scholarly journals Anaesthetic management in COVID-19 parturients scheduled for caesarean delivery - a comparison with non-COVID-19 parturients

2021 ◽  
Vol 9 (12) ◽  
pp. 3495
Author(s):  
Ranju Singh ◽  
Pooja Singh ◽  
Eashwar Neelakandan ◽  
Maitree Pandey ◽  
Manju Puri ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Vertical Transmission ◽  
Caesarean Delivery ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
Anaesthetic Management ◽  
Neonatal Outcomes ◽  
Intraoperative Hypotension ◽  
Maternal And Neonatal Outcomes ◽  
Polymerase Chain

Background: Data regarding outcomes after anaesthesia in COVID-19 parturients is scanty. There is hardly any information about the length of hospital stay in COVID-19 parturients who undergo caesarean delivery (CD) as compared to non-COVID-19 parturients.Methods: An observational study of COVID-19 parturients undergoing CD was conducted. Age and CD indication matched non COVID-19 parturients were taken as controls. The length of hospital stay along with maternal and neonatal outcomes were studied.Results: A total of 45 COVID-19 parturients and an equal number of non-COVID-19 parturients were studied. The length of hospital stay was significantly longer in COVID-19 parturients as compared to non-COVID-19 parturients (4.3±1.6 days versus 3.3±0.6 days, p=0.02). One COVID-19 parturient developed severe disease and expired. Apart from this case, the maternal and neonatal outcomes were comparable between the two groups. Mild thrombocytopenia was seen in COVID-19 parturients. One neonate had a positive reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on first day of life.Conclusions: COVID-19 parturients who undergo CD have a longer length of hospital stay than non-COVID-19 parturients. Severe disease is likely to be associated with longer length of hospital stay. Intraoperative hypotension, maternal and neonatal outcome is not significantly different between COVID-19 and non COVID-19 although mild thrombocytopenia is seen in COVID-19 parturients. While vertical transmission of SARS-CoV-2 may be possible, more data is needed regarding vertical transmission is needed.

scholarly journals Use of the Maternal Foetal Triage Index- Addressing the Third Delay in Obstetrics: An Observational Study

2021 ◽  
Author(s):  
Nirzarini Vora ◽  
Nandita Maitra ◽  
Priyam Pandya
Keyword(s):  
Observational Study ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Convenience Sample ◽  
The Third ◽  
Resource Setting ◽  
Maternal And Neonatal Outcomes ◽  
A Priority

OBJECTIVE: The Maternal Foetal Triage Index (MFTI), a five-tier scale designed by Ruhl et al (2015) has been evaluated in this study for women attending the triage area of a tertiary hospital, to examine the effect on third delay and maternal and neonatal outcomes. DESIGN: Prospective observational study SETTING: The Labour and Delivery Unit of a tertiary care hospital SAMPLE: A convenience sample of 1000 women METHODS: Assessment included maternal history, baseline vital signs and obstetric examination and categorised the woman as per the MFTI scale. Evaluation of the MFTI score was assessed based on predefined maternal and neonatal outcomes within 24h of attendance. MAIN OUTCOME MEASURES: Flow of patients to triage, presenting complaints, Duration of hospital stay, maternal and neonatal outcomes within 24h of admission. RESULTS: A priority wise distribution of subjects based on their clinical diagnosis was found to be statistically significant for anaemia, previous caesarean, postpartum haemorrhage, miscarriage and hypertensive disorders. Sixty seven percent of the subjects belonged to Priority 3-4 and the mean hospital stay duration varied from 8.26±7.68 days for Priority 1 to 3.82±2.74 days for Priority 4 ((p<0.0001). The average time spent in the triage room was 30±17minutes. A priority wise analysis of maternal and neonatal outcomes based on OBICU and NICU admissions, mortality and stillbirths was found to be significant. CONCLUSION: The MFTI scale significantly reduced the third delay, which is crucial in a high-volume, low resource setting. This also simplified handover, improved documentation and decreased time to secondary healthcare provider assessment. KEYWORDS:obstetrictriage,acuity,thirddelay,maternalmortality

Abstract P179: Neonatal Outcomes in Normal and Preeclamptic Pregnancies: A retrospective Comparative Study

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Niraj Vora ◽  
Ram R Kalagiri ◽  
Venkata N Raju ◽  
Nathan Drever ◽  
Madhava R Beeram ◽  
...  
Keyword(s):  
Birth Weight ◽  
Hospital Stay ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
De Novo ◽  
Length Of Hospital Stay ◽  
Admission Rate ◽  
Retrospective Chart Review ◽  
Neonatal Outcomes ◽  
Retrospective Comparative Study

