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Iqbal M, Zubair M, Saeed Awan A, Khan Y, Yasmin H, Rahim R, Srichand P, Pal SA, Mazhar SB, Sohail R, Zaman F, Ali S, Ali T. Consensus Statements for Assessment and Management of Threatened Miscarriage in the First Trimester in Pakistan: A Three-Step Modified Delphi Approach. Cureus 2024; 16:e65079. [PMID: 39171060 PMCID: PMC11337146 DOI: 10.7759/cureus.65079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVE It aimed to develop an expert consensus regarding the risk assessment, diagnosis, and threatened miscarriage management during the first trimester in Pakistan. METHODS A three-step modified Delphi method was applied to develop the consensus. Eleven specialized obstetricians and gynecologists participated in its development. If 75% or higher agreement level was attained on each assertion, it was declared as a consensus. RESULTS Age of 35 or above, previous history of two or more previous miscarriages, and direct strong trauma were considered to be threatened miscarriage risk factors. Infection was discussed and specified to include specific infectious diseases, like malaria, and COVID-19 as a risk factor. The experts agreed from the first time on considering endocrinological disorders, thrombophilia, and lifestyle variables as threatened miscarriage risk factors. They proposed adding a statement concerning acquired thrombophilia which was accepted unanimously. Finally, experts agreed on the importance of educating pregnant women about factors whose risk can be modified by modifying their behavior. As for diagnosis statements, it was agreed to be trifold: physical examination, imaging, and laboratory testing. Physical examination included abdominal and pelvic exams but focused more on vaginal examination with speculum to identify bleeding severity and etiology. The statements regarding the imaging approaches to diagnose threatened miscarriage in the first trimester achieved a consensus in most statements. TVS was recommended to check on uterine structural abnormalities, fetus viability focusing on heartbeat and crown-to-rump length, gestation sac size and emptiness, subchorionic hematoma, and ectopic pregnancy. Each was defined on how to identify and diagnose in separate statements. Statements about laboratory tests indicated the need for human chorionic gonadotropin hormone assessment whether serial or once is dependent on the ultrasound. Recommended hematologic investigations include complete blood count for anemia, Rh factor for potential bleeding risk and in special cases, thrombophilia assessment is undertaken. The first and foremost management aspect was follow-up while most management statements were controversial, and some were altogether removed with only some reaching agreement after discussion. CONCLUSION These consensus statements aggregated the best available evidence and experts' opinion-supported statements to improve patient education, risk assessment, diagnosis, and evaluation as well as management of threatened miscarriage during the first trimester in Pakistan.
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Affiliation(s)
- Maryam Iqbal
- Obstetrics and Gynecology, Integrated Medical Care Hospital, Lahore, PAK
| | - Maryam Zubair
- Obstetrics and Gynecology, Azad Jammu Kashmir Medical College, Muzaffarabad, PAK
| | - Azra Saeed Awan
- Obstetrics and Gynecology, Fauji Foundation Hospital, Rawalpindi, PAK
| | - Yousaf Khan
- Obstetrics and Gynecology, Hameed Latif Hospital, Lahore, PAK
| | - Haleema Yasmin
- Obstetrics and Gynecology, Jinnah Postgraduate Medical Center (JPMC), Karachi, PAK
| | - Rehana Rahim
- Obstetrics and Gynecology, Lady Ready Hospital, Peshawar, PAK
| | - Pushpa Srichand
- Obstetrics and Gynecology, Isra University Hospital, Hyderabad, PAK
| | - Sadiah A Pal
- Epidemiology, Concept Fertility Center, Karachi, PAK
| | - Syeda Batool Mazhar
- Obstetrics and Gynecology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Rubina Sohail
- Epidemiology and Public Health, Hameed Latif Hospital, Lahore, PAK
| | - Farrukh Zaman
- Obstetrics and Gynecology, Hameed Latif Hospital, Lahore, PAK
| | - Sobia Ali
- Medical Affairs, Established Pharmaceutical Division, Abbott Laboratories (Pakistan) Limited, Karachi, PAK
