Sepsis: Precision-Based Medicine for Pregnancy and the Puerperium

Sepsis contributes significantly to global morbidity and mortality, particularly in vulnerable populations. Pregnant and recently pregnant women are particularly prone to rapid progression to sepsis and septic shock, with 11% of maternal deaths worldwide being attributed to sepsis. The impact on the neonate is considerable, with 1 million neonatal deaths annually attributed to maternal infection or sepsis. Pregnancy specific physiological and immunological adaptations are likely to contribute to a greater impact of infection, but current approaches to the management of sepsis are based on those developed for the non-pregnant population. Pregnancy-specific strategies are required to optimise recognition and management of these patients. We review current knowledge of the physiology and immunology of pregnancy and propose areas of research, which may advance the development of pregnancy-specific diagnostic and therapeutic approaches to optimise the care of pregnant women and their babies.

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COVID-19 Infection during Pregnancy: Risk of Vertical Transmission, Fetal, and Neonatal Outcomes

Journal of Personalized Medicine ◽

10.3390/jpm11060483 ◽

2021 ◽

Vol 11 (6) ◽

pp. 483

Author(s):

Marwa Saadaoui ◽

Manoj Kumar ◽

Souhaila Al Khodor

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Current Knowledge ◽

Limited Data ◽

Pregnancy Risk ◽

Public Health Challenge ◽

Short And Long Term ◽

Critical Public Health ◽

The Impact

The COVID-19 pandemic is a worldwide, critical public health challenge and is considered one of the most communicable diseases that the world had faced so far. Response and symptoms associated with COVID-19 vary between the different cases recorded, but it is amply described that symptoms become more aggressive in subjects with a weaker immune system. This includes older subjects, patients with chronic diseases, patients with immunosuppression treatment, and pregnant women. Pregnant women are receiving more attention not only because of their altered physiological and immunological function but also for the potential risk of viral vertical transmission to the fetus or infant. However, very limited data about the impact of maternal infection during pregnancy, such as the possibility of vertical transmission in utero, during birth, or via breastfeeding, is available. Moreover, the impact of infection on the newborn in the short and long term remains poorly understood. Therefore, it is vital to collect and analyze data from pregnant women infected with COVID-19 to understand the viral pathophysiology during pregnancy and its effects on the offspring. In this article, we review the current knowledge about pre-and post-natal COVID-19 infection, and we discuss whether vertical transmission takes place in pregnant women infected with the virus and what are the current recommendations that pregnant women should follow in order to be protected from the virus.

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Pregnancy and Breastfeeding During COVID-19 Pandemic: A Systematic Review of Published Pregnancy Cases

Frontiers in Public Health ◽

10.3389/fpubh.2020.558144 ◽

2020 ◽

Vol 8 ◽

Author(s):

Carina Rodrigues ◽

Inês Baía ◽

Rosa Domingues ◽

Henrique Barros

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Web Of Science ◽

Study Quality ◽

Neonatal Deaths ◽

Live Births ◽

Milk Samples ◽

The Impact

Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19.Methods: Searches were conducted in PubMed®, Scopus®, Web of Science®, and MedRxiv® up to 26th June 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality.Results: We identified 161 original studies reporting 3,985 cases of pregnant women with COVID-19 (1,007 discharged while pregnant). The 2,059 published cases with pregnancy outcomes resulted in 42 abortions, 21 stillbirths, and 2,015 live births. Preterm birth occurred in 23% of cases. Around 6% of pregnant women required admission to an intensive care unit and 28 died. There were 10 neonatal deaths. From the 163 cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus, 10 were positive. Sixty-one newborns were positive for SARS-CoV-2. Four breast milk samples from 92 cases showed evidence of SARS-CoV-2.Conclusion: Emerging evidence suggests that vertical transmission is possible, however, there is still a limited number of reported cases with intrapartum samples. Information, counseling and adequate monitoring are essential to prevent and manage adverse effects of SARS-CoV-2 infection during pregnancy.

