Severe Acute Respiratory Syndrome by COVID-19 in pregnant and postpartum women

Abstract Objectives: to evaluate the morbidity and mortality profile and factors associated with death due to severe acute respiratory syndrome (SARS) by COVID-19 in pregnant and postpartum women. Methods: this is a quantitative and retrospective research that analyzed the SIVEP-gripe Database (Influenza Epidemiological Surveillance Information System), from 01/01/2020 to 04/01/2021. All pregnant women and postpartum women diagnosed with SARS caused by COVID-19 in the State of Minas Gerais were included. After the descriptive analysis of the hospitalizations profile, the association between different exposure variables and the occurrence of death was evaluated. Results: of the 227 records obtained, 94.3% required hospitalization. Among hospitalizations in the Intensive Care Unit, 29.8% used invasive ventilatory support. Fifteen deaths were recorded. The most frequent clinical manifestations were: cough and fever; the predominant comorbidities were cardiovascular disease and diabetes mellitus. The variables “ICU stay”, “use of ventilatory support” and “heart disease” were associated with the occurrence of deaths. Conclusions: hospitalization was necessary for most pregnant women with SARS and the presence of previous heart disease increased the risk of death. Knowing the SARS morbidity and mortality profile is important in the definition of public health strategies aimed at reducing the impacts of COVID-19 during pregnancy and the puerperium.

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Factors associated with death among postpartum women with COVID-19: a Brazilian population-based study

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.5446.3507 ◽

2021 ◽

Vol 29 ◽

Author(s):

Anelise de Toledo Bonatti ◽

Nathassia Miller ◽

Maria Antonieta de Barros Leite Carvalhaes ◽

Rodrigo Jensen ◽

Cristina Maria Garcia de Lima Parada

Keyword(s):

Intensive Care ◽

Ventilatory Support ◽

Signs And Symptoms ◽

Population Based ◽

Epidemiological Surveillance ◽

Postpartum Women ◽

Cross Sectional ◽

Population Based Study ◽

Factors Associated ◽

Respiratory Signs And Symptoms

Objective: to identify the factors associated with death due to COVID-19 among Brazilian postpartum women in the first five months of the pandemic and five subsequent months, and describe the sociodemographic and clinical characteristics of postpartum women who developed the disease. Method: cross-sectional population-based study using a secondary database available in the Sistema de Informação de Vigilância Epidemiológica da Gripe -SIVEP-Gripe (Influenza Epidemiological Surveillance Information System), Brazilian Ministry of Health. A total of 869 postpartum women were included, and the analysis considered the first five months of the pandemic and subsequent five months. Association between the variables of interest and outcome (death due to COVID-19/cure) was investigated using logistic regression. Results: most participants were aged between 20 and 34, of mixed race or Caucasian, and lived in the urban/peri-urban area. The proportion of deaths was 20.2% in the first period and 11.2% in the second. The likelihood of death increased in both periods due to the presence of respiratory signs and symptoms: dyspnea, respiratory distress, and oxygen saturation below 95%, in addition to the need for ventilatory support and intensive care. Conclusion: the proportion of deaths among postpartum women was high and decreased in the second period under study. Respiratory signs and symptoms, mechanical ventilation, and intensive care were associated with death in both periods.

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Mortality and morbidity in patients with congenital heart disease hospitalised for viral pneumonia

Heart ◽

10.1136/heartjnl-2020-317706 ◽

2020 ◽

pp. heartjnl-2020-317706

Author(s):

Gerhard-Paul Diller ◽

Dominic Enders ◽

Astrid E Lammers ◽

Stefan Orwat ◽

Renate Schmidt ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Hospital Admission ◽