| | - Tabrez Ali
- Medical Affairs, Established Pharmaceutical Division, Abbott Laboratories (Pakistan) Limited, Karachi, PAK
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Antoniou E, Tzitiridou-Chatzopoulou M, Voyatzaki C, Iliadou M, Eskitzis P, Dagla M, Palaska E, Orovou E. What Are the Implications of COVID-19 on Breastfeeding? A Synthesis of Qualitative Evidence Studies. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1178. [PMID: 37508675 PMCID: PMC10378339 DOI: 10.3390/children10071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Exclusive breastfeeding until six months of life is the ideal way to feed infants. However, there is a significant number of infants who have never breastfed, despite the beneficial properties of breastfeeding. On the other hand, the coronavirus outbreak had significant effects on people's health, both mentally and physically, and has also impacted the breastfeeding process. AIM The aim of this study was to investigate the implication of COVID-19 on breastfeeding through qualitative data from databases. METHODS We searched online databases (PubMed, Google Scholar, PsycINFO) for studies published from 2019 to 2023. 'Out of the 2598 papers we found, only 12 were included in the review'. More specifically, from the 1558 papers remaining from the title and abstract evaluation as well as duplicates, a further 1546 papers belonging to our exclusion criteria were removed (all types of reviews, letters to editors, and quantitative articles). RESULTS Our results covered three subjects: breastfeeding support during the pandemic, effects of social containment measures on breastfeeding, and additional outcomes regarding breastfeeding. Most voices found the effects of the pandemic on breastfeeding beneficial, with reduced professional support and a high degree of support from the environment. Additional negative factors were observed, as well as consequences of the pandemic in women's lives. CONCLUSIONS COVID-19 was the occasion to understand the power of the supportive environment of the woman, especially the partner, in establishing and maintaining breastfeeding. Therefore, policy makers and health professionals, especially midwives, should implement family-centered breastfeeding strategies that are more supportive of the partner role, providing problem counseling when and where deemed necessary.
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Affiliation(s)
- Evangelia Antoniou
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str., 12243 Egaleo, Greece
| | | | - Chrysa Voyatzaki
- Department of Biomedical Sciences, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str., 12243 Egaleo, Greece
| | - Maria Iliadou
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str., 12243 Egaleo, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - Maria Dagla
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str., 12243 Egaleo, Greece
| | - Ermioni Palaska
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str., 12243 Egaleo, Greece
| | - Eirini Orovou
- Department of Midwifery, Egaleo Park Campus, University of West Attica, Ag. Spyridonos Str., 12243 Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece
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Wu JL, Jiang XM, Zheng QX, Chen XQ, Liu GH. Mothers' breastfeeding six weeks postpartum and factors influencing exclusive breastfeeding during the first six months. Health Care Women Int 2023; 44:262-275. [PMID: 34346293 DOI: 10.1080/07399332.2021.1947287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We aimed to assess the feeding pattern and influencing factors within six weeks postpartum on exclusive breastfeeding duration among Chinese mothers. This study was conducted using 2:1 matched case-control study. Cases and controls were matched for maternal age, parity and mode of birth. A total of 210 women were included. Approximately 67.9% of women stopped exclusive breastfeeding within the first six weeks postpartum. Maternal non-exclusive breastfeeding intention, lower maternal educational level, mother-infant skin to skin contact over one hour, unsatisfied breastfeeding self-evaluation and maternal unhealthy condition within the first six weeks were risk factors for ceasing exclusive breastfeeding early.