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HYPOXIA AND REPRODUCTIVE HEALTH: The presence and role of hypoxia in the endometrium

Reproduction ◽

10.1530/rep-20-0268 ◽

2021 ◽

Vol 161 (1) ◽

pp. F1-F17

Author(s):

Rocío Martínez-Aguilar ◽

Lucy E Kershaw ◽

Jane J Reavey ◽

Hilary O D Critchley ◽

Jacqueline A Maybin

Keyword(s):

Current Knowledge ◽

Abnormal Uterine Bleeding ◽

Future Research ◽

Hypoxic Episode ◽

Optimal Function ◽

Pros And Cons ◽

The Impact ◽

Review Current

The endometrium is a multicellular tissue that is exquisitely responsive to the ovarian hormones. The local mechanisms of endometrial regulation to ensure optimal function are less well characterised. Transient physiological hypoxia has been proposed as a critical regulator of endometrial function. Herein, we review the literature on hypoxia in the non-pregnant endometrium. We discuss the pros and cons of animal models, human laboratory studies and novel in vivo imaging for the study of endometrial hypoxia. These research tools provide mounting evidence of a transient hypoxic episode in the menstrual endometrium and suggest that endometrial hypoxia may be present at the time of implantation. This local hypoxia may modify the inflammatory environment, influence vascular remodelling and modulate endometrial proliferation to optimise endometrial function. Finally, we review current knowledge of the impact of this hypoxia on endometrial pathologies, with a focus on abnormal uterine bleeding. Throughout the manuscript areas for future research are highlighted with the aim of concentrating research efforts to maximise future benefits for women and society.

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Study of spectrum of cardiac disease complicating pregnancy and the maternal and foetal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195324 ◽

2019 ◽

Vol 8 (12) ◽

pp. 4803

Author(s):

Sudha R. ◽

Anjali R.

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Cardiac Disease ◽

Heart Diseases ◽

Cardiac Complications ◽

Team Approach ◽

Maternal Deaths ◽

Neonatal Deaths ◽

Foetal Outcome ◽

Grade Iii

Background: Heart diseases are the most important non obstetrical causes of maternal deaths during pregnancy, accounting for almost 10% of maternal deaths. They complicate 1-3% of all pregnancies.Methods: The study was conducted at Cheluvamba Hospital from January 2015 till July 2016. All pregnant women with cardiac disease were included in the study. Pregnant women with cardiac disease were followed up during antenatal period, evaluated and maternal and foetal outcome was studied.Results: Total number of deliveries in the one and half year study period was 18,803 cases and the total number of women with cardiac disease was 90. Most of the subjects belonged to NYHA grade I and II (95.5%), whereas NYHA grade III and IV constituted only 4.4% of cases. Rheumatic heart disease was the principal cardiac lesion (62.22%) among the pregnancies, while congenital heart disease (33.33%) was the second most common cause. 16.7% had cardiac complications and there were 2(2.22%) maternal mortality. 91.86% were live births with 5.88% IUDs and 2.35% neonatal deaths. 15.29% of the babies were Preterm, 8.14% were IUGR babies and 2.35% had congenital anomalies. It was noted NYHA grade III/IV cases had more preterm babies compared to NYHA grade I/II. NICU admissions were also more with NYHA grade III/IV.Conclusions: The results suggest the need for pre-pregnancy counselling, early diagnosis, correction of cardiac lesions where indicated, close surveillance during pregnancy and a team approach comprising of obstetricians, cardiologists, neonatologists and nursing personnel for a successful pregnancy outcome.

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Knowledge, Attitude and Practice towards COVID-19 Infection during Pregnancy among Antepartum Women

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i47b33171 ◽

2021 ◽

pp. 691-697

Author(s):

Sivasundari Maharajan ◽

Shifa Shahina Nijamudeen ◽

Dhanvarsha Sumaldha Subbiah Ramkumar ◽

Nimrah Amthul

Keyword(s):