Congenital Heart ◽

Viral Pneumonia ◽

Morbidity And Mortality ◽

Risk Of Death ◽

Extracorporeal Lung Support ◽

Cardiac Medication

ObjectivesData on the clinical outcome of patients with congenital heart disease (CHD) affected by severe viral pneumonia are limited. We analysed morbidity and mortality of viral pneumonia and evaluated the association between medical conditions, medication, vaccination and outcome specifically in patients with CHD requiring hospitalisation for viral pneumonia.MethodsBased on data from one of Germany’s largest health insurers, all cases of viral pneumonia requiring hospital admission (2005–2018) were studied. Mortality, and composites of death, transplantation, mechanical circulatory support, ventilation or extracorporeal lung support served as endpoints.ResultsOverall, 26 262 viral pneumonia cases occurred in 24 980 patients. Of these, 1180 cases occurred in patients with CHD. Compared with patients without CHD, mortality rate was elevated in patients with CHD. As a group, patients with CHD aged 20–59 years even exceeded mortality rates in patients without CHD aged >60 years. No mortality was observed in patients with CHD with simple defects <60 years of age without associated cardiovascular risk factors. On multivariable logistic regression analysis, age, CHD complexity, chromosomal anomalies, cardiac medication, use of immunosuppressants and absence of vaccination for influenza emerged as risk factors of adverse outcome.ConclusionsWe present timely data on morbidity and mortality of severe viral pneumonia requiring hospital admission in patients with CHD. Need for mechanical ventilation and risk of death in CHD increase early in life, reaching a level equivalent to non-CHD individuals >60 years of age. Our data suggest that except for patients with isolated simple defects, patients with CHD should be considered higher-risk individuals when faced with severe viral pneumonia.

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Analysis of the Factors That Influence the Clinical Outcome of Severe Acute Respiratory Syndrome Caused by SARS-CoV-2 in Pregnant Women

10.5772/intechopen.99915 ◽

2021 ◽

Author(s):

Yuri de Sousa Cavalcante ◽

Nicolly Castelo Branco Chaves ◽

Jorge Lucas de Sousa Moreira ◽

Samuel de Sá Barreto Lima ◽

Maryana Martins de Freitas ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Clinical Outcome ◽

Pregnant Women ◽

Age Groups ◽

Morbidity And Mortality ◽

Mortality Data ◽

Second Trimester ◽

Significance Level ◽

Significant Difference ◽

Before And After

Introduction: The new coronavirus (SARS-CoV-2) pandemic has shown to cause even more severe problems among pregnant women, increasing the incidence of complications before and after childbirth, especially cardiorespiratory problems, such as the Severe Acute Respiratory Syndrome (SARS). Objectives: To describe the clinical outcome of SARS caused by SARS-CoV-2 in Brazilian pregnant women and to compare the rates of morbidity and mortality from other causes in this group, stratified by the following variables: gestational age and age group. Methodology: Observational, analytical study based on documents whose data were collected from the 2020 Epidemiological Report No. 40 in the database of the Brazilian Department of Health, from which morbidity and mortality data were extracted to calculate the lethality rate and compare rates using a binomial test with a significance level of 0.05. Results: Of the total number of pregnant women hospitalized for SARS, 4,467 (46.6%) were confirmed for COVID-19 and, of these, 233 died, corresponding to a lethality rate of 5.2%. Morbidity was higher in the third trimester of pregnancy, but the disease was more severe in the second trimester (7%), being worse in women aged 40 years and older (40–49; 8.7% and 50–59; 15.3%). A significant difference was observed in the rate of cases between the COVID-19 SARS group and the group with other causes in all gestational strata and age groups. As for deaths, a significant difference was found in the rates between the first and third trimesters, and in pregnant women aged 10 to 19 years. Conclusion: Considering the variables under analysis, evidence shows that pregnant women at an advanced age and in the second trimester of pregnancy contribute to the lethal outcome of the disease. Other variables associated with the presence of comorbidities and quality of care for pregnant women should be considered in the model in future studies.

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FETOMATERNAL OUTCOME IN PREGNANCY WITH CARDIAC DISEASE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i7.2007 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Kalyani K Bafna ◽

