scholarly journals Congenital, Intrapartum and Postnatal Maternal-Fetal-Neonatal SARS-CoV-2 Infections: A Narrative Review

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3570
Author(s):  
Rafael A. Caparros-Gonzalez ◽  
María Angeles Pérez-Morente ◽  
Cesar Hueso-Montoro ◽  
María Adelaida Álvarez-Serrano ◽  
Alejandro de la Torre-Luque
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Umbilical Cord ◽  
Case Reports ◽  
Controlled Trial ◽  
Case Series ◽  
Narrative Review ◽  
Before And After ◽  
Positive Results ◽  
Cervical Secretion

Background: There is inconclusive evidence regarding congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections during the COVID-19 pandemic. A narrative review was conducted with the aim of guiding clinicians on the management of pregnant women with respect to congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections and breastfeeding during the COVID-19 pandemic. Methods: Searches were conducted in Web of Science, PubMed, Scopus, Dialnet, CUIDEN, Scielo, and Virtual Health Library to identify observational, case series, case reports, and randomized controlled trial studies assessing the transmission of SARS-CoV-2 from mother to baby and/or through breastfeeding during the COVID-19 pandemic. Results: A total of 49 studies was included in this review, comprising 329 pregnant women and 331 neonates (two pregnant women delivered twins). The studies were performed in China (n = 26), USA (n = 7), Italy (n = 3), Iran (n = 2), Switzerland (n = 1), Spain (n = 1), Turkey (n = 1), Australia (n = 1), India (n = 1), Germany (n = 1), France (n = 1), Canada (n = 1), Honduras (n = 1), Brazil (n = 1), and Peru (n = 1). Samples from amniotic fluid, umbilical cord blood, placenta, cervical secretion, and breastmilk were collected and analyzed. A total of 15 placental swabs gave positive results for SARS-CoV-2 ribonucleic acid (RNA) on the fetal side of the placenta. SARS-CoV-2 RNA was found in seven breastmilk samples. One umbilical cord sample was positive for SARS-CoV-2. One amniotic fluid sample tested positive for SARS-CoV-2. Conclusions: This study presents some evidence to support the potential of congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections during the COVID-19 pandemic. Mothers should follow recommendations including wearing a facemask and hand washing before and after breastfeeding.

scholarly journals Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management

2019 ◽  
Vol 58 (3) ◽  
pp. 282-292
Author(s):  
Katelyn A Pastick ◽  
Elizabeth Nalintya ◽  
Lillian Tugume ◽  
Kenneth Ssebambulidde ◽  
Nicole Stephens ◽  
...  
Keyword(s):  
Survival Rate ◽  
Pregnant Women ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Case Series ◽  
First Trimester ◽  
Secondary Prophylaxis ◽  
Fetal Survival

Abstract Cryptococcal meningitis causes 15% of AIDS-related deaths. Optimal management and clinical outcomes of pregnant women with cryptococcosis are limited to case reports, as pregnant women are often excluded from research. Amongst pregnant women with asymptomatic cryptococcosis, no treatment guidelines exist. We prospectively identified HIV-infected women who were pregnant or recently pregnant with cryptococcosis, screened during a series of meningitis research studies in Uganda from 2012 to 2018. Among 571 women screened for cryptococcosis, 13 were pregnant, one was breastfeeding, three were within 14 days postpartum, and two had recently miscarried. Of these 19 women (3.3%), 12 had cryptococcal meningitis, six had cryptococcal antigenemia, and one had a history of cryptococcal meningitis and was receiving secondary prophylaxis. All women with meningitis received amphotericin B deoxycholate (0.7–1.0 mg/kg). Five were exposed to 200–800 mg fluconazole during pregnancy. Of these five, three delivered healthy babies with no gross physical abnormalities at birth, one succumbed to meningitis, and one outcome was unknown. Maternal meningitis survival rate at hospital discharge was 75% (9/12), and neonatal/fetal survival rate was 44% (4/9) for those mothers who survived. Miscarriages and stillbirths were common (n = 4). Of six women with cryptococcal antigenemia, two received fluconazole, one received weekly amphotericin B, and three had unknown treatment courses. All women with antigenemia survived, and none developed clinical meningitis. We report good maternal outcomes but poor fetal outcomes for cryptococcal meningitis using amphotericin B, without fluconazole in the first trimester, and weekly amphotericin B in place of fluconazole for cryptococcal antigenemia.

