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Scharf KT, Bharadwaj S, Lankford A, Wong M, Kodali BS. Relationship between maternal arterial and foetal cord carbon dioxide tension and neonatal outcome in critically ill pregnant women at delivery. Indian J Anaesth 2024; 68:354-359. [PMID: 38586257 PMCID: PMC10993940 DOI: 10.4103/ija.ija_1218_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 04/09/2024] Open
Abstract
Background and Aims No studies have evaluated the relationship between maternal arterial partial pressure of carbon dioxide (mPaCO2) and umbilical cord venous partial pressure of carbon dioxide (PCO2) in critically ill pregnant women at delivery. Based on the studies in healthy pregnant women, an mPaCO2 target of ≤50 mmHg is a suggested threshold during mechanical ventilation in critically ill parturients. We evaluated the relationship between mPaCO2 and neonatal cord gases in critically ill parturients at delivery as the primary objective. The relationship between mPaCO2 and APGAR scores at delivery was also analysed as a secondary objective. Methods Maternal and neonatal cord gas data at delivery and APGAR scores were obtained by a retrospective chart review of 25 consecutive parturients with severe respiratory compromise who were delivered during mechanical ventilation. Linear regression was used to assess the relationship between mPaCO2 and umbilical artery and vein PCO2 and between mPaCO2 and APGAR scores at 1 and 5 min. Results There was a positive correlation between mPaCO2 and neonatal cord venous PCO2 (P = 0.013). Foetal venous PCO2 exceeded predelivery mPaCO2 by 17.5 (7.5) mmHg. There was an inverse relationship between mPaCO2 and neonatal APGAR scores at 1 and 5 min (P = 0.006 and P = 0.007, respectively). Conclusion Foetal cord venous PCO2 can be predicted if mPaCO2 values are known. Unlike in healthy pregnant women, there was an inverse relationship between rising mPaCO2 levels and neonatal APGAR scores in critically ill pregnant women who had several associated compounding factors.
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Affiliation(s)
- Katelyn T Scharf
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Shobana Bharadwaj
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Allison Lankford
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Michael Wong
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Bhavani S Kodali
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
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Vernon-Elliot J, Prasad JD, Bonney A. Critical deterioration of chronic eosinophilic pneumonia during pregnancy. BMJ Case Rep 2024; 17:e259019. [PMID: 38395471 PMCID: PMC10895239 DOI: 10.1136/bcr-2023-259019] [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] [Indexed: 02/25/2024] Open
Abstract
Chronic eosinophilic pneumonia (CEP) is a rare, idiopathic interstitial lung disease characterised by the accumulation of eosinophils in the pulmonary interstitia and alveoli. Patients with CEP respond well to systemic corticosteroid therapy and infrequently progress to end-stage lung disease. We report a case of a woman in her 40s with previously stable, steroid-responsive CEP who experienced a critical deterioration of her CEP at 25 weeks of gestation during her third pregnancy. The patient was admitted to the intensive care unit due to respiratory failure requiring intubation and mechanical ventilation. Follow-up investigation revealed advanced fibrotic lung disease requiring long-term oxygen therapy and referral for double lung transplantation. While CEP infrequently advances to permanent parenchymal damage, this case demonstrates the potential for severe exacerbations in the setting of pregnancy and highlights pregnancy as a potential risk factor for disease progression, reinforcing the need for further research to define optimal monitoring and treatment strategies.
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Affiliation(s)
- Jake Vernon-Elliot
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jyotika Devi Prasad
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Respiratory Department, Alfred Health, Melbourne, Victoria, Australia
| | - Asha Bonney
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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Maharjan S, Goswami S, Rong Y, Kirby T, Smith D, Brett CX, Pittman EL, Bhattacharya K. Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid. JAMA Netw Open 2024; 7:e2350750. [PMID: 38190184 PMCID: PMC10774990 DOI: 10.1001/jamanetworkopen.2023.50750] [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] [Received: 08/06/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024] Open
Abstract
Importance Mississippi has one of the highest rates of severe maternal morbidity (SMM) in the US, and SMMs have been reported to be more frequent among Medicaid-insured women. A substantial proportion of pregnant women in Mississippi are covered by Medicaid; hence, there is a need to identify potential risk factors for SMM in this population. Objective To examine the associations of health care access and clinical and sociodemographic characteristics with SMM events among Mississippi Medicaid-enrolled women who had a live birth. Design, Setting, and Participants A nested case-control study was conducted using 2018 to 2021 Mississippi Medicaid administrative claims database. The study included Medicaid beneficiaries aged 12 to 55 years who had a live birth and were continuously enrolled throughout their pregnancy period and 12 months after delivery. Individuals in the case group had SMM events and were matched to controls on their delivery date using incidence density sampling. Data analysis was performed from June to September 2022. Exposure Risk factors examined in the study included sociodemographic factors (age and race), health care access (distance from delivery center, social vulnerability index, and level of maternity care), and clinical factors (maternal comorbidity index, first-trimester pregnancy-related visits, and postpartum care). Main Outcomes and Measures The main outcome of the study was an SMM event. Adjusted odds ratio (aORs) and 95% CIs were calculated using conditional logistic regression. Results Among 13 485 Mississippi Medicaid-enrolled women (mean [SD] age, 25.0 [5.6] years; 8601 [63.8%] Black; 4419 [32.8%] White; 465 [3.4%] other race [American Indian, Asian, Hispanic, multiracial, and unknown]) who had a live birth, 410 (3.0%) were in the case group (mean [SD] age, 26.8 [6.4] years; 289 [70.5%] Black; 112 [27.3%] White; 9 [2.2%] other race) and 820 were in the matched control group (mean [SD] age, 24.9 [5.7] years; 518 [63.2%] Black; 282 [34.4%] White; 20 [2.4%] other race). Black individuals (aOR, 1.44; 95% CI, 1.08-1.93) and those with higher maternal comorbidity index (aOR, 1.27; 95% CI, 1.16-1.40) had higher odds of experiencing SMM compared with White individuals and those with lower maternal comorbidity index, respectively. Likewise, an increase of 100 miles (160 km) in distance between beneficiaries' residence to the delivery center was associated with higher odds of experiencing SMM (aOR, 1.14; 95% CI, 1.07-1.20). Conclusions and Relevance The study findings hold substantial implications for identifying high-risk individuals within Medicaid programs and call for the development of targeted multicomponent, multilevel interventions for improving maternal health outcomes in this highly vulnerable population.
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Affiliation(s)
- Shishir Maharjan
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University
- Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University
| | - Swarnali Goswami
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University
- Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University
- Now with Complete Health Economics and Outcomes Solutions, LLC, Chalfont, Pennsylvania
| | - Yiran Rong
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University
- Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University
- Now with MedTech Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, New Jersey
| | | | | | | | - Eric L. Pittman
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University
- Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University
| | - Kaustuv Bhattacharya
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University
- Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University
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Xiao H, Chen C, Huang S, Zhang W, Cai S, Hou X, Luo Y, Lin Y. Effects of novel coronavirus Omicron variant infection on pregnancy outcomes: a retrospective cohort study from Guangzhou. Front Med (Lausanne) 2023; 10:1256080. [PMID: 38170092 PMCID: PMC10759226 DOI: 10.3389/fmed.2023.1256080] [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: 07/10/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Objective Since 2022, Omicron has been circulating in China as a major variant of the novel coronavirus, but the effects of infection with Omicron variants on pregnant women and newborns are unknown. The purpose of this study was to determine the clinical characteristics of Omicron infection during pregnancy and its effect on pregnancy outcomes. Methods This study retrospectively analyzed the data of 93 confirmed cases of novel coronavirus infection and 109 non-infected patients admitted to the isolation ward of Guangdong Maternal and Child Health Hospital from December 1, 2022 to January 31, 2023, and statistically analyzed the clinical features of Omicron variant infection during pregnancy and its impact on pregnancy outcomes. Further effects of underlying diseases on Omicron infection in pregnant women were analyzed. Results The incubation period of COVID-19 infection was 0.99±0.86 days, 94.38% of patients had fever or other respiratory symptoms, the lymphocyte count in the infected group was lower than that in the uninfected group, and the lymphocyte count was further reduced in the patients with pregnancy complications or complications. Compared with the uninfected group, APTT and PT were prolonged, platelet count and fibrinogen were decreased in the infected group, all of which had statistical significance. COVID-19 infection during pregnancy increased the rate of cesarean section compared to uninfected pregnant patients, and COVID-19 infection in gestational diabetes resulted in a 4.19-fold increase in cesarean section rate. There was no statistically significant difference in gestational age between the two groups. The incidence of intrauterine distress, turbidity of amniotic fluid and neonatal respiratory distress were higher in the infection group. No positive cases of neonatal COVID-19 infection have been found. Conclusion The patients infected with omicron during pregnancy often have febrile respiratory symptoms with lymphocyopenia, but the incidence of severe disease is low. Both Omicron infection and gestational diabetes further increase the incidence of cesarean section, and this study found no evidence of vertical transmission of Omicron.
