scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman

2020 ◽  
Author(s):  
Sam Schoenmakers ◽  
Pauline Snijder ◽  
Robert M Verdijk ◽  
Thijs Kuiken ◽  
Sylvia S M Kamphuis ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Vertical Transmission ◽  
Neonatal Intensive Care ◽  
Quantitative Polymerase Chain Reaction ◽  
Antigen Expression ◽  
Fetal Distress ◽  
Adverse Outcomes ◽  
Placental Infection ◽  
Emergency Cesarean ◽  
Increased Risk

Abstract Background In general, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is not considered to be an increased risk for severe maternal outcomes but has been associated with an increased risk for fetal distress. Maternal-fetal transmission of SARS-CoV-2 was initially deemed uncertain; however, recently a few cases of vertical transmission have been reported. The intrauterine mechanisms, besides direct vertical transmission, leading to the perinatal adverse outcomes are not well understood. Methods Multiple maternal, placental, and neonatal swabs were collected for the detection of SARS-CoV-2 using real-time quantitative polymerase chain reaction (RT-qPCR). Serology of immunoglobulins against SARS-CoV-2 was tested in maternal, umbilical cord, and neonatal blood. Placental examination included immunohistochemical investigation against SARS-CoV-2 antigen expression, with SARS-CoV-2 ribonucleic acid (RNA) in situ hybridization and transmission electron microscopy. Results RT-qPCRs of the oropharynx, maternal blood, vagina, placenta, and urine were all positive over a period of 6 days, while breast milk, feces, and all neonatal samples tested negative. Placental findings showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts. Conclusions Placental infection by SARS-CoV-2 leads to fibrin depositions hampering fetal-maternal gas exchange with resulting fetal distress necessitating a premature emergency cesarean section. Postpartum, the neonate showed a fetal or pediatric inflammatory multisystem-like syndrome with coronary artery ectasia temporarily associated with SARS-CoV-2 for which admittance and care on the neonatal intensive care unit (NICU) were required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current coronavirus disease 2019 pandemic, especially considering that the majority of pregnant women appear asymptomatic.

scholarly journals SARS-CoV-2 placental infection and inflammation leading to fetal distress and neonatal multi-organ failure in an asymptomatic woman

2020 ◽  
Author(s):  
Sam Schoenmakers ◽  
Pauline Snijder ◽  
Robert M. Verdijk ◽  
Thijs Kuiken ◽  
Sylvia S.M. Kamphuis ◽  
...  
Keyword(s):  
Viral Load ◽  
Neonatal Intensive Care ◽  
Antigen Expression ◽  
Fetal Distress ◽  
Maternal Blood ◽  
Adverse Outcomes ◽  
Pathological Examination ◽  
Median Viral Load ◽  
Placental Infection ◽  
Increased Risk

AbstractIntroductionIn general SARS-CoV-2-infection during pregnancy is not considered to be an increased risk for severe maternal outcomes, but has been associated with an increased risk for fetal distress. So far, there is no direct evidence of intrauterine vertical transmission and the mechanisms leading to the adverse outcomes are not well understoodResultsAn asymptomatic pregnant woman with preterm fetal distress during the COVID19 pandemic was included. We obtained multiple maternal, placental and neonatal swabs, which showed a median viral load in maternal blood, urine, oropharynx, fornix posterior over a period of 6 days was 5.0 log copies /mL. The maternal side of the placenta had a viral load of 4.42 log copies /mL, while the fetal side had 7.15 log copies /mL. Maternal breast milk, feces and all neonatal samples tested negative. Serology of immunoglobulins against SARS-CoV-2 was tested positive in maternal blood, but negative in umbilical cord and neonatal blood. Pathological examination of the placenta included immunohistochemical investigation against SARS-CoV-2 antigen expression in combination with SARS-CoV-2 RNA in situ hybridization and transmission electron microscopy. It showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts.DiscussionPlacental infection by SARS-CoV-2 lead to fibrin depositions hampering fetal-maternal gas exchange most likely resulted in fetal distress necessitating a premature emergency caesarean section. Postpartum, the neonate showed a clinical presentation resembling a pediatric inflammatory multisystem syndrome including coronary artery ectasia, most likely associated with SARS-CoV-2 (PIMS-TS) for which admittance and care on the Neonatal Intensive Care unit (NICU) was required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current COVID-19 pandemic, especially considering that the majority of pregnant women appear asymptomatic.

