Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Miha Lucovnik ◽  
Mirjam Druskovic ◽  
Marijana Vidmar Simic ◽  
Ivan Verdenik ◽  
Vita Mesaric ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Critically Ill ◽  
Maternal Death ◽  
Reference Group ◽  
Close Contact ◽  
Perinatal Outcomes ◽  
Linear Regression Models ◽  
Third Trimester ◽  
Adverse Perinatal Outcomes ◽  
Log Linear

Abstract Objectives To compare perinatal outcomes in women with vs. without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Perinatal outcomes in SARS-CoV-2 positive pregnant women who delivered at our institution between October 27th 2020 and January 31st 2021 were compared to SARS-CoV-2 negative pregnancies (contemporary controls) and historical 2019 controls matched by maternal age, pre-pregnancy body mass index and parity. Testing was performed based on symptoms or close contact at any time during pregnancy and as part of universal screening at hospital admission. Multivariable log-linear regression models were used adjusting for potential confounders (p < 0.05 statistically significant). Results One thousand three hundred seventeen women delivered at our institution during the study period. 1,124 (85%) tested negative and 193 (15%) positive for SARS-CoV-2. 189 (98%) were infected during third trimester. 19 (10%) were asymptomatic, 171 (89%) had mild to moderate coronavirus disease 2019 (COVID-19), and 3 (2%) were critically ill with one case of maternal death. There were no significant differences in preterm birth, small-for-gestational-age birth weight, congenital anomalies, operative delivery, intrapartum hypoxia, and perinatal mortality in SARS-CoV-2 positive pregnancies compared to contemporary reference group or historical controls from pre-COVID-19 period. Labor was more commonly induced in SARS-CoV-2 positive women compared to reference SARS-CoV-2 negative group (68 [35%] vs. 278 [25%], adjusted odds ratio 1.62; 95% confidence interval 1.14–2.28). Conclusions SARS-CoV-2 infection in pregnancy was not strongly associated with adverse perinatal outcomes. While the majority of SARS-CoV-2 positive women had no or mild/moderate symptoms, 2% were critically ill, with one case of maternal death.

High-Grade Fetal Vascular Malperfusion Is Associated With Diffuse Chorionic Hemosiderosis

2021 ◽  
pp. 109352662110646
Author(s):  
Eoghan E. Mooney ◽  
Emma Crotty
Keyword(s):  
Perinatal Outcomes ◽  
Low Grade ◽  
High Grade ◽  
Third Trimester ◽  
The Third ◽  
Term Delivery ◽  
Venous Bleeding ◽  
Placental Membranes ◽  
Adverse Perinatal Outcomes ◽  
Cord Length

Introduction Diffuse chorionic hemosiderosis (DCH) is an abnormality of the placental membranes characterized by the deposition of iron pigment. It is usually secondary to recurrent venous bleeding in early pregnancy. In many papers, it is associated with pre-term delivery. Fetal vascular malperfusion (FVM) is an abnormality of the feto-placental circulation that may be seen at any stage of gestation, but most often in the third trimester. It may be graded as low grade (LGFVM) or high grade (HGFVM). No link has been identified in the placental literature between DCH and FVM, but we have noted the 2 co-existing in placentas submitted for analysis. This study explored a possible association of these 2 entities. Methods Laboratory records were searched for singleton cases coded as DCH based on diagnosis on H&E stain over a 6-year period. Of 4478 placentas reported, 66 cases were coded as DCH (1.5%). These were classified as showing HGFVM, LGFVM, or no FVM. Controls (n = 132) were gestational age-matched cases without DCH. Cord length, coiling, insertion, or other abnormalities were noted. Membranes were classified as normal or circumvallate. Results were analyzed using Graphpad. Results Gestation ranged between 16 and 41 weeks gestation. 14/66 (21%) cases of DCH showed HGFVM and 2/66 (3%) showed LGFVM. 16/132 (12%) controls showed HGFVM and 21/132 (15.9%) had LGFVM. Where FVM is present, high-grade FVM is significantly associated with DCH versus controls ( P < .0031 Fischer’s Test). Discussion HGFVM occurs significantly more often in placentas with DCH than in controls. Both FVM and DCH are associated with adverse perinatal outcomes, and a possible relationship between the 2 remains to be clarified.