Kanaklata Nakum ◽

Aditi Vithal

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Cardiac Disease ◽

Maternal Morbidity ◽

Nyha Class ◽

Mode Of Delivery ◽

Fetal Outcome ◽

Morbidity And Mortality ◽

Maternal Complications ◽

Maternal Morbidity And Mortality

Objective(S): Cardiac disease is an important cause of maternal morbidity and mortality in both antepartum as well as in postpartum period. Incidence of heart disease with pregnancy is <1%. Aim of this study is to determine maternal complications with heart disease, mode of delivery & fetal complications. Materials & Methodology: This is a retrospective study conducted at Gopinath Maternity Home, Sir-T Hospital, Bhavnagar. From May 2020- April 2021. All pregnant women with various cardiac disease (previously established or diagnosed during pregnancy) who came to labor room or OPD are included. Result: 30 pregnant women out of 2683 deliveries were identified with cardiac disease giving prevalence of 1.12% in this study. 15(50%) women belonging to NYHA class-1 & 8(26.6%) belonged to NYHA class 2. Class 3(3 patients =10%) & class 4(4patients= 13.3%) were admitted immediately. 18(60%) women were case of valvular heart disease, out of which 12(66.6%) cases were of RHD, 2(11.1%) were MS, 3(16.6%) AS, 1(5.5%) MR. 10(33.33%) cases were congenital heart disease. Maternal mortality were 4(13.33%). Out of 30 cases, 18(69.2%) women had LSCS, 6(23.07%) had vaginal delivery,2(7.7%) had vaccum & 3(10.3%) had abortion. Out of 26 deliveries 2(7.7%) were IUFD, 6(23.07%) Preterm, 7(26.9%) IUGR. Total there were 9(37.5%) NICU admissions. Conclusion: Prognosis of pregnancy with heart disease has improved but management of it is still a challenge for obstetricians. Pre-conceptional counseling plays an important role by benefiting women with severe heart disease and thus help in reducing maternal morbidity and mortality. Keywords: cardiac disease, maternal outcome, fetal outcome

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Structural Heart Diseases during Pregnancy: Part 1—Valvular Heart Diseases

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1676549 ◽

2018 ◽

Vol 03 (02/03) ◽

pp. 108-114

Author(s):

Amar Patnaik

Keyword(s):

Heart Disease ◽

Pregnant Woman ◽

Pregnant Women ◽

Valvular Heart Disease ◽

Heart Diseases ◽

Medical Science ◽

Morbidity And Mortality ◽

Team Approach ◽

Echocardiographic Evaluation ◽

Valvular Heart Diseases

AbstractIt is estimated that about 3% pregnancies can have cardiac disease. There is wide variation in the spectrum of heart diseases. Pregnant women in India and other developing countries continue to show high prevalence of rheumatic heart disease (RHD). Pre-conception counseling based on a good echocardiographic evaluation is the most cost-effective method to prevent morbidity and mortality due to valvular heart disease. With advances in medical science, many with valvular heart disease are living to adulthood and undergoing successful pregnancy. Symptoms of a pregnant woman with a valvular disease depend on the altered hemodynamics of the specific valvular lesion in combination with the physiologic changes inherent to the pregnancy itself. A good echocardiographic evaluation of all pregnant women on their first visit to an obstetrician’s office is an effective strategy to prevent morbidity and mortality from valvular heart diseases. In general, the regurgitant lesions are well tolerated during pregnancy and labor. Asymptomatic but significant valve lesions can be decompensated by many factors. Severely stenosed mitral and, sometimes, aortic valve may have to be balloon-dilated by trained experts in midterm taking due care to avoid excess radiation. Valve surgery is rarely performed in absence of any other safer option. A multidisciplinary team approach is required to manage a pregnant woman with significant cardiac lesion with high-risk features and patients having mechanical valves that require continuous anticoagulation.

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Pregnancy outcomes in women with heart disease at the Colonial War Memorial Hospital, Suva, Fiji.

Pacific Journal of Reproductive Health ◽

10.18313/pjrh.2016.910 ◽

2016 ◽

Vol 1 (4) ◽

Cited By ~ 1

Author(s):