Background: Preeclampsia (PreE), a de novo development of Hypertension in consort with proteinuria after 20 weeks of gestation is the leading cause of morbidity and mortality in mother and the offspring. It affects approximately 3-8% of overall pregnancies. Although, specific etiologies remain unknown, it has been supported by various studies that PreE is not just a single disorder, but a syndrome of pertinent multiple pathophysiological factors. Methods: An IRB approved retrospective chart review over a year (January 2014 to December 2014) was conducted of all pregnancies occurred at Baylor Scott and White Health System, Temple, Texas (N = 3704). We divided all pregnancies into two separate groups: PreE (N = 299) vs. Non PreE (N = 3405). We compared the neonatal outcomes between two groups including their offspring’s gestational age, birth weight, admission rate to Neonatal Intensive Care Unit (NICU), occurrence of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), hypoglycemia, thrombocytopenia, intraventricular hemorrhage (IVH) and length of hospital stay (LOS). Results: We found amongst these two groups, infants born to PreE mothers have significantly lower birthweight (Mean = 2807 grams, SD = 841 grams) compared to Non PreE mothers (Mean = 3383 grams, SD = 619 grams) (P<0.05), significantly lower GA (Mean = 36.7 weeks, SD = 3.25 weeks) compared to Non PreE group (Mean = 38.7 weeks, SD = 2.1 weeks) (P<0.05), significantly higher rate of BPD (11%) compared to Non PreE group (6.9%)(P<0.05), significantly higher occurrence of hypoglycemia (26%) compared to non PreE group (20%) (P<0.05), significantly higher rate of thrombocytopenia (28%) compared to Non PreE group (17%) (P<0.05) and significantly higher length of hospital stay (Mean = 19 days, SD = 20 days) compared to Non PreE group (Mean = 14 days, SD = 20 days) (P<0.05). Conclusion: We can conclude from this retrospective analysis that infants born to PreE mothers have lower birth weight indicating the intrauterine growth restriction and the lower gestational age indicating preterm birth. Moreover, the data indicate the higher rate of BPD, hypoglycemia, thrombocytopenia and requirement of increased length of hospital stay in infants born to PreE mothers compared to Non PreE mothers.

scholarly journals Severity of Maternal SARS-CoV-2 Infection in Pregnancy Predicts Neonatal Outcomes

2021 ◽  
Author(s):  
Beril Yasa ◽  
Seyma Memur ◽  
Dilek Yavuzcan Ozturk ◽  
Onur Bagci ◽  
Sait Ilker Uslu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Disease Severity ◽  
Severe Disease ◽  
Laboratory Data ◽  
Ventilatory Support ◽  
Neonatal Outcomes ◽  
Prolonged Hospital Stay ◽  
Key Points ◽  
Prolonged Hospital ◽  
Maternal Disease

Objective The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak had an enormous global impact. Pregnant women with SARS-CoV-2 appear to have higher morbidity and mortality. This study aimed to evaluate the effect of the severity of maternal SARS-CoV-2 infection on neonatal outcomes. Study Design The clinical and laboratory data of 40 women and neonates evaluated retrospectively. Results This retrospective study showed that SARS-CoV-2 infection had an adverse impact on neonatal outcomes proportionally with the maternal disease severity including increased prematurity rates, postnatal resuscitation need, prolonged hospital stay and longer ventilatory support requirement in infants born to mothers with moderate or severe disease. Conclusion Maternal disease severity had adverse effects on neonatal outcomes. The severity of maternal disease was found to be associated with increased rates of prematurity, requirement of postnatal resuscitation, prolonged hospital stay, and longer ventilatory support. Key Points

scholarly journals A study to assess the magnitude of atypical pneumonia by serum polymerase chain reaction in children aged 3 years to 18 years at Kempegowda Institute of Medical Sciences hospital, Bengaluru, Karnataka, India

2020 ◽  
Vol 7 (6) ◽  
pp. 1243
Author(s):  
Ramya H. S. ◽  
Anjana Gopi ◽  
Vivetha Elango ◽  
Mansi Kumar
Keyword(s):  
Polymerase Chain Reaction ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Atypical Pneumonia ◽  
Medical Sciences ◽  
Chain Reaction ◽  
Viral Pathogens ◽  
Atypical Pathogens ◽  
Polymerase Chain ◽  
High Degree