scholarly journals Perinatal Adverse Effects in Newborns with Estimated Loss of Weight Percentile between the Third Trimester Ultrasound and Delivery. The GROWIN Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4643
Author(s):  
María Sonsoles Galán Arévalo ◽  
Ignacio Mahillo-Fernández ◽  
Luis Mariano Esteban ◽  
Mercedes Andeyro-García ◽  
Roi Piñeiro Pérez ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Late Gestation ◽  
Third Trimester ◽  
Loss Of Weight ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Adverse Perinatal Outcomes ◽  
Weight Percentile

Fetal growth restriction has been associated with an increased risk of adverse perinatal outcomes (APOs). We determined the importance of fetal growth detention (FGD) in late gestation for the occurrence of APOs in small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. For this purpose, we analyzed a retrospective cohort study of 1067 singleton pregnancies. The newborns with higher APOs were SGA non-FGD and SGA FGD in 40.9% and 31.5% of cases, respectively, and we found an association between SGA non-FGD and any APO (OR 2.61; 95% CI: 1.35–4.99; p = 0.004). We did not find an increased APO risk in AGA FGD newborns (OR: 1.13, 95% CI: 0.80, 1.59; p = 0.483), except for cesarean delivery for non-reassuring fetal status (NRFS) with a decrease in percentile cutoff greater than 40 (RR: 2.41, 95% CI: 1.11–5.21) and 50 (RR: 2.93, 95% CI: 1.14–7.54). Conclusions: Newborns with the highest probability of APOs are SGA non-FGDs. AGA FGD newborns do not have a higher incidence of APOs than AGA non-FGDs, although with falls in percentile cutoff over 40, they have an increased risk of cesarean section due to NRFS. Further studies are warranted to detect these newborns who would benefit from close surveillance in late gestation and at delivery.

scholarly journals Gambaran Faktor Risiko pada Wanita Hamil Trimester 3 yang Terkonfirmasi Positif SARS-CoV-2

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Aurelia S. Posumah ◽  
Mayer F. Wowor ◽  
Glady I. Rambert
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Severe Acute Respiratory Syndrome ◽  
Pregnant Women ◽  
Close Contact ◽  
Secondary Data ◽  
Third Trimester ◽  
Travel History ◽  
The Third ◽  
Diabetes Melitus

Abstract: Coronavirus Disease 2019 (COVID-19) a infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There are several groups that are susceptible to infection with SARS-CoV-2, one of which is pregnant women. This can be attributed to changes in the physiology and immune system that occur in pregnant women. This study aimed to determine the most risk factors that cause pregnant women in Prof. Dr. R. D. Kandou was infected with SARS-CoV-2. This type of research is descriptive with a retrospective approach, using secondary data in the form of data from the patient's medical record status. From 5 patients studied, there were 4 patients with risk factors for hypertension (80%) and 1 patient with close contact risk factors (20%), but other risk factors such as diabetes mellitus, travel history in transmission areas, obesity and smoking are not found. In conclusion, from 5 patients studied, the most risk factor that causes pregnant women in the third trimester to be infected with SARS-CoV-2 is hypertension (80%).Keywords: 3rd trimester pregnant women, SARS-CoV-2, risk factor  Abstrak: Coronavirus Disease 2019 (COVID-19) penyakit menular yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Terdapat beberapa kelompok yang rentan terinfeksi SARS-CoV-2, salah satunya wanita hamil. Hal ini dapat dikaitkan dengan perubahan fisiologi dan sistem imunitas tubuh yang terjadi pada wanita hamil. Tujuan penelitian ini untuk mengetahui faktor risiko terbanyak yang menyebabkan wanita hamil di RSUP Prof. Dr. R. D. Kandou terinfeksi SARS-CoV-2. Jenis penelitian yang digunakan bersifat deskriptif dengan pendekatan retrospektif, yaitu menggunakan data sekunder berupa data dari status rekam medik pasien. Dari 5 pasien yang diteliti, didapatkan 4 pasien dengan faktor risiko hipertensi (80%) dan 1 pasien dengan faktor risiko kontak erat (20%), namun pada faktor risiko lain seperti diabetes melitus, riwayat perjalanan di daerah transmisi, obesitas dan merokok tidak ditemukan. Sebagai simpulan, dari 5 pasien yang diteliti, faktor risiko terbanyak yang menyebabkan wanita hamil trimester 3 terinfeksi SARS-CoV-2 adalah hipertensi (80%).Kata Kunci: wanita hamil trimester 3, SARS-CoV-2, faktor risiko

