk of morbidity and mortality, it is recommended that pregnancy should be avoided in PAH. However, some women with mild PAH may consider this recommendation as unsuitable. Unfortunately knowledge on pregnancy outcomes and best management of PAH during pregnancy is limited. Methods: Data from all women with PAH who were followed during pregnancy by a multidisciplinary team at a tertiary referral center for PAH and who delivered between 2004 and 2020 were retrospectively analyzed in a case series. PAH risk factor profiles including WHO functional class (WHO-FC), NT-pro-BNP, echocardiographic pulmonary arterial pressure (PAP) and right heart function were analyzed prior to, during and following pregnancy. Results: In seven pregnancies of five women with PAH (median age 29 (27; 31) years), there were no abortions or terminations. Five pregnancies were planned (all in WHO-FC I-II), two incidental (WHO-FC II, III). During pregnancy none of the women had complications or clinical worsening of PAH. After a median pregnancy duration of 37 1/7 weeks all gave birth to healthy babies by cesarean section in spinal anesthesia. During pregnancy, PAP tended to increase, whilst the course of WHO-FC and NT-pro-BNP were variable and no trend could be detected. Conclusion: Women with PAH with a low risk profile closely followed by a multidisciplinary team had a favorable course during and after pregnancy, resulting in successful deliveries of healthy newborns.
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Affiliation(s)
- Nadine Corbach
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Charlotte Berlier
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Fiorenza Gautschi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Groth
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Schüpbach
- Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Stéphanie Saxer
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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18
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Archiza B, Leahy MG, Kipp S, Sheel AW. An integrative approach to the pulmonary physiology of exercise: when does biological sex matter? Eur J Appl Physiol 2021; 121:2377-2391. [PMID: 33903937 DOI: 10.1007/s00421-021-04690-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Historically, many studies investigating the pulmonary physiology of exercise (and biomedical research in general) were performed exclusively or predominantly with male research participants. This has led to an incomplete understanding of the pulmonary response to exercise. More recently, important sex-based differences with respect to the human respiratory system have been identified. The purpose of this review is to summarize current findings related to sex-based differences in the pulmonary physiology of exercise. To that end, we will discuss how morphological sex-based differences of the respiratory system affect the respiratory response to exercise. Moreover, we will discuss sex-based differences of the physiological integrative responses to exercise, and how all these differences can influence the regulation of breathing. We end with a brief discussion of pregnancy and menopause and the accompanying ventilatory changes observed during exercise.
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Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada.
| | - Michael G Leahy
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - Shalaya Kipp
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T 0B8, Canada
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19
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Kazemi Aski S, Norooznezhad AH, Shamshirsaz AA, Mostafaei S, Aleyasin A, Nabavian SM, Alimohammadi S, Ahangari R, Ariana S, Ghotbizadeh F, Tara F, Pooransari P, Gharib Laki M, Zarean E, Soleimani Z, Saliminia A, Havaei A, Akbari R, Ramezani M, Soleimani A, Naemi M, Shamshirsaz AA, Hantoushzadeh S. Clinical features and risk factors associated with acute respiratory distress syndrome in pregnant women diagnosed with COVID-19: a multi-center case-control study. J Matern Fetal Neonatal Med 2021; 35:4884-4888. [PMID: 33550858 DOI: 10.1080/14767058.2021.1872062] [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] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate differences in clinical features and laboratory parameters in critically ill pregnant women with acute respiratory distress syndrome (ARDS) compared to moderate and severe pregnant women with coronavirus disease-2019 (COVID-19) but without ARDS. METHODS This was a retrospective multicenter study of all pregnant women with COVID-19 diagnosed with ARDS between February 15, and May 1, 2020 in nine level III maternity centers in Iran (ARDS group). The control COVID-19 pregnant women were selected from 3 of 9 level III maternity centers between March 15 and April 20, 2020. Univariate statistics were used to look at differences between groups. Cluster dendrograms were used to look at the correlations between clinical and laboratory findings in the groups. A value of p <.05 was considered statistically significant. RESULTS Fifteen COVID-19 infected women with ARDS were compared to 29 COVID-19 positive and ARDS negative control (moderate: (n = 26) 89.7% and severe: (n = 3)10.3%). The mean maternal age (35.6 vs. 29.4 years; p = .002) and diagnosis of chronic hypertension (20.0% vs. 0%, p = .034) were significantly higher in the ARDS group. There was no significant difference between the two groups in their presenting symptoms. The ARDS group had a significantly higher prevalence of tachypnea (66.6% vs. 10.3%, p = .042) and blood oxygen saturation (SpO2) <93% (66.6% vs. 10.3%, p = .004) at presentation. Relative lymphopenia (lymphocyte ratio < 10.5%, 66.6% vs. 17.2%, p = .002), lymphocytes to leukocytes ratio (11.3% vs. 17.7%, p = .010), and neutrophils to lymphocytes ratio (NLR) >7.5 were significantly different between the two groups (all p < .05). CONCLUSION Our data demonstrate that symptom-based strategies for identifying the critically ill pregnant women with SARS-CoV-2 are insufficient; however, vital signs and laboratory data might be helpful to predict ARDS in critically ill COVID-19 pregnant patients.