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Affiliation(s)
- Huanshun Xiao
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Cheng Chen
- Department of Intensive Care Unit, Baiyun Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shan Huang
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wenni Zhang
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shuangming Cai
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiangling Hou
- Faculty of Science and Technology, BNU-HKBU United International College, Zhuhai, China
| | - Yiping Luo
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yu Lin
- Department of Intensive Care Unit, Baiyun Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
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Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Battaglia MA, Bergamaschi R, Brichetto G, Bunul SD, Calabrese M, Capobianco M, Cavalla P, Celani MG, Clerico M, Cocco E, Comi G, Confalonieri P, Conte A, Cordioli C, De Luca G, De Rossi N, Filippi M, Gumes H, Immovilli P, Inglese M, Karabudak R, Landi D, Lanzillo R, L’Episcopo MR, Lorefice L, Mantero V, Marangoni S, Marfia GA, Masciulli C, Milano E, Moiola L, Orlandi R, Patti F, Perini P, Pesci I, Pucci E, Puthenparampil M, Radaelli M, Salvetti M, Sartori A, Scandellari C, Sen S, Siva A, Strumia S, Teatini F, Tedeschi G, Trojano M, Tutuncu M, Vaula G, Sormani MP, Amato MP. Sars-CoV2 infection in pregnant women with multiple sclerosis. Mult Scler 2023; 29:1090-1098. [PMID: 37232279 PMCID: PMC10225808 DOI: 10.1177/13524585231176174] [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: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients. OBJECTIVE In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis. METHODS We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022. A control group of 1354 women was extracted from the database of the Multiple Sclerosis and COVID-19 (MuSC-19). Univariate and subsequent logistic regression models were fitted to search for risk factors associated with severe COVID-19 course (at least one outcome among hospitalization, intensive care unit [ICU] admission and death). RESULTS In the multivariable analysis, independent predictors of severe COVID-19 were age, body mass index ⩾ 30, treatment with anti-CD20 and recent use of methylprednisolone. Vaccination before infection was a protective factor. Vaccination before infection was a protective factor. Pregnancy was not a risk nor a protective factor for severe COVID-19 course. CONCLUSION Our data show no significant increase of severe COVID-19 outcomes in patients with multiple sclerosis who contracted the infection during pregnancy.
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Affiliation(s)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy/Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | - S Destan Bunul
- Kocaeli University School of Medicine, Kocaeli, Kocaeli, Turkey
| | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Marco Capobianco
- Department of Neurology, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science, University Hospital of Turin, Turin, Italy
| | - Maria Grazia Celani
- Servizio Malattie Demielinizzanti, SC di Neurofisiopatologia, AO di Perugia, Perugia, UK
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | | | - Paolo Confalonieri
- Multiple Sclerosis Centre, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Giovanna De Luca
- MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Haluk Gumes
- Selcuk University School of Medicine, Konya, Turkey
| | - Paolo Immovilli
- Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy/Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | | | - Vittorio Mantero
- UOC Neurologia—Stroke Unit, Presidio “A. Manzoni,” ASST Lecco, Italy/Department of Neurology, Ospedale Santa Chiara, Trento, Italy
| | - Sabrina Marangoni
- Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, “Tor Vergata” University, Rome, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Eva Milano
- SC Neurologia 1, Ospedale Maria Vittoria, Torino, Italy
| | - Lucia Moiola
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Riccardo Orlandi
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Patti
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Paola Perini
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy
| | | | - Marco Puthenparampil
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Marta Radaelli
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy/Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Arianna Sartori
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Cinzia Scandellari
- IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy
| | - Sedat Sen
- Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Aksel Siva
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Silvia Strumia
- UOC di Neurologia, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Francesco Teatini
- Multiple Sclerosis Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - Melih Tutuncu
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Giovanna Vaula
- Department of Neuroscience, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Brendolin M, Fuller T, Wakimoto M, Rangel L, Rodrigues GM, Rohloff RD, Guaraldo L, Nielsen-Saines K, Brasil P. Severe maternal morbidity and mortality during the COVID-19 pandemic: a cohort study in Rio de Janeiro. IJID REGIONS 2023; 6:1-6. [PMID: 36407853 PMCID: PMC9646996 DOI: 10.1016/j.ijregi.2022.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022]
Abstract
Objectives To identify factors associated with adverse maternal outcomes during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a single-centre prospective cohort study at a maternity department in a public general hospital in Rio de Janeiro. All pregnant women evaluated for emergency care, labour and delivery, respiratory symptoms, obstetric reasons or medical reasons between May 2020 and March 2022 at the study institution were invited to enrol in this study. The endpoint was maternal mortality or intensive care unit (ICU) admission. Results In total, 1609 pregnant women were enrolled in this study. Of these, 25.5% (n=410) were infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) based on reverse transcription polymerase chain reaction or an antigen test. There were 21 deaths and 67 ICU admissions in 4% of the cohort. The incidence of severe maternal morbidity and mortality was higher during the Gamma wave than during the Delta wave (P=0.003). Vaccination conferred protection against the endpoint [relative risk (RR) 0.4, 95% confidence interval (CI) 0.1-0.9; P=0.0169]. Factors associated with severe morbidity and mortality included caesarean section (RR 3.7, 95% CI 1.7-7.9; P=0.0008), SARS-CoV-2 infection in the third trimester (RR 2.4, 95% CI 1.1-5.6; P=0.0006) and comorbidities (RR 3, 95% CI 1.8-5.2; P<0.0001). Conclusions COVID-19 was significantly associated with the risk of severe maternal morbidity and mortality. Immunization of pregnant women against COVID-19 was highly protective against adverse outcomes, and should be encouraged during pregnancy.
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Affiliation(s)
- Michelle Brendolin
- Acute Febrile Illnesses Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Maternity Department, Adão Pereira Nunes Hospital, Duque de Caxias, Brazil
| | - Trevon Fuller
- Acute Febrile Illnesses Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Pediatric Infectious Diseases Division, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Mayumi Wakimoto
- Acute Febrile Illnesses Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Larissa Rangel
- Acute Febrile Illnesses Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Roger D. Rohloff
- Perinatal de Laranjeiras Maternity Hospital, Rio de Janeiro, Brazil
| | - Lusiele Guaraldo
- Acute Febrile Illnesses Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Karin Nielsen-Saines
- Pediatric Infectious Diseases Division, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Patrícia Brasil
- Acute Febrile Illnesses Department, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Pulmonary embolism in pregnancy and the puerperium. Best Pract Res Clin Obstet Gynaecol 2022; 85:96-106. [PMID: 35872145 DOI: 10.1016/j.bpobgyn.2022.06.003] [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: 05/11/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022]
Abstract
Pulmonary embolism (PE) in pregnant women appears to be increasing. This could be related in part to improved health care allowing more women with risk factors to conceive, as well as increase in the high-risk groups which include pregnancies conceived on artificial reproductive technology, advancing maternal age, obesity, and caesarean deliveries. Prevention and early diagnosis with prompt effective treatment can reduce maternal mortality and improve pregnancy outcome, so that obstetricians should be on the lookout for venous thrombosis and PE, especially when in the majority of cases, risk factors only start to emerge or develop in the course of pregnancy and delivery. Management includes accurate diagnosis with ventilation/perfusion scan and CT pulmonary angiography, followed by effective anticoagulation and more aggressive measures such as thrombolysis as indicated, together with general supportive measures. Postpartum management should cover subsequent health issues, including breastfeeding, contraception, mood changes, and recurrence in subsequent pregnancies.
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Ashby T, Staiano P, Najjar N, Louis M. Bacterial pneumonia infection in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85:26-33. [PMID: 35970746 DOI: 10.1016/j.bpobgyn.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
Bacterial pneumonia in pregnancy is the most common fatal non-obstetrical infection and is associated with poorer maternal and fetal outcomes. Risk factors include normal physiological and anatomic changes that occur during pregnancy. In this review, we will discuss the etiological pathogens of bacterial pneumonias in pregnancy and its common complications, including both maternal and fetal outcomes. We will also review the diagnosis and management of bacterial pneumonia in the outpatient and inpatient setting and highlight the major pregnancy and lactation considerations when choosing antibiotic therapies.
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Affiliation(s)
- Tracy Ashby
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA
| | - Peter Staiano
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA
| | - Nimeh Najjar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA
| | - Mariam Louis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, UF Health Clinical Center, 655 West 8th Street, Suite 7-088, C-54, Jacksonville, FL, 32209, USA.
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9
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Lao TT. Acute respiratory distress and amniotic fluid embolism in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85:83-95. [PMID: 35840499 PMCID: PMC9264283 DOI: 10.1016/j.bpobgyn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022]
Abstract
Respiratory failure in pregnant and postpartum women is uncommon, but it is one of the leading causes of maternal admission into the intensive care unit and is associated with high mortality. The underlying causes include sequelae of underlying medical conditions, such as congenital heart diseases, but it is more often related to acute respiratory distress syndrome from obstetric complications like pre-eclampsia, effect of treatment like tocolysis, coincidental to pregnancy like transfusion-related acute lung injury, and accidental like amniotic fluid embolism. The pathophysiological mechanisms involved in many of these conditions remain to be clearly established, but maternal inflammatory response and activation of the immune and complement systems appear to play leading roles. Prompt recognition of maternal respiratory distress and related manifestations and aggressive and adequate supportive treatment, especially cardiopulmonary resuscitation, ventilation, maintenance of circulation, and timely termination of the pregnancy, play key roles in achieving survival of both mother and foetus.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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10
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Aissi James S, Guervilly C, Lesouhaitier M, Coppens A, Haddadi C, Lebreton G, Nizard J, Brechot N, Assouline B, Saura O, Levy D, Lefèvre L, Barhoum P, Chommeloux J, Hékimian G, Luyt CE, Kimmoun A, Combes A, Schmidt M. Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study. Crit Care 2022; 26:312. [PMID: 36253839 PMCID: PMC9574812 DOI: 10.1186/s13054-022-04189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background Although rarely addressed in the literature, a key question in the care of critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially at the time of extracorporeal membrane oxygenation (ECMO) decision, is whether delivery might substantially improve the mother’s and child’s conditions. This multicenter, retrospective cohort aims to report maternal and fetal short- and long-term outcomes of pregnant women with ECMO-rescued severe ARDS according to the timing of the delivery decision taken before or after ECMO cannulation.
