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Feng Q, Cui Q, Xiao Z, Liu Z, Fan S. Maternal and Perinatal Outcomes of SARS-CoV-2 and Variants in Pregnancy. MATERNAL-FETAL MEDICINE 2023. [DOI: 10.1097/fm9.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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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: 7] [Impact Index Per Article: 7.0] [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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Iacob D, Enatescu I, Dima M, Bernad E, Pantea M, Bozgan D, Bernad S, Craina M. First Neonates with Vertical Transmission of SARS-CoV-2 Infection in Late Pregnancy in West Part of Romania: Case Series. Diagnostics (Basel) 2022; 12:diagnostics12071668. [PMID: 35885572 PMCID: PMC9324313 DOI: 10.3390/diagnostics12071668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 12/26/2022] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has exposed the vulnerable neonatal population to unknown risks. Given that herd immunity is has not been reached, the entire population is susceptible to Severe Acute Respiratory Syndrome Coronavirus 2 Virus(SARS-CoV-2) infection. The arising concern about the vertical transmission of neonatal complications caused by the novel coronavirus is a continuous challenge for managing newborns, considering the rare cases and unclear guidelines. Therefore, a retrospective study was conducted in a tertiary unit from Timisoara, Romania. Of the 283 newborns born during the study period, only 3 neonates were diagnosed with SARS-CoV-2 infection in the first 24 h of life (DOL-0). The present study plans to identify the findings, including clinical features, laboratory characteristics, and outcomes of newborns with vertical transmission of SARS-CoV-2. All infected neonates were confirmed with COVID-19 by Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) from nasal aspirates and were isolated in the neonatology department. They were the first and the only neonate infected at birth from the West part of Romania. The clinical findings were unremarkable except for one neonate who developed mild respiratory distress syndrome. Elevated IgG-specific anti-SARS-CoV-2 serum levels were found in one newborn. Swab samples in DOL-0 strengthened the awareness of vertical transmission, although peripartum SARS-CoV-2 infection does not seem responsible for severe symptoms. We conclude that vertical transmission is rare in late pregnancy. Even if the studied newborns showed mild forms of COVID-19, it is essential to note that newborns represent a particular category of patients. More studies are needed to complete the observations of this study.
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Affiliation(s)
- Daniela Iacob
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy, EftimieMurgu Square no 2, 300041 Timisoara, Romania; (D.I.); (I.E.); (M.D.); (M.P.)
| | - Ileana Enatescu
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy, EftimieMurgu Square no 2, 300041 Timisoara, Romania; (D.I.); (I.E.); (M.D.); (M.P.)
| | - Mirabela Dima
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy, EftimieMurgu Square no 2, 300041 Timisoara, Romania; (D.I.); (I.E.); (M.D.); (M.P.)
| | - Elena Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, EftimieMurgu Square no 2, 300041 Timisoara, Romania;
- Correspondence:
| | - Manuela Pantea
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy, EftimieMurgu Square no 2, 300041 Timisoara, Romania; (D.I.); (I.E.); (M.D.); (M.P.)
| | - Daiana Bozgan
- Clinic of Neonatology, “PiusBrinzeu” County Emergency Hospital, 300723 Timisoara, Romania;
| | - Sandor Bernad
- Romanian Academy Timisoara Branch, Mihai Viteazul Avenue, 24, 300275 Timisoara, Romania;
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, EftimieMurgu Square no 2, 300041 Timisoara, Romania;
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Ghafoor H, Abdus samad A, Bel Khair AOM, Ahmed O, Khan MNA. Critical Care Management of Severe COVID-19 in Pregnant Patients. Cureus 2022; 14:e24885. [PMID: 35572463 PMCID: PMC9097928 DOI: 10.7759/cureus.24885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 12/15/2022] Open
Abstract
Since December 2019, the coronavirus disease (COVID-19) pandemic has had a disastrous impact worldwide. COVID-19 is caused by the SARS-CoV-2 virus and was declared a pandemic by the WHO on March 11, 2020. The virus has been linked to a wide range of respiratory illnesses, ranging from mild symptoms to acute pneumonia and severe respiratory distress syndrome. Pregnant women are more vulnerable to COVID-19 complications owing to the physiological and immunological changes caused by pregnancy. According to the CDC, pregnant patients with COVID-19 are commonly hospitalized and often require admission to ICUs and ventilator support. Therefore, it is especially important for pregnant women to adhere to disease prevention measures to lower the risk of contracting the disease. In addition, the guidelines of several clinical societies and local health authorities should be followed when caring for pregnant women with suspected or confirmed COVID-19. In this review article, we discuss the epidemiology of COVID-19 during delivery, its effect on the physiological and immunological changes during pregnancy, the classification of COVID-19 severity, maternal and fetal risks, antenatal care, respiratory management, treatment/medication safety, timing and mode of delivery, anesthetic considerations, and the outcome of critically ill pregnant patients with COVID-19, as well as their post-delivery care and weaning from mechanical ventilation.