Prenatal ultrasonographic markers for prediction of complex gastroschisis and adverse perinatal outcomes: a systematic review and meta-analysis

2021 ◽  
pp. fetalneonatal-2021-322612
Author(s):  
Raphael C Sun ◽  
Kamran Hessami ◽  
Eyal Krispin ◽  
Mohan Pammi ◽  
Shayan Mostafaei ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Length Of Hospital Stay ◽  
Abdominal Circumference ◽  
Second Trimester ◽  
Third Trimester ◽  
Not Otherwise Specified ◽  
Postnatal Mortality ◽  
Adverse Perinatal Outcomes ◽  
Full Enteral Feeding

ObjectiveWe sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal circumference that predict complex gastroschisis and adverse perinatal outcomesData sourcesPubMed, Web of Science, Scopus and Embase were searched for relevant articles up to December 2020. Studies reporting prenatal ultrasonographic markers including intra-abdominal bowel dilation (IABD), extra-abdominal bowel dilation (EABD), bowel wall thickness, polyhydramnios, abdominal circumference <5th percentile, gastric dilation (GD) and bowel dilation not otherwise specified (BD-NOS) were included. The primary outcome was prediction of complex gastroschisis; secondary outcomes were length of hospital stay for newborn, time to full enteral feeding, postnatal mortality rate, incidence of necrotising enterocolitis and short bowel syndrome.ResultsThirty-six studies were included in this meta-analysis. We found significant associations between complex gastroschisis and IABD (OR=5.42; 95% CI 3.24 to 9.06), EABD (OR=2.27; 95% CI 1.40 to 3.66), BD-NOS (OR=6.27; 95% CI 1.97 to 19.97), GD (OR=1.88; 95% CI 1.22 to 2.92) and polyhydramnios (OR=6.93; 95% CI 3.39 to 14.18). Second trimester IABD and EABD have greater specificity for the prediction of complex gastroschisis than third trimester values with specificity of 95.6% (95% CI 58.1 to 99.7) and 94.6% (95% CI 86.7 to 97.9) for the second trimester IABD and EABD, respectively.ConclusionPrenatal ultrasonographic markers, especially the second trimester IABD and EABD, can identify fetuses that develop complex gastroschisis. Furthermore, these specific ultrasonographic markers can identify those babies at the highest risk for severe complications of this congenital anomaly and hence selected for future antenatal interventions.

scholarly journals Placental pathology in COVID-19

2020 ◽  
Author(s):  
Elisheva D Shanes ◽  
Leena B Mithal ◽  
Sebastian Otero ◽  
Hooman A Azad ◽  
Emily S Miller ◽  
...  
Keyword(s):  
Perinatal Outcomes ◽  
Third Trimester ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
History Of ◽  
Retroplacental Hematoma ◽  
Adverse Perinatal Outcomes ◽  
Acute And Chronic Inflammation ◽  
Histopathologic Findings ◽  
Historical Controls