Methods We included critically ill women with ongoing pregnancy or within 15 days after a maternal/child-rescue-aimed delivery supported by ECMO for a severe ARDS between October 2009 and August 2021 in four ECMO centers. Clinical characteristics, critical care management, complications, and hospital discharge status for both mothers and children were collected. Long-term outcomes and premature birth complications were assessed.
Results Among 563 women on venovenous ECMO during the study period, 11 were cannulated during an ongoing pregnancy at a median (range) of 25 (21–29) gestational weeks, and 13 after an emergency delivery performed at 32 (17–39) weeks of gestation. Pre-ECMO PaO2/FiO2 ratio was 57 (26–98) and did not differ between the two groups. Patients on ECMO after delivery reported more major bleeding (46 vs. 18%, p = 0.05) than those with ongoing pregnancy. Overall, the maternal hospital survival was 88%, which was not different between the two groups. Four (36%) of pregnant women had a spontaneous expulsion on ECMO, and fetal survival was higher when ECMO was set after delivery (92% vs. 55%, p = 0.03). Among newborns alive, no severe preterm morbidity or long-term sequelae were reported. Conclusion Continuation of the pregnancy on ECMO support carries a significant risk of fetal death while improving prematurity-related morbidity in alive newborns with no difference in maternal outcomes. Decisions regarding timing, place, and mode of delivery should be taken and regularly (re)assess by a multidisciplinary team in experienced ECMO centers. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04189-5.
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Affiliation(s)
- Sarah Aissi James
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Christophe Guervilly
- grid.414244.30000 0004 1773 6284Service de Médecine Intensive-Réanimation, APHM, CHU Hôpital Nord, Marseille, France
| | - Mathieu Lesouhaitier
- grid.411154.40000 0001 2175 0984Service de Maladies Infectieuses Et Réanimation Médicale, CHU de Rennes, Rennes, France
| | - Alexandre Coppens
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Clément Haddadi
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Université de Lorraine, Nancy, France
| | - Guillaume Lebreton
- grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France ,grid.411439.a0000 0001 2150 9058Service de Chirurgie Cardiaque, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Jacky Nizard
- grid.462844.80000 0001 2308 1657Department of Gynaecology and Obstetrics, Groupe Hospitalier Pitié-Salpêtrière, CNRS UMR 7222, INSERM U1150, Sorbonne Universités, Paris, France
| | - Nicolas Brechot
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Benjamin Assouline
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Ouriel Saura
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - David Levy
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Lucie Lefèvre
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Pétra Barhoum
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Juliette Chommeloux
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Guillaume Hékimian
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Charles-Edouard Luyt
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France
| | - Antoine Kimmoun
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Université de Lorraine, Nancy, France
| | - Alain Combes
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France ,grid.411439.a0000 0001 2150 9058Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France ,grid.477396.80000 0004 3982 4357Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France ,grid.411439.a0000 0001 2150 9058Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France ,grid.411439.a0000 0001 2150 9058Service de Medecine Intensive Reanimation, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de La Pitié-Salpêtrière, 47, Bd de L’Hôpital, 75651 Paris Cedex 13, France
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11
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Burger A, Smit MI, van Dyk D, Reed AR, Dyer RA, Hofmeyr R. Predictors of difficult tracheal intubation during general anaesthesia: an analysis of an obstetric airway management registry. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.5.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Burger
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - MI Smit
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - D van Dyk
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - AR Reed
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - RA Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
| | - R Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital,
South Africa
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12
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Franquet N, Pierart J, Defresne A, Joachim S, Fraipont V. Veno-venous Extracorporeal Membrane Oxygenation for pregnant women with Acute Respiratory Distress Syndrome: a narrative review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Acute respiratory distress syndrome remains an uncommon condition during pregnancy. In patients with severe acute respiratory distress syndrome, when oxygenation or ventilation cannot be supported sufficiently using best practice conventional mechanical ventilation and additional therapies, veno-venous extracorporeal membrane oxygenation may be considered. In the past two decades, there has been increasing adoption of this technique to support adult patients with refractory acute respiratory distress syndrome. However, its use for the management of pregnant women is rare and remains a challenge. This narrative review addresses acute respiratory distress syndrome and its management during pregnancy, and then focuses on indications, contraindications, challenges, potential complications, and outcomes of the use of veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the pregnant patient.
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13
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Wu H, Tang Y, Xiong X, Zhu M, Yu H, Cheng D. Successful Application of Argatroban During VV-ECMO in a Pregnant Patient Complicated With ARDS due to Severe Tuberculosis: A Case Report and Literature Review. Front Pharmacol 2022; 13:866027. [PMID: 35899126 PMCID: PMC9309810 DOI: 10.3389/fphar.2022.866027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/06/2022] [Indexed: 12/27/2022] Open
Abstract
Severe tuberculosis during pregnancy may progress to acute respiratory distress syndrome (ARDS), and venovenous (VV) extracorporeal membrane oxygenation (ECMO) should be considered if conventional lung-protective mechanical ventilation fails. However, thrombocytopenia often occurs with ECMO, and there are limited reports of alternative anticoagulant therapies for pregnant patients with thrombocytopenia during ECMO. This report describes the first case of a pregnant patient who received argatroban during ECMO and recovered. Furthermore, we summarized the existing literature on VV-ECMO and argatroban in pregnant patients. A 31-year-old woman at 17 weeks of gestation was transferred to our hospital with ARDS secondary to severe tuberculosis. We initiated VV-ECMO after implementing a protective ventilation strategy and other conventional therapies. Initially, we selected unfractionated heparin anticoagulant therapy. However, on ECMO day 3, the patient’s platelet count and antithrombin III (AT-III) level declined to 27 × 103 cells/μL and 26.9%, respectively. Thus, we started the patient on a 0.06 μg/kg/min argatroban infusion. The argatroban infusion maintenance dose ranged between 0.9 and 1.2 μg/kg/min. The actual activated partial thromboplastin clotting time and activated clotting time ranged from 43 to 58 s and 220–260 s, respectively, without clinically significant bleeding and thrombosis. On day 27, the patient was weaned off VV-ECMO and eventually discharged. VV-ECMO may benefit pregnant women with refractory ARDS, and argatroban may be an alternative anticoagulant for pregnant patients with thrombocytopenia and AT-III deficiency during ECMO.
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Affiliation(s)
| | | | | | | | - He Yu
- *Correspondence: He Yu, ; Deyun Cheng, ,
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14
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Kodali BS, Wong MJ, Lankford A, Lee K, Bharadwaj S. Effect of Fetal Delivery on Pao2/Fio2 Ratio During Mechanical Ventilation in Parturients With COVID-19: A Case Series. A A Pract 2022; 16:e01587. [PMID: 35878002 DOI: 10.1213/xaa.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is controversial whether fetal delivery improves maternal oxygenation during mechanical ventilation. We evaluated maternal arterial partial pressure of oxygen (Pao2) to fractional oxygen concentration (Fio2) (P/F) ratios before and after delivery in this series of 15 parturients with coronavirus disease 2019 (COVID-19). Compared to the immediate postpartum period, P/F ratio was increased at 48 hours (212 ± 101 vs 271 ± 90; P = .006). Linear regression demonstrated improvement in P/F ratio during the study period (slope, 3.1; 95% confidence interval [CI], 0.87-5.34; P = .007), although predelivery and postdelivery periods separately did not exhibit any specific trend. Five patients required emergent bedside delivery. We discuss numerous considerations guiding delivery planning during mechanical ventilation.
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Affiliation(s)
| | | | - Allison Lankford
- Obstetrics and Gynecology, Program in Trauma and Anesthesia Critical Care, Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Khang Lee
- From the Departments of Anesthesiology
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15
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Impact of pregnancy on airway complications after intubation for COVID-19 infection: A case series. Am J Otolaryngol 2022; 43:103522. [PMID: 35696815 PMCID: PMC9161698 DOI: 10.1016/j.amjoto.2022.103522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
Abstract
Coronavirus disease (COVID-19) is associated with severe acute respiratory illness, often requiring intensive care unit admission. Some patients require prolonged intubation and mechanical ventilation. Post-intubation laryngotracheal stenosis occurs in approximately four to 13 % of adult patients after prolonged intubation in the absence of COVID-19 infection. The rate of COVID-19 related post-intubation laryngotracheal stenosis may be higher. Of 339 pregnant patients with COVID-19, we identified seven who required intubation and mechanical ventilation. Four of the seven developed persistent airway complications, and laryngotracheal stenosis, the most severe, was present in three. Each patient had variations in duration of intubation, endotracheal tube size, re-intubation, presence of superimposed infections, and pre-existing comorbidities. We speculate that underlying physiologic changes of pregnancy in addition to the increased inflammatory state caused by COVID-19 are associated with an increased risk of post-intubation laryngotracheal stenosis. Otolaryngology physicians should have a low threshold for considering this pathophysiology when consulting on obstetric patients who have previously been intubated with COVID-19. Otolaryngologists can educate obstetricians when caring for pregnant patients who have laryngotracheal stenosis, especially those who may require emergency airway management for obstetric indications.