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Abstract
PURPOSE OF REVIEW For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of consensus on details of technique and concerns for risks in certain patient populations. This review summarizes recent literature on the benefits and risks of DCC in term and preterm infants and examines alternative approaches such as physiologic-based cord clamping or intact cord resuscitation (ICR) and umbilical cord milking (UCM). RECENT FINDINGS DCC improves hemoglobin/hematocrit among term infants and may promote improved neurodevelopment. In preterms, DCC improves survival compared to early cord clamping; however, UCM has been associated with severe intraventricular hemorrhage in extremely preterm infants. Infants of COVID-19 positive mothers, growth-restricted babies, multiples, and some infants with cardiopulmonary anomalies can also benefit from DCC. Large randomized trials of ICR will clarify safety and benefits in nonvigorous neonates. These have the potential to dramatically change the sequence of events during neonatal resuscitation. SUMMARY Umbilical cord management has moved beyond simple time-based comparisons to nuances of technique and application in vulnerable sub-populations. Ongoing research highlights the importance of an individualized approach that recognizes the physiologic equilibrium when ventilation is established before cord clamping.
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Affiliation(s)
| | - Susan Niermeyer
- University of Colorado School of Medicine, Colorado School of Public Health, Aurora, Colorado, USA
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Ayala-Ramírez P, González M, Escudero C, Quintero-Arciniegas L, Giachini FR, Alves de Freitas R, Damiano AE, García-Robles R. Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Pregnancy. A Non-systematic Review of Clinical Presentation, Potential Effects of Physiological Adaptations in Pregnancy, and Placental Vascular Alterations. Front Physiol 2022; 13:785274. [PMID: 35431989 PMCID: PMC9005899 DOI: 10.3389/fphys.2022.785274] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
In December 2019, the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) rapidly spread to become a pandemic. To date, increasing evidence has described the potential negative impact of SARS-CoV-2 infection on pregnant women. Although the pathophysiology of coronavirus disease 2019 (COVID-19) is not entirely understood, there is emerging evidence that it causes a severe systemic inflammatory response associated with vascular alterations that could be of special interest considering some physiological changes in pregnancy. Additionally, these alterations may affect the physiology of the placenta and are associated with pregnancy complications and abnormal histologic findings. On the other hand, data about the vaccine against SARS-CoV-2 are limited, but the risks of administering COVID-19 vaccines during pregnancy appear to be minimal. This review summarizes the current literature on SARSCoV2 virus infection, the development of COVID-19 and its relationship with physiological changes, and angiotensin-converting enzyme 2 (ACE2) function during pregnancy. We have particularly emphasized evidence coming from Latin American countries.
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Affiliation(s)
- Paola Ayala-Ramírez
- School of Medicine, Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
- *Correspondence: Paola Ayala-Ramírez,
| | - Marcelo González
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
- Laboratorio de Investigación Materno-Fetal (LIMaF), Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Marcelo González,
| | - Carlos Escudero
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
- Laboratory of Vascular Physiology, Department of Basic Sciences, Faculty of Sciences, Universidad del Bio-Bio, Chillan, Chile
| | - Laura Quintero-Arciniegas
- Perinatal Medicine Seedbed, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Physiological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernanda R. Giachini
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil
| | | | - Alicia E. Damiano
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO)- CONICET- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Cátedra de Biología Celular y Molecular, Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Reggie García-Robles
- Department of Physiological Sciences, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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Skalska-Świstek M, Huras H, Jaworowski AP, Świstek R, Kołak M. COVID-19 Infection Complicated by Disseminated Intravascular Coagulation during Pregnancy—Two Cases Report. Diagnostics (Basel) 2022; 12:diagnostics12030655. [PMID: 35328208 PMCID: PMC8947359 DOI: 10.3390/diagnostics12030655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
Coagulopathies are one of the obstetric complications affecting the period of pregnancy, childbirth, and puerperium. One of the more severe and complex disorders of the haemostatic system is the disseminated intravascular coagulation syndrome (DIC), in which generalised activation of the coagulation system and activation of inflammatory cells occurs. DIC syndrome was observed in patients whose pregnancy was complicated by SARS-CoV-2 infection. Both the course of these cases and literature review indicate that particular notice should be paid to laboratory parameters of the coagulation system, closely monitoring the well-being of the foetus and, in the situation of acute DIC development, it is advised to deliver a baby and initiate intensive therapy.
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Affiliation(s)
- Małgorzata Skalska-Świstek
- Department of Obstetrics and Perinatology, Medical College, Jagiellonian University, 23 Kopernika Str., 31-501 Krakow, Poland; (H.H.); (A.P.J.); (M.K.)
- Correspondence:
| | - Hubert Huras
- Department of Obstetrics and Perinatology, Medical College, Jagiellonian University, 23 Kopernika Str., 31-501 Krakow, Poland; (H.H.); (A.P.J.); (M.K.)
| | - Andrzej Piotr Jaworowski
- Department of Obstetrics and Perinatology, Medical College, Jagiellonian University, 23 Kopernika Str., 31-501 Krakow, Poland; (H.H.); (A.P.J.); (M.K.)
| | - Rafał Świstek
- Department of Anaesthesiology and Intensive Therapy, University Hospital in Krakow, 2 Jakubowskiego Str., 30-688 Krakow, Poland;
| | - Magdalena Kołak
- Department of Obstetrics and Perinatology, Medical College, Jagiellonian University, 23 Kopernika Str., 31-501 Krakow, Poland; (H.H.); (A.P.J.); (M.K.)
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