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Affiliation(s)
- Jing-Ling Wu
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiu-Min Jiang
- Department of Nursing, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing-Xiang Zheng
- Department of Nursing, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Qian Chen
- Department of Nursing, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Gui-Hua Liu
- Department of Child Health, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Dahma G, Craina M, Dumitru C, Neamtu R, Popa ZL, Gluhovschi A, Citu C, Bratosin F, Bloanca V, Alambaram S, Willie A, Kodimala SC, Negrean RA, Bernad E. A Prospective Analysis of Vitamin D Levels in Pregnant Women Diagnosed with Gestational Hypertension after SARS-CoV-2 Infection. J Pers Med 2023; 13:jpm13020317. [PMID: 36836551 PMCID: PMC9963707 DOI: 10.3390/jpm13020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
The great majority of existing studies suggests that the prognosis and outcomes of SARS-CoV-2 infections are improved with adequate vitamin D levels, with or without supplementation. Simultaneously, whether vitamin D supplementation during pregnancy lessens the chance of developing gestational hypertension is controversial. The objective of the present research was to evaluate whether vitamin D levels during pregnancy differ substantially among pregnant women who develop gestational hypertension following SARS-CoV-2 infection. The current research was designed as a prospective cohort following the pregnant women admitted to our clinic with COVID-19 until 36 weeks of gestation. Total vitamin D (25(OH)D) levels were measured in the three study groups in which pregnant women with COVID-19 during pregnancy and a diagnosis of hypertension after 20 weeks of gestation were considered the group of cases (GH-CoV). The second group (CoV) included those with COVID-19 and no hypertension, while the third group (GH) included those with hypertension and no COVID-19. It was observed that 64.4% of SARS-CoV-2 infections in the group of cases occurred during the first trimester, compared to 29.2% in the first trimester among the controls who did not develop GH. Normal vitamin D levels were measured at admission in a significantly higher proportion of pregnant women without GH (68.8% in the CoV group vs. 47.9% in the GH-CoV group and 45.8% in the GH group). At 36 weeks of gestation, the median values of 25(OH)D in the CoV group was 34.4 (26.9-39.7) ng/mL compared to 27.9 (16.2-32.4) ng/mL in the GH-CoV group and 29.5 ng/mL (18.4-33.2) in the GH group, while the blood pressure measurements remained over 140 mmHg among the groups who developed GH. There was a statistically significant negative association between serum 25(OH)D levels and systolic blood pressure (rho = -0.295; p-value = 0.031); however, the risk of developing GH was not significantly higher among pregnant women with COVID-19 if the vitamin D levels were insufficient (OR = 1.19; p-value = 0.092) or deficient (OR = 1.26; p-value = 0.057). Although insufficient or deficient vitamin D among pregnant women with COVID-19 was not an independent risk factor for the development of GH, it is likely that an association between first-trimester SARS-CoV-2 infection and low vitamin D plays a key role in developing gestational hypertension.
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Affiliation(s)
- George Dahma
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Catalin Dumitru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Radu Neamtu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Adrian Gluhovschi
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Cosmin Citu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Vlad Bloanca
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Correspondence:
| | - Satish Alambaram
- Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India
| | - Anthony Willie
- Igbinedion University, Faculty of General Medicine, Main Campus Mission Road 1090, Okada 302111, Nigeria
| | - Shiva Charana Kodimala
- MediCiti Institute of Medical Sciences, NTR University of Health Sciences, Hyderabad 501401, Telangana, India
| | | | - Elena Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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Sayad B, Mohseni Afshar Z, Mansouri F, Salimi M, Miladi R, Rahimi S, Rahimi Z, Shirvani M. Pregnancy, Preeclampsia, and COVID-19: Susceptibility and Mechanisms: A Review Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:64-69. [PMID: 35639648 PMCID: PMC9108291 DOI: 10.22074/ijfs.2022.539768.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells through angiotensin converting enzyme 2 (ACE2), which expression of its gene increases during pregnancy that is resulted in an enhanced level of the ACE2 enzyme. It might enhance the risk of SARS-CoV-2 infection and its complications in the pregnant women. Although, pregnancy hypertensive disorders and severe infection with SARS-CoV-2 are correlated with high comorbidity, these two entities should be discriminated from each other. Also, there is a concern about the risk of preeclampsia and consequently severe coronavirus disease 2019 (COVID-19) development in the pregnant women. So, to answer these questions, in the present review the literature was surveyed. It seems there is higher severity of COVID-19 among pregnant women than non-pregnant women and more adverse pregnancy outcomes among pregnant women infected with SARS-CoV-2. In addition, an association between COVID-19 with preeclampsia and the role of preeclampsia and gestational hypertension as risk factors for SARS-CoV-2 infection and its complications is suggested. However, infection of the placenta and the SARS-CoV-2 vertical transmission is rare. Various mechanisms could explain the role of COVID-19 in the risk of preeclampsia and association between preeclampsia and COVID-19. Suggested mechanisms are included decreased ACE2 activity and imbalance between Ang II and Ang-(1-7) in preeclampsia, association of both of severe forms of COVID-19 and pregnancy hypertensive disorders with comorbidity, and interaction between immune system, inflammatory cytokines and the renin angiotensin aldosterone system and its contribution to the hypertension pathogenesis. It is concluded that preeclampsia and gestational hypertension might be risk factors for SARS-CoV-2 infection and its complications.