scholarly journals Maternal and neonatal response to COVID-19

2020 ◽  
Vol 319 (2) ◽  
pp. E315-E319 ◽  
Author(s):  
Thea N. Golden ◽  
Rebecca A. Simmons
Keyword(s):  
Preterm Birth ◽  
Severe Acute Respiratory Syndrome ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Placental Infection ◽  
Neonatal Response ◽  
Maternal Disease ◽  
Maternal And Newborn

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to maternal and newborn health has yet to be determined. Several reports suggest pregnancy does not typically increase the severity of maternal disease; however, cases of preeclampsia and preterm birth have been infrequently reported. Reports of placental infection and vertical transmission are rare. Interestingly, despite lack of SARS-CoV-2 placenta infection, there are several reports of significant abnormalities in placenta morphology. Continued research on pregnant women infected with SARS-CoV-2 and their offspring is vitally important.

scholarly journals Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report

2019 ◽  
Vol 41 (2) ◽  
pp. 67-69
Author(s):  
Uma Shrestha
Keyword(s):  
Perinatal Mortality ◽  
Elderly Women ◽  
Gestational Hypertension ◽  
Adverse Outcomes ◽  
Obstetric Outcomes ◽  
Labor Dystocia ◽  
Grand Multiparity ◽  
Emergency Cesarean ◽  
Increased Risk ◽  
Multiparous Women

Parity more than five is grand multiparty and more than 10 is great grand multiparity. Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparous women than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternal and prenatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage, maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is also independent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomes that have been associated with grand multiparity may actually be confounded by advanced age, less antenatal care and low socioeconomic level. Although pregnancy hypertension is more commonly seen among youngprimigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grandmultiparous women with moderate anemia who developed gestational hypertension and underwent emergency cesarean section resulting into normal maternal and fetal outcome.

IgG Subclasses and Congenital Transmission of Chagas Disease

2021 ◽  
Author(s):  
Cristian Roca ◽  
Edith S. Málaga-Machaca ◽  
Manuela R. Verastegui ◽  
Billy Scola ◽  
Edward Valencia-Ayala ◽  
...  
Keyword(s):  
Trypanosoma Cruzi ◽  
Chagas Disease ◽  
Vertical Transmission ◽  
Quantitative Polymerase Chain Reaction ◽  
Maternity Hospital ◽  
Igg Subclasses ◽  
Screening Tests ◽  
Congenital Transmission ◽  
Increased Risk ◽  
Previous Blood Transfusion

The mechanism of vertical transmission of Trypanosoma cruzi is poorly understood. In this study, we evaluated the role of IgG subclasses in the congenital transmission of Chagas disease. We conducted a case-control study in a public maternity hospital in Santa Cruz, Bolivia, enrolling women at delivery. Thirty women who transmitted T. cruzi to their newborns (cases), and 51 women who did not (controls) were randomly selected from 676 total seropositive women. Trypanosoma cruzi–specific IgG1, IgG2, and IgG3 levels were measured by in-house ELISA. The IgG4 levels were unmeasurable as a result of low levels in all participants. Quantitative polymerase chain reaction results and demographic factors were also analyzed. One-unit increases in normalized absorbance ratio of IgG1 or IgG2 levels increased the odds of congenital T. cruzi transmission in Chagas-seropositive women by 2.0 (95% CI: 1.1–3.6) and 2.27 (95% CI: 0.9–5.7), adjusted for age and previous blood transfusion. Odds of congenital transmission were 7.0 times higher in parasitemic mothers (95% CI: 2.3–21.3, P < 0.01) compared with nonparasitemic mothers. We observed that all mothers with IgG1 ≥ 4 were transmitters (sensitivity = 20%, specificity = 100%). Additionally, no mothers with IgG2 < 1.13 were transmitters (sensitivity = 100%, specificity = 21.6%). We demonstrated that IgG subclasses and parasite presence in blood are associated with vertical transmission of T. cruzi and could identify women at increased risk for congenital transmission by measuring IgG subclasses. These measures have potential as objective screening tests to predict the congenital transmission of Chagas.