scholarly journals Systematic review to investigate the safety of induction and augmentation of labour among pregnant women with iron-deficiency anaemia

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021793 ◽  
Author(s):  
Kathryn Bunch ◽  
Nia Roberts ◽  
Marian Knight ◽  
Manisha Nair
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Case Reports ◽  
Case Series ◽  
Severe Anaemia ◽  
Risk Of Bias ◽  
Deficiency Anaemia ◽  
Increased Risk

ObjectiveTo conduct a systematic review to investigate the safety of induction and/or augmentation of labour compared with spontaneous-onset normal labour among pregnant women with iron-deficiency anaemia.DesignSystematic review.SettingStudies from all countries, worldwide.PopulationPregnant women with iron-deficiency anaemia at labour and delivery.InterventionAny intervention related to induction and/or augmentation of labour.Outcome measuresPrimary: Postpartum haemorrhage (PPH), heart failure and maternal death. Secondary: Emergency caesarean section, hysterectomy, admission to intensive care unit.MethodWe searched 10 databases, including Medline and Embase, from database inception to 1 October 2018. We included all study designs except cross-sectional studies without a comparator group, case reports, case series, ecological studies, and expert opinion. The searches were conducted by a healthcare librarian and two authors independently screened and reviewed the studies. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approachto ascertain risk of bias and conducted a narrative synthesis.ResultsWe identified 3217 journal articles, 223 conference papers, 45 dissertations and 218 registered trials. Ten articles were included for full-text review and only one was found to fulfil the eligibility criteria. This was a retrospective cohort study from India, which showed that pregnant women with moderate and severe anaemia could have an increased risk of PPH if they underwent induction and/or augmentation of labour, but the evidence was weak (graded as ‘high risk of bias’).ConclusionThe best approach is to prevent anaemia, but a large number of women in low-to-middle-income countries present with severe anaemia during labour. In such women, appropriate peripartum management could prevent complications and death. Our review showed that at present we do not know if induction and augmentation of labour is safe in pregnant women with iron-deficiency anaemia and further research is required.PROSPERO registration numberCRD42015032421.

scholarly journals WOMAN-PharmacoTXA trial: Study protocol for a randomised controlled trial to assess the pharmacokinetics and pharmacodynamics of intramuscular, intravenous and oral administration of tranexamic acid in women giving birth by caesarean section

2021 ◽  
Vol 6 ◽  
pp. 157
Author(s):  
Monica Arribas ◽  
Ian Roberts ◽  
Rizwana Chaudhri ◽  
Amber Geer ◽  
Danielle Prowse ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Oral Administration ◽  
Tranexamic Acid ◽  
Pregnant Women ◽  
Umbilical Cord ◽  
Controlled Trial ◽  
Maternal Blood ◽  
Oral Solution ◽  
Adult Women ◽  
Intravenous And Oral Administration

Background: Intravenous tranexamic acid (TXA) within 3 hours of birth significantly reduces death due to bleeding in women with postpartum haemorrhage (PPH). Most PPH deaths occur in the first hours after giving birth and treatment delay decreases survival.  One barrier to rapid TXA treatment is the need for intravenous injection. Intramuscular injection and oral solution of TXA would be easier and faster to administer and would require less training. However, the pharmacokinetics (PK), pharmacodynamics and safety of TXA administered by different routes in pregnant women have not been established. The main aim of this study is to ascertain whether IM and oral solution of TXA will be absorbed at levels sufficient to inhibit fibrinolysis in pregnant women. Methods: WOMAN-PharmacoTXA is a prospective, randomised, open label trial to be conducted in Zambia and Pakistan.  Adult women undergoing caesarean section with at least one risk factor for PPH will be included.  Women will be randomised to receive one of the following about 1 hour prior to caesarean section: 1-gram TXA IV, 1-gram TXA IM, 4-grams TXA oral solution or no TXA. Randomisation will continue until 120 participants with at least six post randomisation PK samples are included. TXA concentration in maternal blood samples will be measured at baseline and at different time points during 24 hours after receipt of intervention. Blood TXA concentration will be measured from the umbilical cord and neonate. The primary endpoint is maternal blood TXA concentrations over time. Secondary outcomes include umbilical cord and neonate TXA concentration D-dimer concentration, blood loss and clinical diagnosis of PPH, injection site reactions and maternal and neonate adverse events. Discussion: The WOMAN-PharmacoTXA trial will provide important data on pharmacokinetics, pharmacodynamics and safety of TXA after IV, intramuscular and oral administration in women giving birth by caesarean section. Trial registration: ClincalTrials.gov, NCT04274335 (18/02/2020).