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Affiliation(s)
- Babak Sayad
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zeinab Mohseni Afshar
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Salimi
- Department of Internal Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ronak Miladi
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Rahimi
- Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zohreh Rahimi
- Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran ,Behavioral Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran ,P.O.Box: 67148-69914Department of Clinical BiochemistryKermanshah University of Medical SciencesKermanshahIranP.O.Box: 67148-69914Infectious Diseases Research CenterKermanshah University
of Medical SciencesKermanshahIran
Emails:,
| | - Maria Shirvani
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,P.O.Box: 67148-69914Department of Clinical BiochemistryKermanshah University of Medical SciencesKermanshahIranP.O.Box: 67148-69914Infectious Diseases Research CenterKermanshah University
of Medical SciencesKermanshahIran
Emails:,
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6
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Rahayuningsih FB, Fitriani N, Dewi E, Sudaryanto A, Sulastri S, Jihan AF. Knowledge about Care of Pregnant Mothers during the Covid-19 Pandemic. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6845] [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: China reported a case of pneumonia known as severe acute respiratory syndrome coronavirus to the World Health Organization of unknown cause in Wuhan City. Regulation Number 6 of 2018 concerning Health Quarantine regulates the basic provisions of the PSBB. Health services at the primary care are very limited, one of which is the care of pregnant women which is an activity that monitors and supports the health of normal pregnant women and detects normal pregnancies.
AIM: The purpose of this study was to describe the knowledge of pregnant women about the care of pregnant women during the COVID-19 pandemic at the Jayengan primary health care.
METHODS: This study uses a crosssectional design, the sample selection using purposive sampling with a sample of 40 respondents. Data collection was carried out using questionnaires made by researchers and filled out by respondents. Then, the data that have been collected is processed using software.
RESULTS: The results showed that the value of the sub-variable understanding of pregnant women with an average value of 100, the sub-variable time of visit to pregnant women had an average value of 72.5, the sub-variable of breast care for pregnant women had an average value of 79.16, sub-variable nutrition variables in pregnant women have an average of 75.63, the tetanus toxoid immunization sub-variable for pregnant women got an average value of 76.66, the pregnancy check-up sub-variable got an average value of 97.5, and the care of pregnant women who were confirmed to have COVID-19 got an average score of 55.93.
CONCLUSION: The conclusion shows that the average knowledge level of respondents is sufficient.
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Arco-Torres A, Cortés-Martín J, Tovar-Gálvez MI, Montiel-Troya M, Riquelme-Gallego B, Rodríguez-Blanque R. Pharmacological Treatments against COVID-19 in Pregnant Women. J Clin Med 2021; 10:jcm10214896. [PMID: 34768416 PMCID: PMC8584594 DOI: 10.3390/jcm10214896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/05/2021] [Accepted: 10/16/2021] [Indexed: 12/11/2022] Open
Abstract
The recent respiratory virus known as SARS-CoV-2 has caused millions of deaths worldwide, causing great uncertainty due to the lack of a specific treatment, which has been mitigated by the use of various drugs traditionally used against other types of pathologies. Pregnancy presents special physiological conditions that expose the pregnant woman and the foetus to greater risk. Pregnant women are often excluded from trials due to possible risk of toxicity or side effects, resulting in a lack of knowledge about the use of drugs and treatments during pregnancy. The main objective of this review was to compile existing knowledge about currently available drug treatments for COVID-19 in pregnant women. The review report met the criteria of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) review protocol and was registered with the registration number CRD42021251036. The electronic databases searched were Scopus, PubMed, CINAHL and SciELO. Finally, 22 articles were included, resulting in an analysis of drugs with an acceptable safety profile in the treatment of pregnant women with COVID-19.
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Affiliation(s)
- Ana Arco-Torres
- Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (A.A.-T.); (J.C.-M.)
| | - Jonathan Cortés-Martín
- Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (A.A.-T.); (J.C.-M.)
| | - María Isabel Tovar-Gálvez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (M.M.-T.); (B.R.-G.)