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16
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Chang EE, Cordoba M, Vellanki S, Trikannad Ashwini Kumar AK, Segura E. Critical Care Management of a Severe Acute Respiratory Distress Syndrome COVID-19 Patient With Control Cesarean Section. Cureus 2022; 14:e22660. [PMID: 35371736 PMCID: PMC8964022 DOI: 10.7759/cureus.22660] [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: 02/27/2022] [Indexed: 11/05/2022] Open
Abstract
We share our experience of one 29-year-old female, G2 P1, with acute respiratory distress syndrome (ARDS) and at 30 weeks of pregnancy. The 30-week gravid uterus in combination with a poor ventilation-perfusion ratio creates a restrictive lung pattern that may prove to be lethal for both the mother and baby. Due to her rapid deterioration and increased hemodynamic instability we opted for controlled delivery in the operating room with an ICU physician, a Neonatologist, and an Obstetric team. At 3.27 minutes from induction, the baby was born with Apgar scores of 7 and 8. The mother was placed on a RotoProne® bed, treated with remdesivir, steroids, and was subsequently extubated seven days later. The newborn was admitted to the Neonatal Intensive Care Unit (NICU) after delivery. We have reviewed the literature and provided a concise set of recommendations based on our field experience and current world literature review. Prompt delivery in a controlled environment with multiple resuscitating teams provided expeditious treatment of both patients, maintaining oxygenation and perfusion while keeping hemodynamic stability. The controlled environment and the proximity of all teams avoided deleterious consequences to the unborn baby. This is an example where the risk of keeping the baby in the womb outweighs the premature delivery into a NICU. Both mother and baby were downgraded from their respective Intensive Care Units (ICUs) and discharged home in one month.
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17
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Sinaga BYM, Ananda FR. Pregnant Women Infected with Coronavirus Disease 2019 Pneumonia: A Case Series in Medan, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Pregnancy state affects the immune regulation including physical barrier, innate, and adaptive immunity-related to susceptibility of infections and increasing risk for severe to critical case of COVID-19. Further, high risk of thrombosis becomes a challenge in the management of COVID19 in pregnancy due to the strong association with worse outcome.
CASE REPORT: Here, we present three cases of pregnant women infected with COVID-19 pneumonia with different outcomes in maternal and fetal condition related to high-risk thrombosis. Serial inflammatory markers were needed to the early detect the disease progressivity in pregnant women with COVID-19. Further, complete assessment of fetus including reverse transcriptase-polymerase chain reaction and chest X-ray must be performed to the early diagnosis of COVID-19 in neonatal whose mother was infected by SARS-CoV-2.
CONCLUSION: Pregnancy state affects the immune regulation including physical barrier, innate, and adaptive immunity-related to susceptibility of infections and increasing risk for severe to critical case of COVID-19. Further, high risk of thrombosis becomes a challenge in the management of COVID19 in pregnancy due to the strong association with worse outcome. Although fetal transmission of COVID-19 to fetus remains unclear, complete assessment of fetus including RT-PCR, and chest X-ray must be performed to the early diagnosis of COVID-19 in neonatal whose mother was infected by SARS-CoV-2.
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18
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Palati S, Sanchez A, Campbell M, Castaneda M. Cardiac Arrest and Hypoxic-Ischemic Encephalopathy Following an Emergency Caesarean Section in a COVID-19 Patient. Cureus 2022; 14:e21867. [PMID: 35273842 PMCID: PMC8901133 DOI: 10.7759/cureus.21867] [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: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
While young, healthy individuals without underlying medical conditions have generally not suffered catastrophic health consequences from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), gravid patients appear to be at much higher risk of complications from this virus. A 29-year-old G3P2 patient at 30 weeks and three days presented with worsening dyspnea and chest pain after testing positive for coronavirus disease 2019 (COVID-19) infection two days prior. Notably, she had not received COVID-19 vaccination. A non-reassuring fetal tracing and fetal bradycardia were discovered on routine prenatal monitoring during admission, and an urgent caesarean section was performed. She subsequently required supplemental oxygen due to respiratory distress and remained hospitalized. She clinically deteriorated from a respiratory standpoint. Several days later, she experienced cardiac arrest with a return of spontaneous circulation (ROSC) in nine minutes. While the baby was discharged home and is doing well, the patient, unfortunately, expired from hypoxic encephalopathy secondary to COVID-19 pneumonia and complications of cardiorespiratory arrest. This case highlights the severe sequelae of COVID-19 infection in a postpartum patient, including ventilator-dependent respiratory failure, sudden cardiac death, hypoxic encephalopathy, and coma.
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19
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Massey JM, Gable KL. Neuromuscular Disorders and Pregnancy. Continuum (Minneap Minn) 2022; 28:55-71. [DOI: 10.1212/con.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Wong MJ, Bharadwaj S, Galey JL, Lankford AS, Galvagno S, Kodali BS. Extracorporeal Membrane Oxygenation for Pregnant and Postpartum Patients. Anesth Analg 2022; 135:277-289. [PMID: 35122684 DOI: 10.1213/ane.0000000000005861] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) has seen increasing use for critically ill pregnant and postpartum patients over the past decade. Growing experience continues to demonstrate the feasibility of ECMO in obstetric patients and attest to its favorable outcomes. However, the interaction of pregnancy physiology with ECMO life support requires careful planning and adaptation for success. Additionally, the maintenance of fetal oxygenation and perfusion is essential for safely continuing pregnancy during ECMO support. This review summarizes the considerations for use of ECMO in obstetric patients and how to address these concerns.
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Affiliation(s)
- Michael J Wong
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shobana Bharadwaj
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jessica L Galey
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Allison S Lankford
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine and Program in Trauma and Anesthesia Critical Care, Shock Trauma Center, Baltimore, Maryland
| | - Samuel Galvagno
- Department of Anesthesiology, Multi Trauma Critical Care Unit, Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bhavani Shankar Kodali
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
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21
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Adverse Perinatal Outcomes in COVID-19 Infected Pregnant Women: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10020203. [PMID: 35206820 PMCID: PMC8871986 DOI: 10.3390/healthcare10020203] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023] Open
Abstract
The impact of COVID-19 virus infection during pregnancy is still unclear. This systematic review and meta-analysis aimed to quantitatively pool the evidence on impact of COVID-19 infection on perinatal outcomes. Databases of Medline, Embase, and Cochrane library were searched using the keywords related to COVID-19 and perinatal outcomes from December 2019 to 30 June 2021. Observational studies comparing the perinatal outcomes of COVID-19 infection in pregnancy with a non-infected comparator were included. The screening process and quality assessment of the included studies were performed independently by two reviewers. Meta-analyses were used to pool the comparative dichotomous data on perinatal outcomes. The database search yielded 4049 results, 1254 of which were duplicates. We included a total of 21 observational studies that assessed the adverse perinatal outcomes with COVID-19 infection. The odds of maternal death (pooled OR: 7.05 [2.41−20.65]), preeclampsia (pooled OR: 1.39 [1.29−1.50]), cesarean delivery (pooled OR: 1.67 [1.29−2.15]), fetal distress (pooled OR: 1.66 [1.35−2.05]), preterm birth (pooled OR: 1.86 [1.34−2.58]), low birth weight (pooled OR: 1.69 [1.35−2.11]), stillbirth (pooled OR: 1.46 [1.16−1.85]), 5th minute Apgar score of less than 7 (pooled OR: 1.44 [1.11−1.86]) and admissions to neonatal intensive care unit (pooled OR: 2.12 [1.36−3.32]) were higher among COVID-19 infected pregnant women compared to non-infected pregnant women.
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22
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Dogra N, Bharti N, Rawat N, Singla K. Acute respiratory failure and pulmonary edema during peri-partum period in normotensive parturient – diagnosis and management. J Anaesthesiol Clin Pharmacol 2022; 38:316-317. [PMID: 36171938 PMCID: PMC9511837 DOI: 10.4103/joacp.joacp_129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022] Open
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23
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Barbagallo M, Schiappa E. MOF in Pregnancy and Its Relevance to Eclampsia. POSTINJURY MULTIPLE ORGAN FAILURE 2022:205-239. [DOI: 10.1007/978-3-030-92241-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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24
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25
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Gan F, Xia L, Yang Y, Pu Q, Liu L. Fatal congenital lobar emphysema in a puerpera: a case report and literature review. BMC Pulm Med 2021; 21:421. [PMID: 34930207 PMCID: PMC8686282 DOI: 10.1186/s12890-021-01787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/10/2021] [Indexed: 02/08/2023] Open
Abstract
Background Congenital lobal emphysema (CLE) is a developmental lung abnormality usually diagnosed in the neonatal period and is rarely observed in adults. Adults with CLE are usually asymptomatic and only a small fraction may present with coughing, recurrent pneumonia and respiratory distress. In imaging studies, the most frequently affected lobe of CLE is the left upper lobe, followed by the right middle lobe. However, multilobar involvement with severe mediastinal shift is extremely rare. Case presentation We report a case of fatal CLE in a 28-year-old puerpera with postpartum respiratory failure. Chest computed tomography (CT) revealed emphysema of the right upper, middle and lower lobes resulting in adjacent atelectasis. Hyperinflation of the right upper lobe crossed the midline, leading to a deviation of the mediastinal structure to the left hemithorax and severe compression of the left lung. Conclusions Early and timely diagnosis of CLE with routine follow-up is necessary for patients. CLE, especially with multilobar involvement or mediastinal shift, could be life-threatening and should be promptly and aggressively treated to prevent severe complications.
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Affiliation(s)
- Fanyi Gan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, 610041, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, 610041, China
| | - Yushang Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, 610041, China.
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Campbell M, Palati S, Sanchez A, Castaneda M. A Case of Recovery From COVID-19 Pneumonia in Pregnancy After Vaginal Delivery in ICU. Cureus 2021; 13:e19862. [PMID: 34976489 PMCID: PMC8712199 DOI: 10.7759/cureus.19862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/05/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has important implications for gravid patients as they are more likely to experience severe complications of pregnancy such as multisystem inflammatory syndrome if infected with coronavirus disease 2019 (COVID-19). Due to normal physiological adaptations of pregnancy, COVID-19 may strain an already stressed respiratory system, making delivery a viable treatment option. We present a case of a gravid patient infected with COVID-19 pneumonia who delivered vaginally in the intensive care unit (ICU) at our hospital. Further research into clinical progress and management of pregnancy complicated by COVID-19 is necessary.