An Evaluation to Establish the Acceptable Serum Triglyceride Levels in Neonates Receiving Intravenous Fat Emulsion Infusion in a Multicenter Retrospective Study

2020 ◽  
Author(s):  
Belinda Chan ◽  
Anh Lian ◽  
Vickie Baer ◽  
Mandy Robinson ◽  
Zhining Ou ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Serum Triglyceride ◽  
Adverse Outcomes ◽  
Neonatal Intensive Care Units ◽  
Reference Ranges ◽  
Univariable Analysis ◽  
Increased Risk ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
The Relationship

Abstract Objective This study aimed to establish neonatal serum triglyceride (TG) level reference ranges during lipid infusion and correlate peak TG with neonatal outcomes. Study Design This is a retrospective review of 356 neonates with 696 TG measures obtained in four neonatal intensive care units between 2015 and 2017. TG was evaluated collectively to establish a reference range and a threshold limit. To analyze the effects of a higher TG threshold, neonates were categorized by their peak TG: <180 (TG<180), 180 to 400 (TG180–400), and > 400 mg/dL (TG>400). Univariable and multivariable regression models were constructed to compare peak TG to patient characteristic and clinical outcomes. Results The frequency of TG > 400 mg/dL was 5% and found only in neonates weighing < 1.5 kg. Neonates in the TG180–400 (n = 91) group were significantly lower in birth weight and gestational age, had lower 5-minute APGAR scores, and had increased ventilatory requirement when compared with neonates in the TG<180 (n = 240) group (all p < 0.001). The TG180–400 group had increased risk of severe intraventricular hemorrhage (p = 0.02) and bronchopulmonary dysplasia (p = 0.03). Elevated TG was associated with mortality (odds ratio [OR]: 14.4, p < 0.001) in univariable analysis, but the relationship weakened (OR: 4.4, p = 0.05) after adjusting for comorbidities in multivariable logistic regression. Conclusion It is unclear if the adverse outcomes seen in neonates with higher peak TG were due to elevated TG alone, or whether illness severity predicted the increased TG. More prospective studies are needed to further delineate the relationships.

scholarly journals Clinical Analysis of Eleven Cases of Spontaneous Umbilical Cord Vascular Rupture During Pregnancy

2021 ◽  
Author(s):  
Jinying Luo ◽  
Jinfu Zhou ◽  
KeHua Huang ◽  
LiYing Li ◽  
JianYing Yan
Keyword(s):  
Amniotic Fluid ◽  
Umbilical Cord ◽  
Neonatal Intensive Care ◽  
Fetal Distress ◽  
Rapid Response Team ◽  
Clinical Analysis ◽  
Pathological Examination ◽  
Emergency Cesarean ◽  
Response Team

Abstract Background: Spontaneous umbilical cord vascular rupture is a rare but catastrophic event during pregnancy, and the perinatal mortality rate is extremely high. Live neonates may have severe asphyxia and require admission to the neonatal intensive care unit for many days. Methods: A retrospective review of the clinical data of eleven patients with spontaneous umbilical cord vascular rupture from 2012 to 2020, was undertaken at our hospital. Results: All patients were diagnosed by postpartum placental examination and pathological examination. The Obstetric Rapid Response Team performed emergency cesarean sections in fetal distress patients, and the time between detection of fetal heart abnormality and delivery was 5 to 13 minutes. Eight patients had bloodstained amniotic fluid and one had III° foul amniotic fluid. Six patients had the umbilical cord around their necks. Furthermore, pathological examination of postpartum placentas found four cases of intrauterine infection.Among the eight live neonates, one neonate died two days after birth due to severe complications and one had neonatal hyperbilirubinemia. No neurological sequelae, or other severe complications were found in the remaining seven neonates after three months of follow-up, and all of them had a positive prognosis.Conclusion: Spontaneous umbilical cord vascular rupture is a serious risk for perinatal birth life and obstetric complications. For this reason, obstetricians should be familiar with and pay attention to its risk factors.

scholarly journals A study of Maternal BMI as Determinant of Pregnancy & Perinatal Outcomes in Hazaribagh Medical College and Hospital, Hazaribagh.