- Correspondence:
| | - María Montiel-Troya
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (M.M.-T.); (B.R.-G.)
| | - Blanca Riquelme-Gallego
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Grupo de Investigación CTS-1068, 18014 Granada, Spain; (M.M.-T.); (B.R.-G.)
| | - Raquel Rodríguez-Blanque
- Delegación Territorial de Salud y Familias, Grupo de Investigación CTS-1068, 18014 Granada, Spain;
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Jiménez‐Lozano I, Caro‐Teller JM, Fernández‐Hidalgo N, Miarons M, Frick MA, Batllori Badia E, Serrano B, Parramon‐Teixidó CJ, Camba‐Longueira F, Moral‐Pumarega MT, San Juan‐Garrido R, Cabañas Poy MJ, Suy A, Gorgas Torner MQ. Safety of tocilizumab in COVID-19 pregnant women and their newborn: A retrospective study. J Clin Pharm Ther 2021; 46:1062-1070. [PMID: 33638257 PMCID: PMC8014796 DOI: 10.1111/jcpt.13394] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tocilizumab is an IL-6 receptor inhibitor agent which has been proposed as a candidate to stop the inflammatory phase of infection by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, safety data of tocilizumab in pregnant women and their newborn are scarce. We aimed to describe maternal and neonatal safety outcomes associated with tocilizumab treatment in pregnant women with severe COVID-19. METHODS This is a retrospective study of severe COVID-19 pregnant women, treated with tocilizumab in two Spanish hospitals between 1 March and 31 April 2020. Demographics, medical history, clinical and radiologic findings, treatment information and laboratory data of mothers and their newborns were collected from electronic medical records. RESULTS AND DISCUSSION A total of 12 pregnant women were identified to have received tocilizumab during pregnancy in the two hospitals. Median gestational age at admission was 27.7 weeks (interquartile range, 18.0-36.4). Most of them received lopinavir/ritonavir, azithromycin and hydroxychloroquine, two patients received corticosteroids and one received interferon beta 1B. All 12 pregnancies resulted in live births. Somatometric values were normal for all newborns, and evolution at 14 and 28 days was favourable for all of them. Hepatotoxicity was observed in 2 patients, which improved or resolved at discharge. Cytomegalovirus reactivation was detected in another patient who had also received corticosteroids for 15 days, causing a congenital infection in her newborn. Both hepatotoxicity and viral reactivation adverse events were classified as possibly related to tocilizumab administration according to Naranjo's causality algorithm. WHAT IS NEW AND CONCLUSIONS It does not appear that tocilizumab has detrimental effects for the mother and newborn. Close monitoring of infections should be considered, especially if other immunosuppressive agents are used.
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Affiliation(s)
- Inés Jiménez‐Lozano
- Pharmacy DepartmentVall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelonaSpain
| | - José Manuel Caro‐Teller
- Pharmacy Department. HospitalUniversitario "12 de Octubre"Research Institute 12 de Octubre (i+12MadridSpain
| | - Nuria Fernández‐Hidalgo
- Pediatric Infectious Diseases and Primary Immunodeficiencies UnitPediatrics DepartmentVall d´hebron HospitalBarcelonaSpain
| | - Marta Miarons
- Pharmacy DepartmentVall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Marie Antoinette Frick
- Pediatric Infectious Diseases and Primary Immunodeficiencies UnitPediatrics DepartmentVall d´hebron HospitalBarcelonaSpain
| | - Emma Batllori Badia
- Unit of perinatal medicine, Obstetric and Gynaecology DepartmentHospital Universitario "12 de Octubre"Research Institute 12 de Octubre (i+12MadridSpain
| | - Berta Serrano
- Department of Obstetrics and GynecologyVall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelonaSpain
| | | | - Fátima Camba‐Longueira
- Department of NeonatologyVall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Maria Teresa Moral‐Pumarega
- Unit of perinatal medicine, Obstetric and Gynaecology DepartmentHospital Universitario "12 de Octubre"Research Institute 12 de Octubre (i+12MadridSpain
| | - Rafael San Juan‐Garrido
- Unit of Infectious DiseasesHospital Universitario "12 de Octubre"Research Institute 12 de Octubre (i+12MadridSpain
| | - Maria Josep Cabañas Poy
- Pharmacy DepartmentVall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Anna Suy