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Affiliation(s)
- Soudabeh Kazemi Aski
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Guilan University of Medical Scieneces, Rasht, Iran
| | - Amir Hossein Norooznezhad
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir A Shamshirsaz
- Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Shayan Mostafaei
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Epidemiology and Biostatistics Unit, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Aleyasin
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Maedeh Nabavian
- Department of Obstetrics, Gynecology, and Perinatology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shohreh Alimohammadi
- Department of Obstetrics, Gynecology, and Perinatology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Roghaye Ahangari
- Department of Obstetrics and Gynecology, Qom University of Medical Science, Qom, Iran
| | - Shideh Ariana
- Department of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ghotbizadeh
- Maternal Fetal Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Tara
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parichehr Pooransari
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Gharib Laki
- Department of Obstetrics and Gynecology, Qom University of Medical Science, Qom, Iran
| | - Elaheh Zarean
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Guilan University of Medical Scieneces, Rasht, Iran
| | - Zahra Soleimani
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Alireza Saliminia
- Department of anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Tehran, Iran
| | - Arash Havaei
- Maternal Fetal Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Akbari
- Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Ramezani
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Soleimani
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Naemi
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza A Shamshirsaz
- Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Sedigheh Hantoushzadeh
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Guilan University of Medical Scieneces, Rasht, Iran
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20
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Salam AM, Ahmed MB, Sulaiman K, Singh R, Alhashemi M, Carr AS, Alsheikh-Ali AA, AlHabib KF, Al-Zakwani I, Panduranga P, Asaad N, Shehab A, AlMahmeed W, Al Suwaidi J. Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries. ESC Heart Fail 2020; 7:4134-4138. [PMID: 32964700 PMCID: PMC7754996 DOI: 10.1002/ehf2.13030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 12/02/2022] Open
Abstract
Aims Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in‐hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence‐based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in‐hospital death (1.6%), and after 1 year of follow‐up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.
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Affiliation(s)
- Amar M Salam
- College of Medicine, QU Health, Qatar University, University street, Doha, 2713, Qatar.,Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar.,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Mohamed Badie Ahmed
- College of Medicine, QU Health, Qatar University, University street, Doha, 2713, Qatar
| | | | - Rajvir Singh
- Biostatistics Section, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Mohammed Alhashemi
- Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar
| | - Alison S Carr
- College of Medicine, QU Health, Qatar University, University street, Doha, 2713, Qatar
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Al-Zakwani
- College of Medicine and Health Sciences, Department of Pharmacology and Clinical Pharmacy, Sultan Qaboos University, and Gulf Health Research, Muscat, Oman
| | | | - Nidal Asaad
- Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar
| | - Abdulla Shehab
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | | | - Jassim Al Suwaidi
- Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar.,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
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21
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Silvani A, Bucalo F, Voekt C, Tobler D, Girard T. Platypnea-orthodeoxia syndrome: an unusual cause of breathlessness in late pregnancy. Int J Obstet Anesth 2020; 44:122-125. [PMID: 32947104 DOI: 10.1016/j.ijoa.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/08/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
A pregnant patient with shortness of breath and arterial oxygen desaturation is presented. The primary and tentative initial diagnosis was pulmonary embolism. Her desaturation and dyspnea were aggravated in the upright compared with the supine position. The minimal response to supplemental oxygen suggested right-to-left shunting, which was confirmed by echocardiography. Shunting was minimal in the supine and maximal in the upright position, leading to the diagnosis of platypnea-orthodeoxia syndrome. By two weeks postpartum the patient's symptoms had resolved and shunting was undetectable.
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Affiliation(s)
- A Silvani
- Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - F Bucalo
- Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland
| | - C Voekt
- Department of Obstetrics, Womeńs Hospital Grabs, Switzerland
| | - D Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - T Girard
- Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland.