Background: Atypical organisms are a common causative agent of pneumonia in children more than 3 years of age, causing around 10-30% of the cases. Though atypical pathogens are said to cause relatively milder form of pneumonia as compared to other bacterial and viral pathogens, severe manifestations can also occur. Early identification of these pathogens can help in starting treatment with macrolides, which can reduce the length of hospital stay and mortality. Hence in this study the prevalence of atypical organisms was identified by using serum Polymerase chain reaction (PCR).Methods: This was a prospective observational study conducted in children between 3 years to 18 years of age with clinical diagnosis of pneumonia admitted in wards and PICU in KIMS hospital. Authors excluded Immunocompromised children. Detailed history and clinical examination was done. Investigations - complete hemogram, Chest Xray, blood Culture and sensitivity and serum PCR was done for a sample size of 100 children.Results: In this study among the three atypical organisms, Legionella pneumoniae was identified in 2% of the cases by serum PCR.Conclusions: In this study among the three atypical pathogens authors could only identify Legionella pneumoniae. Prevalence of Legionella pneumoniae was 2%. While treating children aged 3 years to 18 years with pneumonia, a high degree of suspicion of atypical pathogens is required, especially in Legionella because of its high mortality rate. In such circumstances adding macrolides along with other antibiotics will be beneficial to the patients outcome and duration of hospital stay.

scholarly journals OP0284 OUTCOME OF COVID-19 IN PATIENTS WITH RHEUMATIC AND INFLAMMATORY DISEASES TREATED WITH RITUXIMAB: DATA FROM DE FRENCH RMD COVID-19 COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 172-173
Author(s):  
J. Avouac ◽  
E. Drumez ◽  
E. Hachulla ◽  
R. Seror ◽  
S. Georgin-Lavialle ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Disease Severity ◽  
Death Rate ◽  
Therapeutic Option ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Confounding Factors ◽  
Disease Group ◽  
Risk Of Death

Background:Various observations have suggested that the course of the COVID-19 infection may be less favorable in patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) receiving rituximab (RTX).Objectives:To investigate whether treatment with RTX is associated with severe infection and death.Methods:We performed an observational, multicenter, French national cohort study querying the French RMD COVID-19 cohort, including highly suspected/confirmed iRMD-COVID-19 patients. The primary endpoint was to assess the severity rate of COVID-19. Severe disease was defined by hospitalization in intensive care unit or death. The secondary objectives were to analyze death rate and length of hospital stay. Two control groups were considered for comparison with RTX treated patients: a first group including all non-RTX treated iRMD patients and a second consisting on RTX untreated iRMD patients with diseases for which RTX is a recognized therapeutic option. Adjusting on potential confounding factors was performed by using inverse probability of treatment weighting (IPTW) propensity score method.Results:We collected a total of 1090 records. Patients were mainly females (67.3%, 734/1090) with a mean age of 55.2±16.4 years, and 51.1% (557/1090) were over the age of 55. Almost 70% of the population had at least one comorbidity (756/1090). A total of 63 patients were treated with RTX, mainly for rheumatoid arthritis (RA) (31/63, 49.2%). RTX treated patients were more likely to be males, with older age, higher prevalence of comorbidities and corticosteroid use. The control population consisted on 1027 non-RTX treated iRMD patients, and 495 RTX untreated iRMD patients with diseases for which RTX is a recognized therapeutic option.Of the 1,090 patients, 137 developed severe disease (12.6%). After adjusting on potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure and the underlying disease), severe disease was confirmed to be observed more frequently in patients receiving RTX compared to all RTX untreated iRMD patients (effect size, ES 3.26, 95% confidence interval, CI 1.66 to 6.40, p<0.001) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (ES 2.62, 95% CI 1.34 to 5.09, p=0.005). Patients who developed a severe disease had a more recent rituximab infusion compared to patients with mild or moderate disease. Indeed, the time between the last infusion of rituximab and the first symptoms of COVID-19 was significantly shorter in patients who developed a severe form of COVID-19 (Figure 1).Figure 1.Distribution (Tukey’s box plot) of Lag time between last infusion of Rituximab according to disease severity. P-Values for comparison between disease severity with Kruskal Wallis test are reported; P-Value<0.001 for either post-hoc comparison of severe disease group with moderate or mild disease group (calculated using Dunn’s test).Eighty-nine patients in our cohort died, resulting in an overall death rate of 8.2%. Death rate was numerically higher in RTX treated patients (13/63, 20.6%) compared to all RTX untreated iRMDs patients (76/1027, 7.4%) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (49/495, 9.9%). After considering the previously described confounding factors, the risk of death was not significantly increased in patients treated with RTX compared to all RTX untreated iRMDs patients (ES 1.32, 95% CI 0.55 to 3.19, p=0.53) (Table 2) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (ES 1.48, 95% CI 0.68 to 3.20, p=0.32). In line with a more severe COVID-19 disease, the length of hospital stay was markedly longer in patients treated with RTX compared to both untreated RTX patient groups.Conclusion:RTX therapy is associated with a more severe COVID-19 infection. RTX will have to be applied with particular caution in patients with iRMDs.Acknowledgements:Muriel Herasse played a major role in collecting the missing data of the cohort.We thank Julien Labreuche (biostatistician, CHU-Lille) for the help in the statistical analysis.Disclosure of Interests:None declared

scholarly journals Routine measurement of serum procalcitonin allows antibiotics to be safely withheld in patients admitted to hospital with SARS-CoV-2 infection

