scholarly journals Severe COVID-19 during Pregnancy and Possible Vertical Transmission

2020 ◽  
Vol 37 (08) ◽  
pp. 861-865 ◽  
Author(s):  
Maria Claudia Alzamora ◽  
Tania Paredes ◽  
David Caceres ◽  
Camille M. Webb ◽  
Luis M. Valdez ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Vertical Transmission ◽  
Disease Onset ◽  
High Risk Group ◽  
Nasopharyngeal Swab ◽  
Low Grade ◽  
Delayed Cord Clamping ◽  
Skin Contact ◽  
Cord Clamping ◽  
History Of

There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons. Key Points

Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact

2014 ◽  
Vol 99 (4) ◽  
pp. F309-F314 ◽  
Author(s):  
Marrit Smit ◽  
Jennifer A Dawson ◽  
Angelina Ganzeboom ◽  
Stuart B Hooper ◽  
Jos van Roosmalen ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Delayed Cord Clamping ◽  
Skin Contact ◽  
Cord Clamping ◽  
Skin To Skin

scholarly journals Seroepidemiology and associated risk factors of hepatitis B and C virus infections among pregnant women attending maternity wards at two hospitals in Swabi, Khyber Pakhtunkhwa, Pakistan

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255189
Author(s):  
Muhammad Israr ◽  
Fawad Ali ◽  
Arif Nawaz ◽  
Muhammad Idrees ◽  
Aishma Khattak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Hepatitis B ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Educational Level ◽  
Khyber Pakhtunkhwa ◽  
History Of ◽  
Associated Risk Factors ◽  
Pregnant Mothers

Background & aim Hepatitis B and C infections are global issues that are associated with a massive financial burden in developing countries where vertical transmission is the major mode and remains high. This cross-sectional study was designed to investigate the seroepidemiology and associated risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among 375 pregnant women attending antenatal care health facilities at Bacha Khan Medical Complex (BKMC) Shahmansoor and District Head Quarter (DHQ) Hospital Swabi, Khyber Pakhtunkhwa, Pakistan. Methodology From a total of 375 pregnant women selected using systematic random sampling from both hospitals, 10 ml of blood samples were collected and alienated serum was examined for indicators identification through the Immuno-Chromatographic Test (ICT) and 3rd Generation Enzyme-Linked Immunosorbent Assay (ELISA). A pre-structured questionnaire was used to collect the socio-demographic data and possible risk factors. The data was analyzed via SPSS 23.0 statistical software. A chi-square analysis was performed to determine the association between variables. P-value < 0.05 was set statistically significant. Results The overall frequency of HBV and HCV among 375 pregnant women involved in the study was 3.7% and 2.1% respectively. None of the pregnant women were co-infected with HBV and HCV. Dental extraction (P = 0.001) and blood transfusion (P = 0.0005) were significantly allied with HBV infection while surgical procedure (P = 0.0001) was significantly associated with HCV infection. Moreover the sociodemographic characteristics: residential status (P = 0.017) and educational level (P = 0.048) were found significant risk factors of HBsAg and maternal age (P = 0.033) of anti-HCV, respectively. Conclusion & recommendation HBV and HCV infections are intermediary endemic in the study area. A higher prevalence of HBV was detected among pregnant mothers with a history of dental extraction, history of blood transfusion, resident to the urban area and low educational level. The age and surgical procedures were the potential risk factors found significantly associated with HCV positivity among pregnant mothers in our setup. Future negotiations to control vertical transmission should include routine antenatal screening for these infections early in pregnancy and the requirement of efficient preventive tools including the birth dose of the hepatitis B vaccine in combination with hepatitis B immune globulins to the neonate.