2021 ◽  
Vol 7 (1) ◽  
pp. 13-20
Author(s):  
Dr. Snehlata Snehlata ◽  
◽  
Dr. Sweta Lal ◽  
Keyword(s):  
Maternal Nutrition ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Adverse Outcomes ◽  
Maternal Body Mass Index ◽  
Medical College ◽  
Pregnant Females ◽  
Increased Risk ◽  
Low Bmi ◽  
Maternal Bmi

Introduction: Maternal nutrition plays an important role in maternal and fetal outcomes. The lowmaternal BMI or Obesity are both associated with adverse outcomes. Objectives: To evaluate theimpact of the maternal body mass index on the pregnancy outcome and neonatal outcomes.Materials and Methods: This is a prospective cohort study in which a total of 200 patients meetingthe inclusion criteria were enrolled in the study after informed consent of which 100 patientsenrolled after 18 weeks of gestation had a low BMI and 100 patients with a higher BMI than normal.Results: Pregnant females having low BMI as baseline had more risk of IUGR, fetal distress and lowbirth weight in newborns while those having high maternal BMI had more incidence of PIH inmothers, oligohydramnios, increased birth weight, increased risk of LSCS and NICU admissions anddelayed maternal wound healing. Conclusion: The health of women, throughout their childbearingages, should be cared, to improve their obstetrical and perinatal outcomes. Also, the high-riskgroups should be managed properly.

scholarly journals The correlation between the cerebroplacental ratio and fetal arterial blood gas in appropriate-for-gestational-age fetuses: A cross-sectional study

2021 ◽  
pp. 821-826
Author(s):  
Ashraf Jamal ◽  
Vajiheh Marsoosi ◽  
Fatemeh Sarvestani ◽  
Neda Hashemi
Keyword(s):  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Fetal Distress ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Emergency Cesarean ◽  
Appropriate For Gestational Age ◽  
Adverse Pregnancy

Background: The cerebroplacental ratio (CPR) is an important index for predicting adverse pregnancy outcomes in small-for-gestational-age and appropriate-forgestational-age fetuses. Objective: To find out whether there is an association between the CPR level and the blood cord gases analysis in appropriate for gestational age fetuses. Materials and Methods: This cross-sectional study included 347 pregnant women at the gestational age of 37-40 wk. Patients had an appropriate-for-gestational-age fetus confirmed from their first ultrasonography results. Participants were divided into two groups based on their CPR, measured before delivery. Finally, after delivery, arterial blood gas level and the incidence of emergency cesarean section, intrapartum fetal distress and neonatal intensive care unit admissions were compared between the two groups. Results: Fifty-four (15.6%) cases had a CPR below the detection limit of the assay. The incidence of fetal distress, emergency cesarean section, neonatal hospitalization in the neonatal intensive care unit, and pH < 7.2 were significantly lower in women with CPR ≥ 0.67 multiples than in women with a CPR < 0.67 multiples of the median. Conclusion: The third-trimester CPR is an independent predictor of stillbirth and perinatal mortality and morbidity. The role of UA/MCA Doppler and the CPR in assessing the risk of adverse pregnancy outcomes should be evaluated prospectively. Key words: Umbilical cord blood, Color Doppler ultrasonography, Gestational age.