- Department of Obstetrics and GynecologyVall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelonaSpain
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Senyuva I, Baysal B. Pregnant and Newborn Health in COVID-19 Pandemic: Knowledge level, Attitude and Perspective of Obstetricians & Gynecologists and Pediatricians in Turkey (A Survey-based Study). ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/10831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Fikadu Y, Yeshaneh A, Melis T, Mesele M, Anmut W, Argaw M. COVID-19 Preventive Measure Practices and Knowledge of Pregnant Women in Guraghe Zone Hospitals. Int J Womens Health 2021; 13:39-50. [PMID: 33442303 PMCID: PMC7800450 DOI: 10.2147/ijwh.s291507] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is caused by a severe acute respiratory syndrome coronavirus which emerged in Wuhan. Recently this virus has rapidly spread throughout Ethiopia. The current preventive measure practices and knowledge have gaps. Therefore this study aimed to assess COVID-19 preventive measure practices and knowledge of pregnant women in Guraghe Zone hospitals. METHODS AND MATERIALS This cross-sectional study was conducted from July 27-August 27, 2020 among pregnant women in Guraghe zone hospitals. Systematic random sampling technique were employed to select 403 participants. Data were checked manually for completeness, cleaned, and stored in Epi Data and exported to SPSS for further analysis. Variables which have a P-value less than 0.25 on bivariate analysis were taken to multivariate analysis. A P-value of less than 0.05 and 95% confidence level was used as a cut-off point for presence of association in multivariate analysis. RESULTS COVID-19 preventive measure practice and knowledge of pregnant women visiting Guraghe Zone hospitals was 76.2% and 54.84%, respectively. Those aged 20-24 (AOR=1.22, 95% CI=1.15-22.24), 25-29 (AOR=1.32, 95% CI=1.20-20.25), and 30-34 (AOR=2.57, 95% CI-2.32-43.38) were more likely to practice COVID-19 preventive measures. Those residing in urban area (AOR=2.16, 95% CI=1.24-3.77) and perceiving that COVID-19 is worst for people with chronic disease (AOR=5.12, 95% CI=1.73-15.17) were more likely to practice COVID-19 preventive measures. CONCLUSION COVID-19 preventive measure practices and knowledge were low. Age, residence, and perception of COVID-19 on chronic disease were independent factors associated with preventive measure practices. Pregnant women aged ≥35 need to be counseled on practices of preventing COVID-19 by their healthcare providers.
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Affiliation(s)
- Yohannes Fikadu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Alex Yeshaneh
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tamirat Melis
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Molalegn Mesele
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Walellign Anmut
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Muche Argaw
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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11
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Goff DA, Ashiru‐Oredope D, Cairns KA, Eljaaly K, Gauthier TP, Langford BJ, Mahmoud SF, Messina AP, Michael UC, Saad T, Schellack N. Global contributions of pharmacists during the COVID-19 pandemic. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020; 3:1480-1492. [PMID: 33043280 PMCID: PMC7537072 DOI: 10.1002/jac5.1329] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/23/2022]
Abstract
Throughout the SARS-CoV-2 (COVID-19) global pandemic, pharmacists were rarely mentioned as essential frontline health care providers by the news media, the public, or politicians. Around the world, pharmacists are working on the frontlines of health care every day providing essential health care services during the pandemic. Pharmacists are medication experts providing patient care in a variety of settings including hospitals, clinics, community pharmacies, long-term care, physician offices, and national and public health. In this paper, we describe how pharmacists from high and low-middle income countries contributed to essential patient care and well-being of the public during the COVID-19 pandemic. While the news media, the public, and politicians often overlooked pharmacists as essential frontline health care providers, we hope that this list of contributions by pharmacists from nine countries in this article can help to change this perspective.