2020 ◽  
Author(s):  
Emma J. Williams ◽  
Luke Mair ◽  
Thushan I. de Silva ◽  
Dan J. Green ◽  
Philip House ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Consumption ◽  
Outcome Data ◽  
Teaching Hospitals ◽  
Inclusion Criteria ◽  
Diagnostic Challenge ◽  
Intensive Care Admission ◽  
Routine Measurement ◽  
Polymerase Chain

ABSTRACTBackgroundIt can be a diagnostic challenge to identify COVID-19 patients without bacterial co-infection in whom antibiotics can be safely stopped. We sought to evaluate the validity of a guideline that recommends withholding antibiotics in patients with a low serum procalcitonin (PCT).MethodsWe retrospectively collected 28-day outcome data on patients admitted to Sheffield Teaching Hospitals NHS Foundation Trust, UK, between 5 March and 15 April 2020, with a positive SARS-CoV-2 polymerase chain reaction (PCR) and PCT within 48 hours of diagnosis. PCT was considered negative if ≤0.25ng/ml and positive if >0.25ng/ml. Primary outcomes included antibiotic consumption, mortality, intensive care admission and length of hospital stay.Results368 patients met the inclusion criteria; 218 (59%) had a negative PCT and 150 (41%) positive. At 48 hours post-diagnosis, 73 (33%) of those with a negative PCT were receiving antimicrobials compared to 126 (84%) with a positive PCT (p<0.001), with a corresponding reduction in antimicrobial usage over 28 days (median DDD of 3.0 vs 6.8 (p<0.001); median DOT 2 vs 5 days (p<0.001) between the negative and positive PCT groups.) In the negative PCT group, there were fewer deaths (62 (28%) vs. 54 (36%), (p=0.021)) and critical care admissions (19 (9%) vs. 28 (19%), (p=0.007)) than in the positive PCT group. Median length of hospital stay was 8.7 and 9 days in the negative and positive PCT groups respectively.ConclusionsProcalcitonin is a valuable tool in the assessment of patients with SARS-CoV-2 infection, safely reducing the potential burden of unnecessary antibiotic usage.

scholarly journals Convalescent Plasma for COVID-19- is it Time to Say Goodbye? A Single-Center, Retrospective, Observational Study from Northern India

2021 ◽  
pp. 32-43
Author(s):  
Rasika Setia ◽  
Mitu Dogra ◽  
Gokhula Prasath Thangavel ◽  
Ramesh Yadav ◽  
Amena Ebadur Rahman ◽  
...  
Keyword(s):  
Observational Study ◽  
Hospital Stay ◽  
Disease Progression ◽  
Severe Disease ◽  
Ventilatory Support ◽  
Length Of Hospital Stay ◽  
Severe Infection ◽  
Northern India ◽  
Conflicting Evidence ◽  
Group 2

Background: COVID-19 pandemic continues threatening the world with no effective treatment to tackle the menace. Till date, there is conflicting evidence on efficacy of CP in reducing COVID-19 related mortality. The objective of this study was to see disease progression and 7, 14 and 28-day mortality after CP therapy and analyze CP efficacy with/without Remdesivir. Materials and Methods: A retrospective single-centre observational study done from August 20, 2020, to 20 November 2020. Records of 294 COVID-19 patients with moderate to severe disease given CP therapy were analysed based on disease progression and length of hospital stay, further subcategorized on age, clinical profile, risk factors, ward/ICU, ventilatory support and co-administration of Remdesivir. Results: Lowest 7-day mortality rate was seen within age group 20-40 years (0%) and was highest in ≥61 years (24.3%). 87 patients on ventilatory support showed higher 28day mortality (48.28%) compared to non-ventilated (10.14%), (P<0.00001). Lesser 7-day mortality was seen in early CP therapy ≤3 days of admission (P=0.01). Patients requiring ICU admission showed higher 14 and 28-day mortality compared to ward P=0.001%). Median (IQR) length of hospital stay from CP transfusion was shorter, 4 (3 to 9) days in group 2 (CP only) compared to 7 (4 to 12) days in group1 (CP+Remdesivir ). Conclusion: CP therapy in ≤3 days of hospital admission in COVID-19 patients with moderate to severe infection not on ventilatory support showed reduction in mortality and length of hospital stay. Length of hospital stay was shorter in the CP-only group as compared to the CP+ Remdesivir group.

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