Pregnant Women ◽

Outpatient Clinic ◽

Current Knowledge ◽

Pearson Correlation ◽

Good Knowledge ◽

Preventive Practices ◽

Attitude And Practice ◽

Knowledge And Attitude ◽

Prevention Methods ◽

The Impact

Background: Pregnant women are more susceptible to developing severe cases of COVID-19. They need to be more careful during the antepartum, intrapartum, and postpartum periods to prevent untoward outcomes. As no definite treatment for COVID- 19 has yet been proven, the only effective approach to prevent unfavorable outcome is by increasing awareness of COVID-19 among pregnant women and by encouraging them to follow the necessary prevention methods. This study was done to know, if the adherence to the recommended preventive practices were influenced by the knowledge and attitude of the mothers and whether having a good knowledge and attitude led to better adherence to prevention methods. It also aims to assess if current knowledge on the effects of COVID-19 infection on pregnancy among antenatal women is sufficient or if more efforts have to be taken to educate the mothers regarding the same. Aims: This research aims to assess the knowledge, attitude, and precautionary measures taken towards COVID-19 infection in pregnancy among antenatal women attending the outpatient clinic. Materials and Methods: It is a descriptive cross-sectional questionnaire-based study conducted in Saveetha Medical College Hospital from January 2021 to March 2021. All antenatal women attending the obstetrics outpatient clinic were included in the study. After obtaining their consent, each woman was given a semi-structured, pre-tested questionnaire to solve on the spot. The statistical analysis used were descriptive analysis, proportions, percentages, chi-square test, and Pearson correlation coefficient. Results: Among the 465 pregnant women included in the study, 86.02% had good knowledge of COVID-19 and its impact on pregnancy, 89.89% of women held a positive attitude towards battling the pandemic and 98.92% had good prevention practices against COVID-19 infection. There was a significant association between age and knowledge and a significant association between socioeconomic status with the knowledge, attitude, or preventive practices of the patients and between education level and attitude of the women at p<0.05. Knowledge, attitude and prevention were found to be strongly positively correlated indicating that with an increase in the knowledge there is an increase in attitude and practice of preventive measures by pregnant women. Conclusion: The women included in this study had adequate knowledge and a good attitude towards the impact of COVID-19 on pregnancy and lactation. They also take necessary precautionary methods to safeguard against acquiring COVID -19 infection.

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Protein Phosphatase 2A (PP2A) mutations in brain function, development, and neurologic disease

Biochemical Society Transactions ◽

10.1042/bst20201313 ◽

2021 ◽

Author(s):

Iris Verbinnen ◽

Pieter Vaneynde ◽

Sara Reynhout ◽

Lisa Lenaerts ◽

Rita Derua ◽

...

Keyword(s):

Protein Phosphatase ◽

Brain Function ◽

Current Knowledge ◽

Gene Mutations ◽

Neurologic Disease ◽

Protein Substrates ◽

Phosphatase 2A ◽

The Impact ◽

Review Current ◽

Protein Phosphatase Type

By removing Ser/Thr-specific phosphorylations in a multitude of protein substrates in diverse tissues, Protein Phosphatase type 2A (PP2A) enzymes play essential regulatory roles in cellular signalling and physiology, including in brain function and development. Here, we review current knowledge on PP2A gene mutations causally involved in neurodevelopmental disorders and intellectual disability, focusing on PPP2CA, PPP2R1A and PPP2R5D. We provide insights into the impact of these mutations on PP2A structure, substrate specificity and potential function in neurobiology and brain development.

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Use of Orthodontic Methods in the Treatment of Dental Luxations: A Scoping Review

Dentistry Journal ◽

10.3390/dj9020018 ◽

2021 ◽

Vol 9 (2) ◽

pp. 18

Author(s):

Enrico Spinas ◽

Laura Pipi ◽

Silvia Mezzena ◽

Luca Giannetti

Keyword(s):