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Affiliation(s)
- Debra A. Goff
- The Ohio State University Wexner Medical CenterThe Ohio State University College of PharmacyColumbusOhioUSA
| | - Diane Ashiru‐Oredope
- National Infection ServicePublic Health EnglandLondonUK
- Commonwealth Pharmacists AssociationLondonUK
| | | | - Khalid Eljaaly
- Faculty of PharmacyKing Abdulaziz UniversityJeddahSaudi Arabia
- College of PharmacyUniversity of ArizonaTucsonArizonaUSA
| | | | - Bradley J. Langford
- Public Health OntarioTorontoOntarioCanada
- Hotel Dieu Shaver Health and Rehabilitation CentreSt. CatharinesOntarioCanada
| | | | - Angeliki P. Messina
- Division of PharmacyNetcare Hospitals LtdJohannesburgSouth Africa
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Thérèse Saad
- Department of PharmacyAmerican University of Beirut Medical CenterBeirutLebanon
| | - Natalie Schellack
- School of Pharmacy, Faculty of Health SciencesSefako Makgatho Health Sciences UniversityPretoriaSouth Africa
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12
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Ang XL, Chonkar SP, Chua MSQ, Sulaiman S, Lee JCS. Problems with Early Systematic Reviews: The Case of Coronavirus Disease 2019 (COVID-19) in Pregnancy. Matern Child Health J 2020; 25:38-41. [PMID: 33222027 PMCID: PMC7680632 DOI: 10.1007/s10995-020-03046-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 12/18/2022]
Abstract
Introduction Rapid dissemination of findings regarding the Coronavirus Disease 2019 (COVID-19) and its potential effects on pregnancy is crucial to support understanding and development of recommendations for optimization of obstetrics care. However, much of the current studies published are in the form of case reports or case series which can be prone to biases. Other factors also further complicate attempts to analyze data accurately. Hence, this evaluation hopes to highlight some of these problems and provide suggestions to help clinicians mitigate and make reasonable conclusions when reading the abundant yet limited body of evidence when furthering their research efforts. Methods Studies regarding COVID-19 and pregnancy were searched on databases such as PubMed, EMBASE, Scopus, the Cochrane Library. Manual search of references of select articles were also undertaken. Apart from summarizing study limitations identified by authors, the characteristics of current literature and systematic reviews were also evaluated to identify potential factors affecting accuracy of subsequent analysis. Results Factors such as innate biasness in study design of current literature, duplicate reporting, differing inclusion criteria of systematic reviews, scarce data, inadequate follow-up period and limitations of systematic reviews have been shown to hinder the ability for accurate data extrapolation. Discussion Unless additional studies are conducted in identified areas of data scarcity and a common list of factors affecting accuracy of data analysis are taken into account when developing recommendations, discrepancies will continue to arise and accurate data analysis and valid systematic reviews will be precluded.
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Affiliation(s)
- Xue Ling Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sonali Prashant Chonkar
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Monica Shi Qi Chua
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Suzanna Sulaiman
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jill Cheng Sim Lee
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
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13
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Sharma JB, Sharma E, Sharma S, Singh J. Recommendations for prenatal, intrapartum, and postpartum care during COVID-19 pandemic in India. Am J Reprod Immunol 2020; 84:e13336. [PMID: 32877014 DOI: 10.1111/aji.13336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
The pandemic of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 19.7 million persons worldwide with 7 28 013 deaths till August 10, 2020. It has put an unprecedented workload on healthcare systems with special reference to labor rooms and obstetrics as deliveries cannot be stopped or postponed. Preparing their facilities using triage (COVID-positive patients, COVID-suspect patients, and COVID-negative patients) can help to better utilize the limited resources and help in prevention of spread of disease, and improve maternal and perinatal outcome. There is a need for proper training of healthcare providers for judicious use of personal protective equipment (PPE) for optimum outcome. Fortunately, the available literature suggests that there is no substantial increased risk of acquiring COVID-19 in pregnancy or its increased virulence in pregnancy and labor and there are no adverse effects on fetus and neonate with negligible fetal transmission rate. Nevertheless, utmost care is needed to manage such pregnancies, their prenatal care, and labor. This review aimed to highlight the main recommendations applied in Indian maternities for better management of pregnancy during the COVID-19 pandemic.
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Affiliation(s)
- Jai B Sharma
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Eshani Sharma
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - Janmeeta Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
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