Acupuncture in the Management of Anxiety Related to Dental Treatment: A Case Series

2010 ◽  
Vol 28 (1) ◽  
pp. 3-5 ◽  
Author(s):  
Palle Rosted ◽  
Mads Bundgaard ◽  
Sian Gordon ◽  
Anne Marie Lynge Pedersen
Keyword(s):  
Acupuncture Treatment ◽  
Dental Treatment ◽  
Case Reports ◽  
Dental Anxiety ◽  
Case Series ◽  
Randomised Clinical Trial ◽  
Common Phenomenon ◽  
Inexpensive Method ◽  
Before And After ◽  
Severe Anxiety

Background Anxiety related to dental treatment is a common phenomenon that has a significant impact on the provision of appropriate dental care. The aim of this case series was to examine the effect of acupuncture given prior to dental treatment on the level of anxiety. Methods Eight dentists submitted 21 case reports regarding the treatment of dental anxiety. The level of anxiety was assessed by the Beck Anxiety Inventory (BAI). Only patients with moderate to severe anxiety (BAI score ≥16) were included. The remaining 20 patients, 16 women and 4 men, with a mean age of 40.3 years, had a median BAI score of 26.5 at baseline. The BAI score was assessed before and after the acupuncture treatment. All patients received acupuncture treatment for 5 min prior to the planned dental treatment using the points GV20 and EX6. Results There was a significant reduction in median value of BAI scores after treatment with acupuncture (26.5 reduced to 11.5; p<0.01), and it was possible to carry out the planned dental treatment in all 20 cases after acupuncture treatment. Previously this had only been possible in six cases. Conclusion Acupuncture prior to dental treatment has a beneficial effect on the level of anxiety in patients with dental anxiety and may offer a simple and inexpensive method of treatment. However, the present results need to be tested in a larger randomised clinical trial in order to evaluate the effectiveness of the acupuncture treatment in patients with dental anxiety.

scholarly journals Antidopaminergic treatment is associated with reduced chorea and irritability but impaired cognition in Huntington’s disease (Enroll-HD)

2020 ◽  
Vol 91 (6) ◽  
pp. 622-630
Author(s):  
Kate L Harris ◽  
Wei-Li Kuan ◽  
Sarah L Mason ◽  
Roger A Barker
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Case Reports ◽  
Controlled Trial ◽  
Rate Of Change ◽  
Control Group ◽  
Open Label ◽  
Double Blind ◽  
Before And After ◽  
Rate Of Decline

ObjectivesAlterations in dopamine neurotransmission underlie some of the clinical features of Huntington’s disease (HD) and as such are a target for therapeutic intervention, especially for the treatment of chorea and some behavioural problems. However, justification for such an intervention is mainly based on case reports and small open label studies and the effects these drugs have on cognition in HD remain unclear.MethodsIn this study, we used the Enroll-HD observational database to assess the effects of antidopaminergic medication on motor, psychiatric and cognitive decline, over a 3-year period. We first looked at the annual rate of decline of a group of HD patients taking antidopaminergic medication (n=466) compared with an untreated matched group (n=466). The groups were matched on specified clinical variables using propensity score matching. Next, we studied a separate group of HD patients who were prescribed such medications part way through the study (n=90) and compared their rate of change before and after the drugs were introduced and compared this to a matched control group.ResultsWe found that HD patients taking antidopaminergic medication had a slower progression in chorea and irritability compared with those not taking such medications. However, this same group of patients also displayed significantly greater rate of decline in a range of cognitive tasks.ConclusionIn conclusion we found that antidopaminergic treatment is associated with improvements in the choreic movements and irritability of HD but worsens cognition. However, further research is required to prospectively investigate this and whether these are causally linked, ideally in a double-blind placebo-controlled trial.