Litia Narube ◽

James Fong ◽

Tom Parks ◽

Alec Joseph Ekeroma ◽

Ilisapeci Kubuabola

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Case Fatality ◽

Morbidity And Mortality ◽

Memorial Hospital ◽

Cardiac Lesion ◽

Heart Lesion ◽

Cardiac Lesions ◽

Rheumatic Heart ◽

In Pregnancy

<div>Background: Cardiac disease in pregnancy is the third most common cause of maternal mortality in Fiji. The aim of this study was to determine the characteristics of pregnant women with heart disease presenting to the Colonial War Memorial Hospital (CWMH).Method: A retrospective review of case notes of all pregnant women identified with heart disease who birthed in the hospital between January 2011 and December 2013 (36 months). Findings: Of the 24,844 livebirths in CWMH during the study period, 153 women, aged 15 to 43 years of age, were confirmed with a cardiac lesion, which gives a prevalence rate of 6.2 per 1,000 livebirths. Rheumatic heart disease was the commonest cardiac lesion (112, 90%) followed by congenital heart disease (6, 5%) and hypertensive cardiomyopathy (3, 2%). Most of the cardiac lesions (120, 73%) were detected during pregnancy.There was a higher rate of intervention, morbidity and mortality associated with a cardiac lesion. The rate of instrumental deliveries, caesarean sections and admissions to intensive care were 3.5, 1.5 and 44 times higher compared to pregnant women without a heart lesion. The case-fatality rate was 2.0%.Conclusion: Women with a cardiac lesion in pregnancy had more interventions, higher morbidity and mortality compared to women without a cardiac lesion. Early diagnosis and evaluation of cardiac function were essential for better maternal outcomes. All pregnant women should be screened with an echocardiogram to improve early detection of cardiac lesions. </div>

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Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-041868 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041868

Author(s):

Magnus Yap ◽

Luke Debenham ◽

Tania Kew ◽

Shaunak Rhiju Chatterjee ◽

John Allotey ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Social Media ◽

Pregnant Women ◽

Case Reports ◽

Clinical Manifestations ◽

Postpartum Women ◽

Mother To Child Transmission ◽

Child Transmission ◽

Mother To Child

IntroductionRapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic.Methods and analysisWe plan to undertake a living systematic review to assess the prevalence, clinical manifestations, risk factors, rates of maternal and perinatal complications, potential for mother-to-child transmission, accuracy of diagnostic tests and effectiveness of treatment for COVID-19 in pregnant and postpartum women (including after miscarriage or abortion). We will search Medline, Embase, WHO COVID-19 database, preprint servers, the China National Knowledge Infrastructure system and Wanfang databases from 1 December 2019. We will supplement our search with studies mapped by Cochrane Fertility and Gynaecology group, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), COVID-19 study repositories, reference lists and social media blogs. The search will be updated every week and not be restricted by language. We will include observational cohort (≥10 participants) and randomised studies reporting on prevalence of COVID-19 in pregnant and postpartum women, the rates of clinical manifestations and outcomes, risk factors in pregnant and postpartum women alone or in comparison with non-pregnant women with COVID-19 or pregnant women without COVID-19 and studies on tests and treatments for COVID-19. We will additionally include case reports and series with evidence on mother-to-child transmission of SARS-CoV-2 in utero, intrapartum or postpartum. We will appraise the quality of the included studies using appropriate tools to assess the risk of bias. At least two independent reviewers will undertake study selection, quality assessment and data extraction every 2 weeks. We will synthesise the findings using quantitative random effects meta-analysis and report OR or proportions with 95% CIs and prediction intervals. Case reports and series will be reported as qualitative narrative synthesis. Heterogeneity will be reported as I2 and τ2 statistics.Ethics and disseminationEthical approval is not required as this is a synthesis of primary data. Regular updates of the results will be published on a dedicated website (https://www.birmingham.ac.uk/research/who-collaborating-centre/pregcov/index.aspx) and disseminated through publications, social media and webinars.PROSPERO registration numberCRD42020178076.

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COVID-19 during pregnancy. Analytical inspection

Ukrainian journal of Perinatology and Pediatrics ◽

10.15574/pp.2021.85.74 ◽

2021 ◽

pp. 74-80

Author(s):

G.I. Ischenko ◽

Keyword(s):