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Kobylianskii J, Hutchinson-Jaffe A, Cabanero M, Thenganatt J. Pathologically confirmed diffuse alveolar haemorrhage in lymphangioleiomyomatosis. BMJ Case Rep 2021; 14:e238713. [PMID: 34753716 PMCID: PMC8578943 DOI: 10.1136/bcr-2020-238713] [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: 10/07/2021] [Indexed: 11/03/2022] Open
Abstract
A 40-year-old woman was referred to pulmonology after presenting with dyspnoea and self-limiting haemoptysis. Chest CT revealed diffuse ground glass opacities and small thin-walled cysts. Bronchoalveolar lavage cultures were negative and cytology revealed haemosiderin-laden macrophages. Transthoracic echocardiogram was normal. Connective tissue disease and vasculitis work-up were negative. Vascular endothelial growth factor-D level was indeterminate. Lung function was normal. She underwent video-assisted thoracoscopic lung biopsy. In addition to findings consistent with lymphangioleiomyomatosis, histopathological examination identified haemosiderosis without capillaritis, confirming a diagnosis of diffuse alveolar haemorrhage in the context of the associated clinical and radiographic features. Follow-up imaging after 5 months showed resolution of the diffuse ground glass opacities. Pharmacotherapy with sirolimus was not initiated due to absence of deterioration in pulmonary function. Diffuse alveolar haemorrhage in patients with lymphangioleiomyomatosis is a rare but important presentation. The few previously reported cases progressed to respiratory failure requiring mechanical ventilation.
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Affiliation(s)
- Jane Kobylianskii
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adam Hutchinson-Jaffe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, North York, Ontario, Canada
| | - Michael Cabanero
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Anatomical Pathology, University Health Network, Toronto, Ontario, Canada
| | - John Thenganatt
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, University Health Network, Toronto, Ontario, Canada
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Wong MJ, Bharadwaj S, Lankford AS, Galey JL, Kodali BS. Mechanical ventilation and prone positioning in pregnant patients with severe COVID-19 pneumonia: experience at a quaternary referral center. Int J Obstet Anesth 2021; 49:103236. [PMID: 34840019 PMCID: PMC8574076 DOI: 10.1016/j.ijoa.2021.103236] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND We present the care of 17 consecutive pregnant patients who required mechanical ventilation for Coronavirus disease 2019 (COVID-19) pneumonia at a quaternary referral center in the United States. We retrospectively describe the management of these patients, maternal and fetal outcomes, as well as the feasibility of prone positioning and delivery. METHODS Between March 2020 and June 2021, all pregnant and postpartum patients who were mechanically ventilated for COVID-19 pneumonia were identified. Details of their management including prone positioning, maternal and neonatal outcomes, and complications were noted. RESULTS Seventeen pregnant patients required mechanical ventilation for COVID-19. Thirteen patients received prone positioning, with a total of 49 prone sessions. One patient required extracorporeal membrane oxygenation. All patients in this series survived until at least discharge. Nine patients delivered while mechanically ventilated, and all neonates survived, subsequently testing negative for SARS-CoV-2. There was one spontaneous abortion. Four emergent cesarean deliveries were prompted by refractory maternal hypoxemia or non-reassuring fetal heart rate after maternal intubation. CONCLUSIONS Overall, maternal and neonatal survival were favorable even in the setting of severe COVID-19 pneumonia requiring mechanical ventilation. Prone positioning was well tolerated although the impact of prone positioning or fetal delivery on maternal oxygenation and ventilation are unclear.
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Affiliation(s)
- M J Wong
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - S Bharadwaj
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - A S Lankford
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine and Program in Trauma and Anesthesia Critical Care, Shock Trauma Center, Baltimore, MD, United States
| | - J L Galey
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - B S Kodali
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States.
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Kidson KM, Lapinsky S, Grewal J. A Detailed Review of Critical Care Considerations for the Pregnant Cardiac Patient. Can J Cardiol 2021; 37:1979-2000. [PMID: 34534620 DOI: 10.1016/j.cjca.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023] Open
Abstract
Maternal cardiovascular disease is a leading cause of maternal death worldwide and recently, maternal mortality has increased secondary to cardiovascular causes. Maternal admissions to critical care encompass 1%-2% of all critical care admissions, and although not common, the management of the critically ill pregnant patient is complex. Caring for the critically ill pregnant cardiac patient requires integration of pregnancy-associated physiologic changes, understanding pathophysiologic disease states unique to pregnancy, and a multidisciplinary approach to timing around delivery as well as antenatal and postpartum care. Herein we describe cardiorespiratory changes that occur during pregnancy and the differential diagnosis for cardiorespiratory failure in pregnancy. Cardiorespiratory diseases that are either associated or exacerbated by pregnancy are highlighted with emphasis on perturbations secondary to pregnancy and appropriate management strategies. Finally, we describe general management of the pregnant cardiac patient admitted to critical care.
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Affiliation(s)
- Kristen M Kidson
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Stephen Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Grewal
- Division of Cardiology, University of British Columbia, Pacific Adult Congenital Heart Disease Program, St Paul's Hospital, Vancouver, British Columbia, Canada.
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Baghirzada L, Archer D, Walker A, Balki M. Anesthesia-related adverse events in obstetric patients: a population-based study in Canada. Can J Anaesth 2021; 69:72-85. [PMID: 34494224 DOI: 10.1007/s12630-021-02101-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Anesthesia-related complications in obstetric patients could be catastrophic and impact the lives of both the parturient and the neonate. The objective of this study was to determine the frequency, temporal trend, and risk factors of anesthesia-related adverse events during hospitalization for delivery in Canada. METHODS This retrospective population-based study utilized the hospitalization database of the Canadian Institute for Health Information for all parturients (gestation ≥ 20 weeks) in Canada (except Quebec) hospitalized for childbirth from April 2004 to March 2017. Complications were identified by the enhanced Canadian version of the tenth revision of the International Statistical Classification of Diseases and Related Health Problems codes. Data were summarized with descriptive statistics. Associations between hospitalizations with an anesthesia-related adverse event and patient characteristics, delivery method, and modality of anesthesia were assessed using multivariate logistic regression. RESULTS Among 2,601,034 hospitalizations (3,194,875 interventions), 8,361 anesthesia-related adverse events occurred over a 13-year period (262 per 100,000 interventions; 95% confidence interval [CI], 256 to 267), with a significant decline over time (P < 0.001). These were two-fold and seven-fold higher per 100,000 interventions with general (488; 95% CI, 438 to 542) and general plus neuraxial (1,476; 95% CI, 1,284 to 1,689) anesthesia compared with neuraxial anesthesia alone (225; 95% CI, 219 to 230). Serious adverse events constituted 9% of all adverse events. The most common adverse event was spinal and epidural anesthesia-induced headache (6,908/8,361; 83%); the overall rate of failed or difficult intubations was low (201/8,361; 2%). Anesthesia-related events were more likely in those who had a Cesarean delivery compared with vaginal delivery (odds ratio [OR], 1.12; 95% CI, 1.06 to 1.18) and general anesthesia compared with neuraxial anesthesia (OR, 1.71; 95% CI, 1.53 to 1.93). Noteworthy associations were found between any anesthesia-related adverse events and cardiomyopathy (OR, 8.34; 95% CI, 2.59 to 26.83), eclampsia (OR, 3.11; 95% CI, 1.95 to 4.97), and obstructive sleep apnea (OR, 1.91; 95% CI, 1.66 to 2.19). CONCLUSION The incidence of anesthesia-related adverse events in obstetric patients in Canada is low and declining. High vigilance is required in parturients undergoing Cesarean delivery, receiving general anesthesia, and those with pre-existing medical conditions.
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Affiliation(s)
- Leyla Baghirzada
- Department of Anesthesiology, Perioperative and Pain Medicine, South Health Campus, University of Calgary, 4448 Front St SE, Calgary, AB, T3M 1M4, Canada.
| | - David Archer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew Walker
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Mrinalini Balki
- Department of Anesthesia and Obstetrics & Gynaecology, University of Toronto, Mount Sinai Hospital, The Lunenfeld-Tanenbaum Research Institute, Sinai Health System, TorontoToronto, ON, Canada
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Trahan MJ, Malhamé I, Mitric C, Simard C, Lipes J, Abenhaim HA. Severe and critical COVID-19 in pregnancy: A case series from Montreal. Obstet Med 2021; 14:170-176. [PMID: 34646346 PMCID: PMC8504303 DOI: 10.1177/1753495x21990213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/08/2020] [Accepted: 01/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Optimal obstetric management for women with coronavirus disease (COVID-19) is not known. We describe the management of six pregnant women requiring in-hospital care for severe COVID-19. METHODS A retrospective chart review was conducted to identify pregnant women who tested positive for Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) between 15 March and 30 June 2020. A subset of women meeting criteria for severe COVID-19 was included. RESULTS Four women required non-invasive supplemental oxygen therapy and two required mechanical ventilation. Four women were discharged from hospital undelivered and two required preterm delivery. One woman had a pulmonary embolism, and two required re-admission for worsening symptoms. CONCLUSION Management of pregnant women with severe COVID-19 is complex and should involve multidisciplinary expertise. Avoiding early delivery may be a safe option. We recommend an individualized approach to care, including careful consideration of the expected risks and benefits of expectant obstetric management versus delivery.