The Puerperium

2018 ◽  
Author(s):  
Sarah Kleinman ◽  
Hope A Ricciotti
Keyword(s):  
Pelvic Floor ◽  
Perinatal Depression ◽  
Muscle Tone ◽  
Postpartum Visit ◽  
Delayed Cord Clamping ◽  
Maternal Sleep ◽  
Skin Contact ◽  
Cord Clamping ◽  
Baby Blues ◽  
Pregnancy And Postpartum

The puerperium starts after the birth of a baby and continues until 6 to 8 weeks postpartum. Several recent interventions in management have been shown to improve outcomes. Delayed cord clamping, the practice of waiting for a period of time after a baby is born before clamping and cutting the umbilical cord, can increase hemoglobin levels, improve iron stores, and increase birth weight in newborns. Rooming in, the practice of mothers and newborns staying together, improves infant sleep and breast-feeding without affecting maternal sleep. Immediately after birth, significant physiologic and anatomic changes occur. Thromboembolic events are more common in the postpartum state than during pregnancy, but the majority of women do not require specific thromboprophylaxis but should be encouraged to walk after birth. Women who have not been previously immunized for influenza; tetanus, diphtheria, pertussis (Tdap); and rubella should be offered these immunizations. Women with uncomplicated pregnancies may engage in exercise within days after delivery. Pelvic floor physical therapy performed during pregnancy and postpartum may assist in maintaining or regaining muscle tone of the pelvic floor and may prevent or treat urinary incontinence. Perinatal depression affects one in seven women. Baby blues, which include mood swings, anxiety, tearfulness, and insomnia, should resolve by 2 weeks after delivery. Patients should be screened for depression using a standardized, validated tool and appropriate treatment initiated. All women should undergo a comprehensive postpartum visit within 6 weeks of delivery.   This review contains 2 figures, 1 table and 32 references Key words: delayed cord clamping, hemodynamic changes, perinatal depression, postpartum, puerperium, rooming in, skin-to-skin contact  

Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women

2007 ◽  
Vol 98 (12) ◽  
pp. 1237-1245 ◽  
Author(s):  
Joachim Dudenhausen ◽  
Andree Faridi ◽  
Thorsten Fischer ◽  
Samson Fung ◽  
Ulrich Geisen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Management Strategies ◽  
Prospective Trial ◽  
High Risk Group ◽  
Group I ◽  
Increased Risk ◽  
History Of ◽  
Heparin Prophylaxis

SummaryWomen with a history of venous thromboembolism (VTE), thrombophilia or both may be at increased risk of thrombosis during pregnancy, but the optimal management strategy is not well defined in clinical guidelines because of limited trial data. A strategy of risk assessment and heparin prophylaxis was evaluated in pregnant women at increased risk of VTE. In a prospective trial (Efficacy of Thromboprophylaxis as an Intervention during Gravidity [EThIG]), 810 pregnant women were assigned to one of three management strategies according to pre-defined risk factors related to history of VTE and thrombophilic profile. Low-risk women (group I), received 50–100 IU dalteparin/ kg body weight/ day for 14 days postpartum, or earlier when additional risk factors occurred. Women at high (group II) or very high risk (group III) received dalteparin from enrolment until six weeks postpartum (50–100 IU and 100–200 IU/ kg/ day, respectively). Objectively confirmed, symptomatic VTE occurred in 5/810 women (0.6%; 95% confidence interval [CI], 0.2 to 1.5%) (group I, 0 of 225; II, 3/469; III, 2/116). The rate of serious bleeding was 3.0% (95 % CI, 1.9 to 4.4%); 1.1% (95 % CI, 0.5 to 2.2%) was possibly dalteparin-related. There was no evidence of heparin- induced thrombocytopenia, one case of osteoporosis, and rates of miscarriage and stillbirth were similar to previous, retrospective studies. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic VTE and few clinically important adverse events. Antepartum heparin prophylaxis is, therefore, warranted in pregnant women with idiopathic thrombosis or symptomatic thrombophilia.

scholarly journals SARS-CoV-2 in Pregnancy—The First Wave

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 241
Author(s):  
Andreia de Vasconcelos Gaspar ◽  
Isabel Santos Silva
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Maternity Hospital ◽  
Nasopharyngeal Swab ◽  
Cesarean Sections ◽  
Maternal Deaths ◽  
History Of ◽  
Threatened Abortion ◽  
Severity Of The Disease ◽  
Prelabor Rupture Of Membranes

Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.

scholarly journals Center-Based Experiences Implementing Strategies to Reduce Risk of Horizontal Transmission of SARS-Cov-2: Potential for Compromise of Neonatal Microbiome Assemblage