scholarly journals 32. Risk Factors for Vertical Transmission of t. Cruzi infection in an Endemic Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S17-S17
Author(s):  
Melissa D Klein ◽  
Freddy Tinajeros ◽  
Edith Malaga ◽  
Manuela Verástegui ◽  
Beth J Condori ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cesarean Delivery ◽  
Chagas Disease ◽  
Vertical Transmission ◽  
Quantitative Polymerase Chain Reaction ◽  
Diagnostic Testing ◽  
Rapid Test ◽  
Congenital Infection ◽  
Increased Risk ◽  
Cruzi Infection

Abstract Members of the Chagas Disease Working Group in Peru and Bolivia include Edith Hinojosa, Clariza Chavez, Jean Karla Velarde, Carla Chavarria, Victoria Serrudo, Roberto Araya, Alcides Buitron, Rita Mendieta, Holger Mayta, Maritza Calderon, Holger Mayta and Yagahira Castro. Background Vertical transmission of Trypanosoma cruzi infection accounts for a growing proportion of new cases of Chagas disease. Congenital infection is curable if treated promptly, but the majority of infected infants do not receive timely diagnosis or treatment. Better risk stratification is needed to predict which women are more likely to transmit the infection. Methods This study enrolled women who presented for delivery and their infants at the Percy Boland Women’s Hospital in Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease by rapid test. The infants of seropositive mothers underwent diagnostic testing with microscopy (“micromethod”) and quantitative polymerase chain reaction (qPCR) as newborns and at one- and nine-month follow-up. Mothers completed surveys about demographics and medical history. Results Among 5,828 enrolled women, 1,271 (21.8%) screened positive for Chagas disease. Of the 1,325 infants of seropositive mothers, 113 (8.5%) were diagnosed with congenital Chagas disease by microscopy or qPCR. Cesarean delivery was significantly associated with lower odds of vertical transmission (adjusted OR: 0.63, 95% CI: 0.41–0.98, p=0.040). Congenital infection was more common in twins (adjusted OR: 3.30, 95% CI: 1.97–5.54, p&lt; 0.001) and male infants (adjusted OR: 1.50, 95% CI: 1.01–1.22, p=0.045). Conclusion Our findings suggest that Cesarean delivery may be protective against vertical transmission of T. cruzi, while twins and male infants may have an increased risk. A better understanding of risk stratification for congenital Chagas disease may help improve regional initiatives to reduce disease burden. Disclosures All Authors: No reported disclosures

scholarly journals Cholestasis of pregnancy: effects on maternal and fetal outcome

2020 ◽  
Vol 9 (8) ◽  
pp. 3202
Author(s):  
Nazia Hassan ◽  
Rabia Khurshid ◽  
Mudasir Muzamil ◽  
Shameema Parveen
Keyword(s):  
Preterm Births ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Adverse Outcomes ◽  
Common Symptom ◽  
Gamma Glutamyl Transferase ◽  
Increased Risk ◽  
Glutamyl Transferase ◽  
The Impact ◽  
Cholestasis Of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) typically occurs in late pregnancy affecting 1.5-2% pregnancies. Limited data is available regarding its fetal and maternal implications. This study aims to assess the impact of ICP on maternal and fetal outcome.Methods: A total 200 patients with pruritus in later half of pregnancy were studied over a period of 18 months out of which 135 were diagnosed as ICP. Clinical and biochemical parameters like serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, and gamma glutamyl transferase was recorded. Maternal and fetal outcome was noted in the form of LSCS rate, preterm births, fetal distress and neonatal ICU admissions.Results: In this study, most common symptom was pruritus. Most of cases had onset of symptoms between 32-36 weeks. High LSCS rates were seen among cases. Intrapartum complications viz. meconium staining of amniotic fluid (57.8%), preterm delivery (11.9%), fetal distress (42.2%) were significantly higher in study population and there was high incidence of NICU admissions (49. 6% neonates) among cases mostly due to meconium aspiration and prematurity.Conclusions: ICP increases maternal morbidity and is associated with adverse perinatal outcome viz. increased risk of fetal distress, preterm births and sudden IUD at term as evidenced in this study. A timely intervention at 37-38 weeks will reduce the adverse outcomes.

Sign in / Sign up

Export Citation Format

Share Document