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Affiliation(s)
- Marie-Julie Trahan
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| | - Isabelle Malhamé
- Department of Medicine, McGill University, Montreal, Canada
- Department of Medicine, Division of General Internal Medicine, McGill University Health Centre, Montreal, Canada
| | - Cristina Mitric
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| | - Camille Simard
- Department of Medicine, McGill University, Montreal, Canada
| | - Jed Lipes
- Department of Medicine, McGill University, Montreal, Canada
- Department of Medicine, Division of Internal Medicine, Jewish General Hospital, Montreal, Canada
- Department of Medicine, Division of Adult Critical Care, Jewish General Hospital, Montreal, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jewish General Hospital, Montreal, Canada
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Khalil M, Butt A, Kseibi E, Althenayan E, Alhazza M, Sallam H. COVID-19-Related Acute Respiratory Distress Syndrome in a Pregnant Woman Supported on ECMO: The Juxtaposition of Bleeding in a Hypercoagulable State. MEMBRANES 2021; 11:membranes11070544. [PMID: 34357194 PMCID: PMC8307442 DOI: 10.3390/membranes11070544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 01/29/2023]
Abstract
A 40-year-old pregnant woman at 28 weeks of gestation was diagnosed with severe acute respiratory failure syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). She had severe hypoxemia despite the use of mechanical ventilation and muscle relaxant infusion. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was used, and she had a cesarian section while on ECMO support. She developed disseminated intravascular coagulation (DIC) with overt bleeding. This was managed by a multidisciplinary team (MDT) and a change of the ECMO circuit resulted in a dramatic improvement of her coagulation profile. Both the mother and the baby were discharged and went home in good condition.
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Anter ME, Abdel Attey Saleh S, Shawkey Allam S, Mohamed Nofal A. Efficacy and safety of intravenous paracetamol in management of labour pains in a low resource setting: a randomized clinical trial. J Matern Fetal Neonatal Med 2021; 35:6320-6328. [PMID: 33902372 DOI: 10.1080/14767058.2021.1911995] [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: 10/21/2022]
Abstract
OBJECTIVE To assess the use of single dose of paracetamol intravenously in management of labour pains. BACKGROUND Pain during labour is a complex, subjective and multi-faceted physiological phenomenon that varies in intensity among women and is subjected to many social and cultural modifiers. SUBJECTS AND METHODS This randomized clinical study was conducted in Obstetrics and gynecology department from March 2019 to March 2020 including 96 primiparous women randomized into paracetamol group (n = 48) received 1000 mg of paracetamol IV infusion and pethidine group (n = 48) received 50 mg of pethidine given slowly IV. Primary outcome is the change of the intensity of perceived labor pain. Pain score was followed and recorded by visual analogue scale (VAS). Our study protocol was registered at ClinicalTrials.gov; NCT04744727. RESULTS VAS score was highly significant improved gradually after 30 min, 1, 2 and 3 h of paracetamol and pethidine taken compared at start study, but participants in paracetamol group had lower pain after 2 and 3 h (3.92 ± 1.42 and 5.69 ± 1.07) than those of the pethidine groups (4.42 ± 1.87 and 5.38 ± 1.34). Also, 2.1% of paracetamol group developed dizziness and 4.2% developed nausea and vomiting, while there was 29.2% of pethidine group developed dizziness and 37.5% developed nausea and vomiting. CONCLUSIONS Intravenous paracetamol as labour analgesia is effective, safe, inexpensive, available and with no maternal or fetal side effects as compared to Pethidine. Paracetamol needs to have more chance in comparison to other forms as a labour pain analgesia, especially in our communities.
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Affiliation(s)
- Mohamed Elsibai Anter
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia Univesity, Menoufia, Egypt
| | - Said Abdel Attey Saleh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia Univesity, Menoufia, Egypt
| | - Sara Shawkey Allam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia Univesity, Menoufia, Egypt
| | - Ahmed Mohamed Nofal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia Univesity, Menoufia, Egypt
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Arasu M, Swaminathan N, Cherian A, Parthiban M. Prone ventilation in a pregnant patient with scrub typhus-induced acute respiratory distress syndrome. BMJ Case Rep 2021; 14:e242870. [PMID: 33827889 PMCID: PMC8031017 DOI: 10.1136/bcr-2021-242870] [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: 03/22/2021] [Indexed: 11/03/2022] Open
Abstract
A 23-year-old primigravida at 20 weeks of gestation presented to our hospital with undifferentiated febrile illness and severe acute respiratory distress syndrome. She was intubated in the emergency department and transferred to the intensive care unit. Initial treatment included ventilatory care, vasopressor support and broad-spectrum antibiotics. Based on a positive PCR assay for scrub typhus, she was treated with intravenous doxycycline and azithromycin. Despite reduction in fever, her oxygenation further declined. Following a risk-benefits assessment, we decided to ventilate her in prone position for 8 hours a day for three consecutive days using a checklist-based protocol. Her oxygenation indices and lung compliance markedly improved over this period, and she was extubated a day later. She was eventually discharged home after 1 week.
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Affiliation(s)
- Meenupriya Arasu
- Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Nagalakshmi Swaminathan
- Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Anusha Cherian
- Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Magesh Parthiban
- Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
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Vergara-Merino L, Meza N, Couve-Pérez C, Carrasco C, Ortiz-Muñoz L, Madrid E, Bohorquez-Blanco S, Pérez-Bracchiglione J. Maternal and perinatal outcomes related to COVID-19 and pregnancy: An overview of systematic reviews. Acta Obstet Gynecol Scand 2021; 100:1200-1218. [PMID: 33560530 PMCID: PMC8014248 DOI: 10.1111/aogs.14118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
Introduction Evidence about coronavirus disease 2019 (COVID‐19) and pregnancy has rapidly increased since December 2019, making it difficult to make rigorous evidence‐based decisions. The objective of this overview of systematic reviews is to conduct a comprehensive analysis of the current evidence on prognosis of COVID‐19 in pregnant women. Material and methods We used the Living OVerview of Evidence (L·OVE) platform for COVID‐19, which continually retrieves studies from 46 data sources (including PubMed/MEDLINE, Embase, other electronic databases, clinical trials registries, and preprint repositories, among other sources relevant to COVID‐19), mapping them into PICO (population, intervention, control, and outcomes) questions. The search covered the period from the inception date of each database to 13 September 2020. We included systematic reviews assessing outcomes of pregnant women with COVID‐19 and/or their newborns. Two authors independently screened the titles and abstracts, assessed full texts to select the studies that met the inclusion criteria, extracted data, and appraised the risk of bias of each included systematic review. We measured the overlap of primary studies included among the selected systematic reviews by building a matrix of evidence, calculating the corrected covered area, and assessing the level of overlap for every pair of systematic reviews. Results Our search yielded 1132 references. 52 systematic reviews met inclusion criteria and were included in this overview. Only one review had a low risk of bias, three had an unclear risk of bias, and 48 had a high risk of bias. Most of the included reviews were highly overlapped among each other. In the included reviews, rates of maternal death varied from 0% to 11.1%, admission to intensive care from 2.1% to 28.5%, preterm deliveries before 37 weeks from 14.3% to 61.2%, and cesarean delivery from 48.3% to 100%. Regarding neonatal outcomes, neonatal death varied from 0% to 11.7% and the estimated infection status of the newborn varied between 0% and 11.5%. Conclusions Only one of 52 systematic reviews had a low risk of bias. Results were heterogeneous and the overlap of primary studies was frequently very high between pairs of systematic reviews. High‐quality evidence syntheses of comparative studies are needed to guide future clinical decisions.
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Affiliation(s)
- Laura Vergara-Merino
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | - Nicolás Meza
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | - Constanza Couve-Pérez
- Department of Gynecology and Obstetrics, Division of Maternal and Fetal Medicine, Faculty of Medicine, Universidad de Valparaíso, Hospital Dr. Gustavo Fricke, Viña del Mar, Chile
| | - Cynthia Carrasco
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | - Luis Ortiz-Muñoz
- UC Evidence Center, Cochrane Chile Associate Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eva Madrid
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | | | - Javier Pérez-Bracchiglione
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
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Huang CY, Tsai YL, Lin CK. The prone position ventilation (PPV) as an approach in pregnancy with acute respiratory distress syndrome (ARDS). Taiwan J Obstet Gynecol 2021; 60:574-576. [PMID: 33966753 PMCID: PMC7985960 DOI: 10.1016/j.tjog.2021.03.036] [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: 10/12/2020] [Indexed: 12/01/2022] Open
Abstract
Objective In Taiwan, the overall incidence of acute respiratory distress syndrome (ARDS) is 15.74 per 100,000 person-years, the mortality rate is 57.8%, and its overall prevalence in the intensive care unit (ICU) is 10.4%. Women who are pregnant and have ARDS have a high risk of fetal death and fetal asphyxia. Case report A 26-1/7-week pregnant woman presented with upper respiratory infection symptoms progressing to ARDS. While receiving ventilation, maintaining a prone position is an option for pregnant patients with severe ARDS. This case demonstrated a supplementary approach for pregnant women with ARDS. Conclusion Prone position ventilation is indicated for pregnant women, as for any patient with ARDS. The Proning Severe ARDS Patients trial showed no difference in the complication between pregnant patients and other groups.