Measurement of CEA, TPA, Neopterin, CA125, CA153 and CA199 in Sera of Pregnant Women, Umbilical Cord Blood and Amniotic Fluid

1989 ◽  
Vol 27 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Ralph J. Lell&eacute; ◽  
Eberhard Henkel ◽  
Dieter Leinemann ◽  
Klaus Goeschen
Keyword(s):  
Amniotic Fluid ◽  
Cord Blood ◽  
Pregnant Women ◽  
Umbilical Cord ◽  
Umbilical Cord Blood

Steroid-resistant sarcoidosis: is antagonism of TNF-α the answer?

2007 ◽  
Vol 112 (5) ◽  
pp. 281-289 ◽  
Author(s):  
Bart G. Denys ◽  
Yves Bogaerts ◽  
Kenneth L. Coenegrachts ◽  
An S. De Vriese
Keyword(s):  
Case Reports ◽  
Controlled Trial ◽  
Critical Role ◽  
Case Series ◽  
Experimental Treatment ◽  
Diagnostic Challenge ◽  
Open Label ◽  
Modest Improvement ◽  
Steroid Resistant ◽  
Tnf Α

Steroid-resistant sarcoidosis has conventionally been treated with various drugs, including methotrexate, azathioprine, cyclophosphamide, cyclosporine, antimalarial drugs and thalidomide, with variable success. There is a compelling need for more efficient and safer alternatives to these agents. Several lines of evidence suggest a critical role of TNF-α (tumour necrosis factor-α) in the initiation and organization of sarcoid granulomas. Inhibition of TNF-α with monoclonal antibodies has therefore received attention as a potential treatment option in therapy-resistant sarcoidosis. A number of case reports and small case series describe successful treatment of refractory disease with infliximab. Preliminary evidence from an RCT (randomized controlled trial) with infliximab in pulmonary sarcoidosis suggests a modest improvement in functional and radiological parameters. In contrast, the results with etanercept have been disappointing, perhaps related to differences in the mechanism of TNF-α blockade. The experience with adalimumab in sarcoidosis is too limited to draw conclusions. An open-label study and an RCT evaluating the efficacy of adalimumab in sarcoidosis with pulmonary and cutaneous involvement respectively, have been initiated. Although TNF-α antagonists appear relatively safe, especially when compared with conventional agents, caution is warranted in view of the increased incidence of tuberculosis, which may be a particular diagnostic challenge in patients with sarcoidosis. Pending publication of the RCTs, the use of TNF-α blockade in sarcoidosis should remain in the realm of experimental treatment.

scholarly journals Assessing SARS-CoV-2 Vertical Transmission and Neonatal Complications

2021 ◽  
Vol 10 (22) ◽  
pp. 5253
Author(s):  
Cosmin Citu ◽  
Radu Neamtu ◽  
Virgiliu-Bogdan Sorop ◽  
Delia Ioana Horhat ◽  
Florin Gorun ◽  
...  
Keyword(s):  
Breast Milk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Umbilical Cord ◽  
Gestational Hypertension ◽  
Close Contact ◽  
Outpatient Setting ◽  
Serum Samples ◽  
Increased Risk ◽  
A Prospective Study

We designed and implemented a prospective study to analyze the maternal and neonatal outcomes associated with COVID-19 and determine the likelihood of viral transmission to the fetus and newborn by collecting samples from amniotic fluid, placenta, umbilical cord blood, and breast milk. The study followed a prospective observational design, starting in July 2020 and lasting for one year. A total of 889 pregnant women were routinely tested for SARS-CoV-2 infection in an outpatient setting at our clinic, using nasal swabs for PCR testing. A total of 76 women were diagnosed with COVID-19. The positive patients who accepted study enrollment were systematically analyzed by collecting weekly nasal, urine, fecal, and serum samples, including amniotic fluid, placenta, umbilical cord, and breast milk at hospital admission and postpartum. Mothers with COVID-19 were at a significantly higher risk of developing gestational hypertension and giving birth prematurely by c-section than the general pregnant population. Moreover, their mortality rates were substantially higher. Their newborns did not have negative outcomes, except for prematurity, and an insignificant number of newborns were infected with SARS-CoV-2 (5.4%). No amniotic fluid samples were positive for SARS-CoV-2, and only 1.01% of PCR tests from breast milk were confirmed positive. Based on these results, we support the idea that SARS-CoV-2 positive pregnant women do not expose their infants to an additional risk of infection via breastfeeding, close contact, or in-utero. Consequently, we do not support maternal–newborn separation at delivery since they do not seem to be at an increased risk of SARS-CoV-2 infection.