Objectives: To describe histopathologic findings in the placentas of women with COVID-19 during pregnancy. Methods: Pregnant women with COVID-19 delivering between March 18, 2020 and May 5, 2020 were identified. Placentas were examined and compared to historical controls and women with placental evaluation for a history of melanoma. Results: 16 placentas from patients with SARS-CoV-2 were examined (15 with live birth in the 3rd trimester 1 delivered in the 2nd trimester after intrauterine fetal demise). Compared to controls, third trimester placentas were significantly more likely to show at least one feature of maternal vascular malperfusion (MVM), including abnormal or injured maternal vessels, as well as delayed villous maturation, chorangiosis, and intervillous thrombi. Rates of acute and chronic inflammation were not increased. The placenta from the patient with intrauterine fetal demise showed villous edema and a retroplacental hematoma. Conclusions: Relative to controls, COVID-19 placentas show increased prevalence of features of maternal vascular malperfusion (MVM), a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.

scholarly journals A Comparison of Prediction of Adverse Perinatal Outcomes between Hadlock and INTERGROWTH-21st Standards at the Third Trimester

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Chen Zhu ◽  
Yun-Yun Ren ◽  
Jiang-Nan Wu ◽  
Qiong-Jie Zhou
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Perinatal Outcomes ◽  
Third Trimester ◽  
Clinical Value ◽  
Cutoff Value ◽  
The Third ◽  
Increased Risk ◽  
Adverse Perinatal Outcomes

Little is known about the clinical value of the Hadlock and INTERGROWTH-21st EFW standards for predicting adverse perinatal outcomes (APOs) in the third trimester. The purpose of this study was to study the association between low estimated fetal weight percentile (EFWc) in the third trimester and the risk of APOs and compare predictions of APOs between Hadlock and INTERGROWTH-21st EFW standards. A prospective cohort of 690 singleton pregnancies with ultrasonography performed in the third trimester between March 2015 and March 2016 in China was conducted. EFW and the corresponding EFWc were measured using the Hadlock and INTERGROWTH-21st standards, respectively. Cox proportional hazard models were used to assess the relationship between low EFWc (i.e., <5 percentile, P5) and the risk of APOs. Compared with fetuses with ≥P5 of the EFWc, fetuses with <P5 of the EFWc were much more likely to have an APO, with adjusted hazard ratios of 35.0 (95% confidence interval, 13.9-88.5) and 17.5 (7.7-39.6) for the Hadlock and INTERGROWTH standards, respectively. The Hadlock-EFWc had a higher predictive accuracy for APOs than the INTERGROWTH-EFWc, with area under the receiver operating characteristic curve of 0.94 (0.92-0.95) and 0.90 (0.87-0.92), respectively (P=0.007). The cutoff value for the INTERGROWTH-EFWc was percentile 11.61 with a sensitivity and specificity of 87.9% and 80.5%, respectively. For the Hadlock-EFWc, the corresponding sensitivity and specificity were 93.9% and 81.2%, with a cutoff value of percentile 8.65. Fetuses with low EFWc (i.e., <P5) were associated with an increased risk of APOs. APOs were more accurately predicted when EFWc was measured by the Hadlock standard than by the INTERGROWTH-21st standard.

scholarly journals Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial

BMJ ◽  
2019 ◽  
pp. l5517 ◽  
Author(s):  
Jens Henrichs ◽  
Viki Verfaille ◽  
Petra Jellema ◽  
Laura Viester ◽  
Eva Pajkrt ◽  
...  
Keyword(s):  
Usual Care ◽  
Randomised Trial ◽  
Intervention Strategy ◽  
Perinatal Outcomes ◽  
Low Risk ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Third Trimester ◽  
The Third ◽  
Adverse Perinatal Outcomes

AbstractObjectivesTo investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions.DesignPragmatic, multicentre, stepped wedge cluster randomised trial.Setting60 midwifery practices in the Netherlands.Participants13 046 women aged 16 years or older with a low risk singleton pregnancy.Interventions60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks’ gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies.Main outcome measuresThe primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth.ResultsBetween 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P<0.001). The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). The intervention strategy showed a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). Maternal outcomes and other obstetric interventions did not differ between the strategies.ConclusionIn low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies.Trial registrationNetherlands Trial Register NTR4367.

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