2021 ◽  
Author(s):  
Joann Romano-Keeler ◽  
Dana Fiszbein ◽  
Jilei Zhang ◽  
Joseph Horowitz ◽  
Karen Hayani ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Horizontal Transmission ◽  
Perinatal Transmission ◽  
Neonatal Intensive Care Units ◽  
Delayed Cord Clamping ◽  
Average Hospital ◽  
Skin Contact ◽  
Cord Clamping ◽  
Hospital Stays ◽  
Skin To Skin

Perinatal transmission of COVID-19 is poorly understood and many neonatal intensive care units' (NICU) policies minimize mother-infant contact to prevent transmission. We present our unit's approach and ways it may impact neonatal microbiome acquisition. We attending COVID-19 positive mothers' deliveries from March-August 2020. Delayed cord clamping and skin-to-skin were avoided and infants were admitted to the NICU. No parents' visits were allowed and discharge was arranged with COVID-19 negative family members. Maternal breast milk was restricted in the NICU. All twenty-one infants tested negative at 24 and 48 hours and had average hospital stays of nine days. 40% of mothers expressed breastmilk and 30% of infants were discharged with COVID-19 negative caregivers. Extended hospital stays, no skin-to-skin contact, limited maternal milk use, and discharge to caregivers outside primary residences, potentially affect the neonatal microbiome. Future studies are warranted to explore how ours and other centers'with similar policies influence this outcome.

The Puerperium

2021 ◽  
Author(s):  
Sarah Kleinman ◽  
Hope A Ricciotti
Keyword(s):  
Pelvic Floor ◽  
Perinatal Depression ◽  
Muscle Tone ◽  
Postpartum Visit ◽  
Delayed Cord Clamping ◽  
Maternal Sleep ◽  
Skin Contact ◽  
Cord Clamping ◽  
Baby Blues ◽  
Pregnancy And Postpartum

The puerperium starts after the birth of a baby and continues until 6 to 8 weeks postpartum. Several recent interventions in management have been shown to improve outcomes. Delayed cord clamping, the practice of waiting for a period of time after a baby is born before clamping and cutting the umbilical cord, can increase hemoglobin levels, improve iron stores, and increase birth weight in newborns. Rooming in, the practice of mothers and newborns staying together, improves infant sleep and breast-feeding without affecting maternal sleep. Immediately after birth, significant physiologic and anatomic changes occur. Thromboembolic events are more common in the postpartum state than during pregnancy, but the majority of women do not require specific thromboprophylaxis but should be encouraged to walk after birth. Women who have not been previously immunized for influenza; tetanus, diphtheria, pertussis (Tdap); and rubella should be offered these immunizations. Women with uncomplicated pregnancies may engage in exercise within days after delivery. Pelvic floor physical therapy performed during pregnancy and postpartum may assist in maintaining or regaining muscle tone of the pelvic floor and may prevent or treat urinary incontinence. Perinatal depression affects one in seven women. Baby blues, which include mood swings, anxiety, tearfulness, and insomnia, should resolve by 2 weeks after delivery. Patients should be screened for depression using a standardized, validated tool and appropriate treatment initiated. All women should undergo a comprehensive postpartum visit within 6 weeks of delivery.   This review contains 2 figures, 4 tables and 34 references Key words: delayed cord clamping, hemodynamic changes, perinatal depression, postpartum, puerperium, rooming in, skin-to-skin contact  

scholarly journals Neonatal Outcomes In Cord Clamping And Its Association With Hematological Parameters

2019 ◽  
Vol 09 (04) ◽  
pp. 271-274
Author(s):  
Zara Jamali ◽  
Shazia Naseeb ◽  
Saba Khan ◽  
Khadija Bano
Keyword(s):  
Pregnant Women ◽  
Hematological Parameters ◽  
Medical Centre ◽  
Neonatal Outcomes ◽  
P Value ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Group 2 ◽  
High Bilirubin ◽  
Group 1