scholarly journals Visceral Leishmaniasis in pregnancy and vertical transmission: A systematic literature review on the therapeutic orphans

2021 ◽  
Vol 15 (8) ◽  
pp. e0009650
Author(s):  
Prabin Dahal ◽  
Sauman Singh-Phulgenda ◽  
Brittany J. Maguire ◽  
Eli Harriss ◽  
Koert Ritmeijer ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Pregnant Women ◽  
Amphotericin B ◽  
Vertical Transmission ◽  
Liposomal Amphotericin ◽  
Case Reports ◽  
Case Series ◽  
Liposomal Amphotericin B ◽  
Cochrane Central Register ◽  
In Pregnancy

Background Reports on the occurrence and outcome of Visceral Leishmaniasis (VL) in pregnant women is rare in published literature. The occurrence of VL in pregnancy is not systematically captured and cases are rarely followed-up to detect consequences of infection and treatment on the mother and foetus. Methods A review of all published literature was undertaken to identify cases of VL infections among pregnant women by searching the following database: Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; World Health Organization Global Index Medicus: LILACS (Americas); IMSEAR (South-East Asia); IMEMR (Eastern Mediterranean); WPRIM (Western Pacific); ClinicalTrials.gov; and the WHO International Clinical Trials Registry Platform. Selection criteria included any clinical reports describing the disease in pregnancy or vertical transmission of the disease in humans. Articles meeting pre-specified inclusion criteria and non-primary research articles such as textbook, chapters, letters, retrospective case description, or reports of accidental inclusion in trials were also considered. Results The systematic literature search identified 272 unique articles of which 54 records were included in this review; a further 18 records were identified from additional search of the references of the included studies or from personal communication leading to a total of 72 records (71 case reports/case series; 1 retrospective cohort study; 1926–2020) describing 451 cases of VL in pregnant women. The disease was detected during pregnancy in 398 (88.2%), retrospectively confirmed after giving birth in 52 (11.5%), and the time of identification was not clear in 1 (0.2%). Of the 398 mothers whose infection was identified during pregnancy, 346 (86.9%) received a treatment, 3 (0.8%) were untreated, and the treatment status was not clear in the remaining 49 (12.3%). Of 346 mothers, Liposomal amphotericin B (L-AmB) was administered in 202 (58.4%) and pentavalent antimony (PA) in 93 (26.9%). Outcomes were reported in 176 mothers treated with L-AmB with 4 (2.3%) reports of maternal deaths, 5 (2.8%) miscarriages, and 2 (1.1%) foetal death/stillbirth. For PA, outcomes were reported in 88 mothers of whom 4 (4.5%) died, 24 (27.3%) had spontaneous abortion, 2 (2.3%) had miscarriages. A total of 26 cases of confirmed, probable or suspected cases of vertical transmission were identified with a median detection time of 6 months (range: 0–18 months). Conclusions Outcomes of VL treatment during pregnancy is rarely reported and under-researched. The reported articles were mainly case reports and case series and the reported information was often incomplete. From the studies identified, it is difficult to derive a generalisable information on outcomes for mothers and babies, although reported data favours the usage of liposomal amphotericin B for the treatment of VL in pregnant women.

Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy

2018 ◽  
Vol 12 (2) ◽  
pp. 134-144
Author(s):  
Thomas Ahn ◽  
Matthew J Roberts ◽  
Anojan Navaratnam ◽  
Eric Chung ◽  
Simon T Wood
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Case Reports ◽  
Contemporary Literature ◽  
Case Series ◽  
Artery Aneurysm ◽  
Well Being ◽  
Renal Neoplasm ◽  
Level Of Evidence ◽  
Meta Analyses

Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4

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