Scoping Review ◽

Current Knowledge ◽

Analytical Data ◽

Permanent Teeth ◽

Therapeutic Approaches ◽

Traumatic Injuries ◽

Stabilization Phase ◽

Research Questions ◽

Review Current

(1) Background: Treating dental luxation injuries is challenging for the clinician. Dental luxations account for 18–33% of injuries to permanent teeth and can be addressed using different therapeutic approaches. The present work was conducted with two aims: (i) to evaluate, through a scoping review, current knowledge of the orthodontic methods (repositioning and stabilization splinting) that can be used at the time of the trauma, and (ii) to investigate the frequency and type of pulp consequences arising after these traumatic injuries. (2) Methods: The literature search was conducted in the period June 2020–December 2020 using the PubMed/MEDLINE, SCOPUS and Web of Science databases. The research questions were formulated according to the PICO (Population, Intervention, Comparison, Outcomes) method and considered the following aspects: type of luxation injury and stage of root development; use of orthodontic repositioning and splinting techniques; frequency and type of pulp consequences; and compliance of treatments with international guidelines. (3) Results: The initial screening of the databases, using the selected search keywords, yielded a total of 587 articles, just 8 fully met the inclusion criteria. Closer analysis of these 8 publications revealed that they would not produce clear meta-analytical data. This made it necessary to limit the data collected to the following six items: number and type of injuries, initial therapeutic intervention, duration of follow-up, number, and type of different pulp consequences. (4) Conclusions: While orthodontic techniques are commonly used to treat dental intrusions, in the case of extrusive and lateral luxation injuries, they are less frequently used and the orthodontic approach is generally confined to the stabilization phase. Among the various possible pulp consequences, many authors consider only pulp canal obliteration (PCO) and pulp necrosis (PN), often tending to overlook physiological healing (pulp survival) and the possible development of PN after PCO. There is therefore a clear need for new, high-quality clinical studies of this topic based on systematic and standardized data collection.

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COVID-19 in pregnancy: What do we really know?

F1000Research ◽

10.12688/f1000research.23543.1 ◽

2020 ◽

Vol 9 ◽

pp. 362

Author(s):

Jerome Bouaziz ◽

Marc Even ◽

Frederique Isnard-Bogillot ◽

Eli Vesale ◽

Mariam Nikpayam ◽

...

Keyword(s):

Clinical Practice ◽

Pregnant Women ◽

Current Knowledge ◽

Case Reports ◽

Case Series ◽

Adverse Outcomes ◽

Health Concern ◽

Case Control Studies ◽

Increased Risk ◽

The Impact

Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-to-child transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice.

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Dampak COVID-19 Terhadap Pelayanan KIA di Kabupaten Tangerang

Jurnal Keperawatan Muhammadiyah ◽

10.30651/jkm.v6i3.8445 ◽

2021 ◽

Vol 6 (3) ◽

Author(s):

Dewi Ayu Puspitasari ◽

Hadi Pratomo ◽

Trini Sudiarti ◽

Sri Indriyani

Keyword(s):

Pregnant Women ◽

Qualitative Data ◽

Routine Data ◽

Child Health Services ◽

District Health ◽

Maternal Deaths ◽

Pandemic Response ◽

The Impact ◽

Depth Interviews ◽

And Child Health

Objective: The COVID-19 pandemic response is affecting maternal and Child health services in Indonesia including Kabupaten tangerang. This study aimed to identify the impact of COVID-19 on MCH services in Kabupaten Tangerang.Methods: This article used a mixed-method study with deductive sequential design. The quantitative data was obtained from routine data on the PulihCovid dashboard, while the qualitative data was obtained from in-depth interviews with responsible officers in Dinas kesehatan Kabupaten Tangerang.Results: In general, there was a decrease in the number of visits by pregnant women in 2020 compared to the previous year starting in April, one month after the first positive cases of COVID-19 appeared in Kabupaten Tangerang. In line with this, there has been an increase in the number of maternal deaths due to COVID-19. To overcome this, the Tangerang District Health Office uses WhatsApp and selular in conducting education and morning assistance for pregnant women during the COVID-19 pandemic.Conclusion: The recommendation proposed in this study are to improve the referral system for pregnant women and improve delivery facilities for pregnant women with COVID-19.

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The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial (Preprint)

10.2196/preprints.11213 ◽

2018 ◽

Author(s):

Ri-Hua Xie ◽

Hongzhuan Tan ◽

Monica Taljaard ◽

Yan Liao ◽

Daniel Krewski ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Mortality ◽

Education Program ◽

Text Messaging ◽

Maternal Education ◽

World Health ◽

Maternal Deaths ◽

Perinatal Deaths ◽

Cluster Randomized ◽

The Impact

BACKGROUND In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse. OBJECTIVE This study aimed to explore the impact of a maternal education program through text messaging. METHODS We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes. RESULTS A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant. CONCLUSIONS Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging–based maternal education program suggested by this trial. CLINICALTRIAL ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo)

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