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Affiliation(s)
- Chuang-Yen Huang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ling Tsai
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Radiology, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Chi-Kang Lin
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Oshay RR, Chen MYC, Fields BKK, Demirjian NL, Lee RS, Mosallaei D, Gholamrezanezhad A. COVID-19 in pregnancy: a systematic review of chest CT findings and associated clinical features in 427 patients. Clin Imaging 2021; 75:75-82. [PMID: 33508754 PMCID: PMC7804384 DOI: 10.1016/j.clinimag.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/27/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
Purpose Our purpose was to conduct a comprehensive systematic review of all existing literature regarding imaging findings on chest CT and associated clinical features in pregnant patients diagnosed with COVID-19. Materials & methods A literature search was conducted on April 21, 2020 and updated on July 24, 2020 using PubMed, Embase, World Health Organization, and Google Scholar databases. Only studies which described chest CT findings of COVID-19 in pregnant patients were included for analysis. Results A total of 67 articles and 427 pregnant patients diagnosed with COVID-19 were analyzed. The most frequently encountered pulmonary findings on chest CT were ground-glass opacities (77.2%, 250/324), posterior lung involvement (72.5%, 50/69), multilobar involvement (71.8%, 239/333), bilateral lung involvement (69.4%, 231/333), peripheral distribution (68.1%, 98/144), and consolidation (40.9%, 94/230). Pregnant patients were also found to present more frequently with consolidation (40.9% vs. 21.0–31.8%) and pleural effusion (30.0% vs. 5.0%) in comparison to the general population. Associated clinical features included antepartum fever (198 cases), lymphopenia (128 cases), and neutrophilia (97 cases). Of the 251 neonates delivered, 96.8% had negative RT-PCR and/or IgG antibody testing for COVID-19. In the eight cases (3.2%) of reported neonatal infection, tests were either conducted on samples collected up to 72 h after birth or were found negative on all subsequent RT-PCR tests. Conclusion Pregnant patients appear to present more commonly with more advanced COVID-19 CT findings compared to the general adult population. Furthermore, characteristic laboratory abnormalities found in pregnant patients tended to mirror those found in the general patient population. Lastly, results from neonatal testing suggest a low risk of vertical transmission.
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Affiliation(s)
- Rachel R Oshay
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Integrative Anatomical Sciences, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Michael Y C Chen
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Integrative Anatomical Sciences, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Brandon K K Fields
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America. https://twitter.com/bkkfields
| | - Natalie L Demirjian
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Integrative Anatomical Sciences, University of Southern California, Los Angeles, CA 90033, United States of America. https://twitter.com/nataliedemir
| | - Ryan S Lee
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Daniel Mosallaei
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Ali Gholamrezanezhad
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America; Department of Radiology, Los Angeles, CA 90033, United States of America.
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Malinowski AK, Noureldin A, Othman M. COVID-19 susceptibility in pregnancy: Immune/inflammatory considerations, the role of placental ACE-2 and research considerations. Reprod Biol 2020; 20:568-572. [PMID: 33183974 PMCID: PMC7832785 DOI: 10.1016/j.repbio.2020.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 12/19/2022]
Abstract
SARS-CoV-2 is a new virus, to which herd immunity has not yet developed and both molecular and serological testing are not without flaws. The virus evokes a state of severe and widespread inflammation, and stimulates both innate and adaptive immune response. The angiotensin-converting enzyme 2 (ACE2), which acts as the SARS-CoV-2 receptor, is present in endothelial cells and has been noted within the human placenta. There are questions about whether pregnancy would increase the susceptibility of pregnant women to COVID-19 and disease severity within this population. In this report, we highlight physiological and immune/inflammatory considerations that may explain the susceptibility and disease pathology in response to SARS CoV-2 during pregnancy, explore testing considerations in asymptomatic individuals, discuss the potential role and of placental ACE2 receptor in the pathogenesis of COVID-19 in pregnancy and in pregnancy outcomes, and finally share our perspective with respect to an urgently needed change concerning involvement of pregnant women in research addressing COVID-19.
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Affiliation(s)
- Ann Kinga Malinowski
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, Canada; Department of Obstetrics & Gynaecology, University of Toronto, Canada
| | - Abdelrahman Noureldin
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Canada; School of Baccalaureate Nursing, St. Lawrence College, Kingston, Canada.
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Abstract
The purpose of this article is to review key areas that should be considered and modified in our obstetric protocols, specifically: 1) Patient triage, 2) Labor and delivery unit policies, 3) Special considerations for personal protective equipment (PPE) needs in obstetrics, 4) Intrapartum management, and 5) Postpartum care.
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Affiliation(s)
- Rupsa C Boelig
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital/Sidney Kimmel Medical College, Philadelphia, PA, 19107, USA.
| | - Calvin Lambert
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan A Pena
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Joanne Stone
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Peter S Bernstein
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital/Sidney Kimmel Medical College, Philadelphia, PA, 19107, USA
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Characteristics and Outcomes of 241 Births to Women With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection at Five New York City Medical Centers. Obstet Gynecol 2020; 136:273-282. [PMID: 32555034 DOI: 10.1097/aog.0000000000004025] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe the characteristics and birth outcomes of women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as community spread in New York City was detected in March 2020. METHODS We performed a prospective cohort study of pregnant women with laboratory-confirmed SARS-CoV-2 infection who gave birth from March 13 to April 12, 2020, identified at five New York City medical centers. Demographic and clinical data from delivery hospitalization records were collected, and follow-up was completed on April 20, 2020. RESULTS Among this cohort (241 women), using evolving criteria for testing, 61.4% of women were asymptomatic for coronavirus disease 2019 (COVID-19) at the time of admission. Throughout the delivery hospitalization, 26.5% of women met World Health Organization criteria for mild COVID-19, 26.1% for severe, and 5% for critical. Cesarean birth was the mode of delivery for 52.4% of women with severe and 91.7% with critical COVID-19. The singleton preterm birth rate was 14.6%. Admission to the intensive care unit was reported for 17 women (7.1%), and nine (3.7%) were intubated during their delivery hospitalization. There were no maternal deaths. Body mass index (BMI) 30 or higher was associated with COVID-19 severity (P=.001). Nearly all newborns tested negative for SARS-CoV-2 infection immediately after birth (97.5%). CONCLUSION During the first month of the SARS-CoV-2 outbreak in New York City and with evolving testing criteria, most women with laboratory-confirmed infection admitted for delivery did not have symptoms of COVID-19. Almost one third of women who were asymptomatic on admission became symptomatic during their delivery hospitalization. Obesity was associated with COVID-19 severity. Disease severity was associated with higher rates of cesarean and preterm birth.
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Gray KM, Murphy L, Buckner B. Osteopathic Considerations for the Pregnant Patient with COVID-19. J Osteopath Med 2020; 120:2765218. [PMID: 32776139 DOI: 10.7556/jaoa.2020.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In any given year, approximately 130 million babies are born worldwide. Previous research has shown that pregnant women may be more severely affected and vulnerable to contracting emerging infections, making them a particularly high-risk population. Therefore, special considerations should be given to treatment methods for pregnant women with COVID-19. In this narrative review, the authors evaluate scholarly journal articles and electronic databases to determine what is known about the pathophysiology of COVID-19 in pregnancy and the associated mortality rate. Osteopathic manipulative treatment techniques to mitigate the underlying pathology were identified, and modifications for use in pregnancy and the critical care setting are described.
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Bampoe S, Odor PM, Lucas DN. Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for obstetric anaesthesia: what we have learned thus far. Int J Obstet Anesth 2020; 43:1-8. [PMID: 32437912 PMCID: PMC7179500 DOI: 10.1016/j.ijoa.2020.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023]
Abstract
SARS-CoV-2 is a novel coronavirus causing a global pandemic of a severe respiratory illness known as COVID-19. To date, globally, over 30,000 people have died from this emerging disease. As clinicians and healthcare systems around the world are rapidly adapting to manage patients with COVID-19, limited data are emerging from different patient populations to support best-practice and improve outcomes. In this review, we present a summary of emerging data in the obstetric population and offer obstetric and anaesthetic clinicians around the world a set of evidence-driven, practice-based recommendations for the anaesthetic management of pregnant women with suspected or confirmed COVID-19.
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Affiliation(s)
- S Bampoe
- University College London Hospital NHS Foundation Trust, London, UK.
| | - P M Odor
- University College London Hospital NHS Foundation Trust, London, UK
| | - D N Lucas
- Northwick Park Hospital NHS Trust, London, UK
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43
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Reed A, Smit M, Hofmeyr R, Van Dyk D, Dyer R, Van Tonder C, Du Toit L. Implementation and initial validation of a multicentre obstetric airway management registry. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.4.2423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A.R. Reed
- University of Cape Town
- Khayelitsha District Hospital
| | - M.I. Smit
- University of Cape Town
- Khayelitsha District Hospital
| | - R. Hofmeyr
- University of Cape Town
- Khayelitsha District Hospital
| | - D. Van Dyk
- University of Cape Town
- Khayelitsha District Hospital
| | - R.A. Dyer
- University of Cape Town
- Khayelitsha District Hospital
| | - C. Van Tonder
- University of Cape Town
- Khayelitsha District Hospital
| | - L. Du Toit
- University of Cape Town
- Khayelitsha District Hospital
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Lentz S, Grossman A, Koyfman A, Long B. High-Risk Airway Management in the Emergency Department: Diseases and Approaches, Part II. J Emerg Med 2020; 59:573-585. [PMID: 32591298 DOI: 10.1016/j.jemermed.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Successful airway management is critical to the practice of emergency medicine. Thus, emergency physicians must be ready to optimize and prepare for airway management in critically ill patients with a wide range of physiologic challenges. Challenges in airway management commonly encountered in the emergency department are discussed using a pearl and pitfall discussion in this second part of a 2-part series. OBJECTIVE This narrative review presents an evidence-based approach to airway and patient management during endotracheal intubation in challenging cases commonly encountered in the emergency department. DISCUSSION Adverse events during emergent airway management are common with postintubation cardiac arrest, reported in as many as 1 in 25 intubations. Many of these adverse events can be avoided by proper identification and understanding the underlying physiology, preparation, and postintubation management. Those with high-risk features including trauma, elevated intracranial pressure, upper gastrointestinal bleed, cardiac tamponade, aortic stenosis, morbid obesity, and pregnancy must be managed with airway expertise. CONCLUSIONS This narrative review discusses the pearls and pitfalls of commonly encountered physiologic high-risk intubations with a focus on the emergency clinician.