Pregnant Women ◽

Pregnancy Complications ◽

Vascular Dysfunction ◽

Clinical Manifestations ◽

Morbidity And Mortality ◽

Pharmacologic Therapy ◽

Target Cells ◽

Pathophysiological Mechanism ◽

Pregnancy And Lactation ◽

High Level

The cause of the current pandemic was the rapid spread of the coronavirus SARS-CoV-2 and the development of respiratory syndrome with significant morbidity and mortality. Pregnant women have the higher risk of morbidity and mortality than non-pregnant women. Pregnancy is the vulnerable condition that may contribute to a higher risk of infection due to the change in physiology during gestation. Physiologic, metabolic, and vascular changes in normal and high-risk pregnancies may affect risks for severe acute respiratory syndrome SARS-CoV-2 infection. The pathogenesis of COVID-19 during pregnancy explains the functioning of the renin-angiotensin-aldosterone system. SARS-CoV-2 uses angiotensin-converting enzyme-2 receptors to enter target cells. Its regulation during pregnancy may increase the risk of respiratory syndrome with COVID-19. The virus, by binding to receptors, causes decreasing its regulation and can lead to increasing angiotensin II, relative to angiotensin 1, 7, which is manifested by vasoconstriction and vascular dysfunction in preeclampsia. Coronavirus disease and preeclampsia have partially the same pathophysiological mechanism, which includes endothelial dysfunction and coagulation disorders. There is systemic inflammation or microcirculation disorders, which is characterized by vasoconstriction and ischemia, hypercoagulation. Thus, abnormalities that are characteristic of COVID-19 infection are similar to those that occur with preeclampsia during pregnancy. In addition, the known pathological mechanism of COVID-19 is an excessive anti-inflammatory response called the cytokine storm. The immune response is sufficiently altered during pregnancy, which can significantly alter the laboratory and clinical manifestations of COVID-19 during pregnancy. Therefore, the combination of these conditions can potentially lead to vascular damage. Currently, there are very limited data on the course, clinic and consequences of infection during pregnancy. This literature review combines various high-level studies that indicate higher rates of preeclampsia and other complications associated with pregnancy and SARS-CoV-2 infection. Studies to date have reported higher risks of pregnancy complications, including preterm birth and preeclampsia, as well as higher rates of cesarean delivery. For the fetus were recorded isolated cases of stillbirth, which was less than <1%. Accordingly, this signals needs to increase attention to the course of infection during pregnancy, and the optimal treatment of COVID-19, as well as prevention strategies during pregnancy. Pharmacologic therapy is limited to medications with proven safety during pregnancy and lactation. No conflict of interest was declared by the authors. Key words: COVID-19, pregnancy, newborns, pregnancy complications.

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COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women: a population study

10.1101/2021.07.27.21261163 ◽

2021 ◽

Author(s):

Fabiano Elisei Serra ◽

Rossana Pulcineli Vieira Francisco ◽

Patricia de Rossi ◽

Maria de Lourdes Brizot ◽

Agatha Sacramento Rodrigues

Keyword(s):

Pregnant Women ◽

Disease Progression ◽

Clinical Characteristics ◽

Demographic Data ◽

Ventilatory Support ◽

Epidemiological Data ◽

The Other ◽

Reproductive Age ◽

Epidemiological Surveillance ◽

Reproductive Age Women

Objective To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. Methods A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020, to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. Results As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities. Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other. Pregnant women, however, had a higher frequency of cough, anosmia, and ageusia. Puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death. Conclusion Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.

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COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women

PLoS ONE ◽

10.1371/journal.pone.0259911 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259911

Author(s):

Fabiano Elisei Serra ◽

Rossana Pulcineli Vieira Francisco ◽

Patricia de Rossi ◽

Maria de Lourdes Brizot ◽

Agatha Sacramento Rodrigues

Keyword(s):

Pregnant Women ◽

Disease Progression ◽

Clinical Characteristics ◽

Demographic Data ◽

Ventilatory Support ◽

Epidemiological Data ◽

The Other ◽

Reproductive Age ◽

Epidemiological Surveillance ◽

Reproductive Age Women

Objective To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. Methods A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. Results As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p<0.0001). Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other (72.1%, 69.7% and 88.8%, respectively). Pregnant women, however, had a higher frequency of anosmia, and ageusia than the others. After PSM, puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death, with OR (95% CI) 1.97 (1.55 – 2.50), 2.71 (1.78 – 4.13), and 2.51 (1.79 – 3.52), respectively. Conclusion Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.

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