Objective: To compare the neonatal outcomes in early and delayed cord clamping and to find Its association with hematological parameters in neonates of Jinnah Postgraduate Medical Centre, Karachi. Study Design and Setting: It was a cross sectional study conducted from 1st July 2016 to 31st December 2016 at Department of Obstetrics & Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. Methodology: 342 pregnant women were selected through convenient sampling technique meeting inclusion criteria after obtaining ethical approval all pimigravida with age range of 25 to 45 years with singleton term pregnancy delivered through normal vaginal delivery, in 3rd stages of labour were included in the study. Multi-gravid women or any women with a Systemic disease such as hypertension, diabetes mellitus thyroid disorder, and cardiac disease were excluded. Demographic variables, blood parameters, were recorded. SPSS version 20.0 was used for data analysis. Neonatal outcomes were assessed in terms of neonatal haemoglobin, haematocrit, platelet count and bilirubin level with respect to early and delayed cord clamping. Descriptive statistics were calculated. P-value = 0.05 was taken as significant. Results: the total of 342 pregnant women selected for this study, divided into 2 groups depending upon early (gp-1) or late clamping(gp-2). The mean haemoglobin in group 1 was 13.2 mg/dl and in group 2 was 13.4 mg/dl. Mean haematocrit in group 1 was 40.8 % and in group 2 were 41.3 %. (P-value=0.03). Polycythemia in group 1 was found to be present in 5 (2.92%) neonates while in group 2, 19 (11.11 %) neonates had polycythemia (p-value=0.003). High bilirubin in group 1 was present in 7 (4.09 %) of neonates while 33 (19.30 %) neonates in group 2 had high bilirubin.(p-value=0.001) Conclusion: Our study showed that neonates with late clamping had lower incidence of anaemia, higher haematocrit as compared to early clamping but were prone to a higher levels of bilirubin as well as polycythemia. Significant variations for haematocrit, polycythemia and bilirubin were found

scholarly journals Coverage of the WHO’s four essential elements of newborn care and their association with neonatal survival in southern Nepal

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Emily Bryce ◽  
Luke C. Mullany ◽  
Subarna K. Khatry ◽  
James M. Tielsch ◽  
Steven C. LeClerq ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Newborn Care ◽  
Newborn Health ◽  
Essential Elements ◽  
Delayed Cord Clamping ◽  
Skin Contact ◽  
Cord Clamping ◽  
Risk Of Mortality ◽  
Skin To Skin ◽  
Initiation Of Breastfeeding

Abstract Background Despite recent improvements in child survival, neonatal mortality continues to decline at a slower rate and now represents 47% of under-five deaths globally. The World Health Organization developed core indicators to better monitor the quality of maternal and newborn health services. One such indicator for newborn health is “the proportion of newborns who received all four elements of essential care”. The four elements are immediate and thorough drying, skin to skin contact, delayed cord clamping, and early initiation of breastfeeding. Although there is existing evidence demonstrating an association with decreased neonatal mortality for each element individually, the cumulative impact has not yet been examined. Methods This analysis uses data from a randomized trial to examine the impact of sunflower versus mustard seed oil massage on neonatal mortality and morbidity in the Sarlahi district in Southern Nepal from 2010 to 2017. The proportion of newborn infants receiving an intervention was the exposure and neonatal mortality was the outcome in this analysis. Neonatal mortality was defined as a death between three hours and less than 28 days of age. Associations between neonatal mortality and the essential elements were estimated by Cox proportion hazards models. The hazard ratios and corresponding 95% confidence intervals were reported. Results 28,121 mother-infant pairs and 753 neonatal deaths were included. The percent receiving the individual elements ranged from 19.5% (skin to skin contact) to 68.2% (delayed cord clamping). The majority of infants received one or two of the elements of essential care, with less than 1% receiving all four. Skin to skin contact and early initiation of breastfeeding were associated with lower risk of neonatal mortality (aHR = 0.64 [0.51, 0.81] and aHR = 0.72 [0.60, 0.87], respectively). The risk of mortality declined as the number of elements received increased; receipt of one element compared to zero was associated with a nearly 50% reduction in risk of mortality and receipt of all four elements resulted in a 72% decrease in risk of mortality. Conclusions The receipt of one or more of the four essential elements of newborn care was associated with improved neonatal survival. The more elements of care received, the more survival improved.

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