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22
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Risk factors for aortic dissection in patients aged <40. Am J Emerg Med 2020; 38:1942. [DOI: 10.1016/j.ajem.2020.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/22/2022] Open
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23
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Bhatia M, Mahtani KR, Rochman R, Collins SL. Primary care assessment and management of common physical symptoms in pregnancy. BMJ 2020; 370:m2248. [PMID: 32718941 DOI: 10.1136/bmj.m2248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Meena Bhatia
- Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sally L Collins
- Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
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24
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Righini M, Robert-Ebadi H, Elias A, Sanchez O, Le Moigne E, Schmidt J, Le Gall C, Cornuz J, Aujesky D, Roy PM, Chauleur C, Rutschmann OT, Poletti PA, Le Gal G. Diagnosis of Pulmonary Embolism During Pregnancy: A Multicenter Prospective Management Outcome Study. Ann Intern Med 2018; 169:766-773. [PMID: 30357273 DOI: 10.7326/m18-1670] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Data on the optimal diagnostic management of pregnant women with suspected pulmonary embolism (PE) are limited, and guidelines provide inconsistent recommendations on use of diagnostic tests. OBJECTIVE To prospectively validate a diagnostic strategy in pregnant women with suspected PE. DESIGN Multicenter, multinational, prospective diagnostic management outcome study involving pretest clinical probability assessment, high-sensitivity D-dimer testing, bilateral lower limb compression ultrasonography (CUS), and computed tomography pulmonary angiography (CTPA). (ClinicalTrials.gov: NCT00740454). SETTING 11 centers in France and Switzerland between August 2008 and July 2016. PATIENTS Pregnant women with clinically suspected PE in emergency departments. INTERVENTION Pulmonary embolism was excluded in patients with a low or intermediate pretest clinical probability and a negative D-dimer result. All others underwent lower limb CUS and, if results were negative, CTPA. A ventilation-perfusion (V/Q) scan was done if CTPA results were inconclusive. Pulmonary embolism was excluded if results of the diagnostic work-up were negative, and untreated pregnant women had clinical follow-up at 3 months. MEASUREMENTS The primary outcome was the rate of adjudicated venous thromboembolic events during the 3-month follow-up. RESULTS 441 women were assessed for eligibility, and 395 were included in the study. Among these, PE was diagnosed in 28 (7.1%) (proximal deep venous thrombosis found on ultrasonography [n = 7], positive CTPA result [n = 19], and high-probability V/Q scan [n = 2]) and excluded in 367 (clinical probability and negative D-dimer result [n = 46], negative CTPA result [n = 290], normal or low-probability V/Q scan [n = 17], and other reason [n = 14]). Twenty-two women received extended anticoagulation during follow-up, mainly for previous venous thromboembolic disease. The rate of symptomatic venous thromboembolic events was 0.0% (95% CI, 0.0% to 1.0%) among untreated women after exclusion of PE on the basis of negative results on the diagnostic work-up. LIMITATION There were several protocol deviations, reflecting the difficulty of performing studies in pregnant women with suspected PE. CONCLUSION A diagnostic strategy based on assessment of clinical probability, D-dimer measurement, CUS, and CTPA can safely rule out PE in pregnant women. PRIMARY FUNDING SOURCE Swiss National Foundation for Scientific Research, Groupe d'Etude de la Thrombose de Bretagne Occidentale, and International Society on Thrombosis and Haemostasis.
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Affiliation(s)
- Marc Righini
- Geneva University Hospitals, Geneva, Switzerland (M.R., H.R., O.T.R., P.P.)
| | - Helia Robert-Ebadi
- Geneva University Hospitals, Geneva, Switzerland (M.R., H.R., O.T.R., P.P.)
| | | | - Olivier Sanchez
- Université Paris Descartes, Sorbonne Paris Cité, and Hôpital Européen Georges Pompidou, Paris, France (O.S.)
| | - Emmanuelle Le Moigne
- INSERM UMR S 1140, Paris, France, F-CRIN INNOVTE, Saint-Etienne, France, and Université de Brest, Brest, France (E.L.)
| | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France (J.S.)
| | | | - Jacques Cornuz
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (J.C.)
| | - Drahomir Aujesky
- Bern University Hospital, University of Bern, Bern, Switzerland (D.A.)
| | | | - Céline Chauleur
- INSERM U1059, University of Lyon, and University Hospital, Saint-Etienne, France (C.C.)
| | | | | | - Grégoire Le Gal
- Université de Brest, Brest, France, and Ottawa Health Research Institute, Ottawa, Ontario, Canada (G.L.)
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