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Affiliation(s)
- Skyler Lentz
- Division of Emergency Medicine, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Alexandra Grossman
- Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance, California
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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Smith V, Seo D, Warty R, Payne O, Salih M, Chin KL, Ofori-Asenso R, Krishnan S, da Silva Costa F, Vollenhoven B, Wallace E. Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review. PLoS One 2020; 15:e0234187. [PMID: 32497090 PMCID: PMC7272020 DOI: 10.1371/journal.pone.0234187] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022] Open
Abstract
Background COVID-19 has created an extraordinary global health crisis. However, with limited understanding of the effects of COVID-19 during pregnancy, clinicians and patients are forced to make uninformed decisions. Objectives To systematically evaluate the literature and report the maternal and neonatal outcomes associated with COVID-19. Search strategy PubMed, MEDLINE, and EMBASE were searched from November 1st, 2019 and March 28th, 2020. Selection criteria Primary studies, reported in English, investigating COVID-19-positive pregnant women and reporting their pregnancy and neonatal outcomes. Data collection and analysis Data in relation to clinical presentation, investigation were maternal and neonatal outcomes were extracted and analysed using summary statistics. Hypothesis testing was performed to examine differences in time-to-delivery. Study quality was assessed using the ICROMS tool. Main results Of 73 identified articles, nine were eligible for inclusion (n = 92). 67.4% (62/92) of women were symptomatic at presentation. RT-PCR was inferior to CT-based diagnosis in 31.7% (26/79) of cases. Maternal mortality rate was 0% and only one patient required intensive care and ventilation. 63.8% (30/47) had preterm births, 61.1% (11/18) fetal distress and 80% (40/50) a Caesarean section. 76.92% (11/13) of neonates required NICU admission and 42.8% (40/50) had a low birth weight. There was one indeterminate case of potential vertical transmission. Mean time-to-delivery was 4.3±3.08 days (n = 12) with no difference in outcomes (p>0.05). Conclusions COVID-19-positive pregnant women present with fewer symptoms than the general population and may be RT-PCR negative despite having signs of viral pneumonia. The incidence of preterm births, low birth weight, C-section, NICU admission appear higher than the general population.
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Affiliation(s)
- Vinayak Smith
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- * E-mail:
| | - Densearn Seo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ritesh Warty
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Olivia Payne
- Fetal Monitoring Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Mohamed Salih
- Fetal Monitoring Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Ken Lee Chin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Sathya Krishnan
- Newborn Services, Western Health, Sunshine, Victoria, Australia
| | - Fabricio da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Beverley Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Euan Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Mehta H, Ivanovic S, Cronin A, VanBrunt L, Mistry N, Miller R, Yodice P, Rezai F. Novel coronavirus-related acute respiratory distress syndrome in a patient with twin pregnancy: A case report. Case Rep Womens Health 2020; 27:e00220. [PMID: 32426242 PMCID: PMC7229956 DOI: 10.1016/j.crwh.2020.e00220] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022] Open
Abstract
We present the case of a 39-year-old woman, G1P0, who had conceived twins via in-vitro fertilization, who presented at 27 weeks of gestation with nasal congestion and dry cough for 7 days. On presentation, her physical examination was benign, except for sinus tachycardia, and she was oxygenating adequately on room air. Laboratory studies were unremarkable, except a PCR test positive for SARS-COV2, and a CT scan of her chest showed bilateral multi-focal ground-glass opacities. A fetal non-stress test was reassuring. She was treated with intravenous fluids, ceftriaxone, azithromycin, and hydroxychloroquine. During her hospital stay, she developed progressively worsening respiratory failure, initially requiring non-invasive ventilation, and subsequently progressed to acute respiratory distress syndrome requiring mechanical ventilation. She then suffered from sudden hypoxemia and hemodynamic collapse, on maximal ventilatory support, prompting an emergency cesarean section at bedside. This led to rapid stabilization of hemodynamic parameters, and of her overall respiratory status. Both the twins were born prematurely, and one of them tested positive for SARS-COV2. Pregnant women are more susceptible to respiratory pathogens and might be at an increased risk for COVID-19. A case of acute respiratory distress syndrome due to SARS-CoV2 in a patient pregnant with twins is discussed. A dramatic improvement in oxygenation was observed after delivery. One of the twins tested positive for SARS-CoV2.
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Affiliation(s)
- Harsh Mehta
- Saint Barnabas Medical Center, Department of Medicine, Livingston, NJ 07039, USA
| | - Sasa Ivanovic
- Saint Barnabas Medical Center, Department of Medicine, Livingston, NJ 07039, USA
| | - Amanda Cronin
- Saint Barnabas Medical Center, Department of Obstetrics and Gynecology, Livingston, NJ 07039, USA
| | - Lindsey VanBrunt
- Saint Barnabas Medical Center, Department of Obstetrics and Gynecology, Livingston, NJ 07039, USA
| | - Nirav Mistry
- Saint Barnabas Medical Center, Department of Medicine, Livingston, NJ 07039, USA.,Saint Barnabas Medical Center, Division of Critical Care, Department of Medicine, Livingston, NJ 07039, USA
| | - Richard Miller
- Saint Barnabas Medical Center, Department of Obstetrics and Gynecology, Livingston, NJ 07039, USA
| | - Paul Yodice
- Saint Barnabas Medical Center, Department of Medicine, Livingston, NJ 07039, USA.,Saint Barnabas Medical Center, Division of Critical Care, Department of Medicine, Livingston, NJ 07039, USA
| | - Fariborz Rezai
- Saint Barnabas Medical Center, Department of Medicine, Livingston, NJ 07039, USA.,Saint Barnabas Medical Center, Division of Critical Care, Department of Medicine, Livingston, NJ 07039, USA
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Non-invasive ventilation for acute respiratory failure during labor: A management dilemma. Med J Armed Forces India 2020; 76:232-234. [DOI: 10.1016/j.mjafi.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022] Open
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Borre-Naranjo D, Santacruz J, Gonzalez-Hernandez J, Anichiarico W, Rubio-Romero J. Infección por SARS-CoV-2 en la paciente obstétrica: una perspectiva desde el cuidado crítico. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2020. [PMCID: PMC7158844 DOI: 10.1016/j.acci.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
La nueva infección por coronavirus (COVID-19) se constituye en el principal problema de salud pública en el mundo. Entre el 5 y el 30% de los pacientes afectados por esta enfermedad requieren manejo en una unidad de cuidado intensivo. Se han generado diferentes publicaciones con recomendaciones para la población general. Sin embargo, en la población obstétrica la evidencia científica es reducida, aún más cuando se trata de infección por COVID-19 en escenarios de cuidado intensivo obstétrico. Por esta razón, se realizó una revisión narrativa no sistemática de la literatura utilizando como fuente de información MEDLINE, sociedades científicas y los repositorios de la Organización Mundial de la Salud y el Ministerio de Salud y Protección Social de Colombia, con el objetivo de describir algunas sugerencias para el manejo de una paciente embarazada con COVID-19 en una unidad de cuidado intensivo. Se resalta que la atención debe ser realizada por un equipo interdisciplinario, bajo monitorización materna y fetal cuando corresponda, vigilando los niveles de saturación de oxígeno y la hemodinamia materna para minimizar la hipoxemia fetal. Se describen recomendaciones sobre algunos tópicos relevantes en el escenario crítico, como la intubación oportuna, la utilización adecuada de los equipos de protección personal (EPP), el manejo de la falla circulatoria, las estrategias restrictivas de fluidos y/o vasopresores, entre otros.
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Han M, Liu D, Zeb S, Li C, Tong M, Li X, Chen Q. Are maternal and neonatal outcomes different in placental abruption between women with and without preeclampsia? Placenta 2019; 85:69-73. [DOI: 10.1016/j.placenta.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 01/01/2023]
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50
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Carlier L, Muller J, Debaveye Y, Verelst S, Rex S. Successful use of VV-ECMO in a pregnant patient with severe ARDS. Turk J Emerg Med 2019; 19:111-112. [PMID: 31321344 PMCID: PMC6612621 DOI: 10.1016/j.tjem.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/17/2019] [Accepted: 04/30/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Around 0.1–0.2% of all pregnancies are complicated by respiratory failure. The altered physiology of pregnancy predisposes mother and child to develop hypoxia and respiratory failure more easily than a non-pregnant patient. Respiratory failure in pregnancy may have detrimental fetal complications, therefore extensive knowledge of the range of therapeutic options is necessary. If conventional lung-protective mechanical ventilation strategies fail, alternative approaches such as veno-venous extracorporeal membrane oxygenation (VV-ECMO) should be considered. Case presentation A previously healthy 30-year-old P1G2 at 26 weeks and 6 days of gestation was admitted to the emergency department because of a severe respiratory infection. She suffered of severe hypoxic respiratory failure due to an overwhelming pneumonia (influenza type A) with acute respiratory distress syndrome (ARDS). Because long protective ventilation strategies and ventilation in prone positioning were inadequate, and further respiratory deterioration occurred, VV-ECMO was initiated. Conclusion In a pregnant patient with severe respiratory failure, when other interventions fail, initiation of VV-ECMO should not be delayed. The use of VV-ECMO in pregnancy is a multi-disciplinary team approach.
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Affiliation(s)
- Laurence Carlier
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.,Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jan Muller
- Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium
| | - Yves Debaveye
- Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium.,Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Sandra Verelst
- Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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