Outcome of SARS-CoV-2 in pregnancy and newborns – is there a new kid in the TORCH block?

Objective. This study aimed to perform a systematic review of existing literature to assess the outcomes of pregnancy in women with COVID-19 infection and their newborns while estimating the possibility of vertical transmission. Materials and methods. We conducted a systematic literature research using Pubmed and Google Scholar covering the period from December 2019 to 20th of November 2020. The review was conducted in accordance with PRISMA guidelines. Outcomes. We included 16 studies – systematic reviews and meta-analyses published between May 2020 and November 2020 – which focused on perinatal outcomes of pregnant women with COVID-19 and 7 case reports of neonates with congenital transmission of COVID-19. Overall, the rate of COVID-19 cases in neonates of COVID-19 positive mothers was 3% with 95% CI [1.86, 4.24]). The preterm birth rate was 16.4% with 95% CI [10.5, 22.3] and the rate of stillbirths and foetal deaths was 1.4% (11 studies, 0 to 4.8%). From the 7 newborns with proved vertical transmission, majority were born preterm, with good birth weight and APGAR score and heterogenous symptoms; 4 developed severe symptoms. Overall progress and evolution for both mother and newborn was good. Conclusions. COVID-19 impact on pregnancy outcome is similar to general population in regard to preterm rate and stillbirth rate. Vertical transmission is possible and it seems to occur in about 3% of cases. Overall maternal and perinatal outcome is favourable and clinical presentation of in utero transmission of SARSCoV-2 in newborns is heterogenous.

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Hepatitis C Virus in Pregnancy: Case Reports and Literature Review

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744995000731 ◽

1995 ◽

Vol 3 (6) ◽

pp. 248-251 ◽

Cited By ~ 1

Author(s):

Gary M. Joffe

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Vertical Transmission ◽

Case Reports ◽

Sexual Transmission ◽

Severity Of Illness ◽

The United States ◽

Maternal Disease ◽

In Pregnancy

Background: Hepatitis C virus (HCV) is now recognized as the cause of 90% of non-A, non-B (NANB) hepatitis. This virus is responsible for a large percentage of chronic persistent and chronic active hepatitis in the United States. Parenteral and sexual transmission are well described, so a significant population of pregnant patients is at risk. Vertical transmission of the virus to the fetus is dependent upon the level of maternal viremia.Case: The cases described in the following report demonstrate that fulminant disease may present in pregnancy. They also demonstrate the cofactors promoting the severity of illness, methods of diagnosis, potential treatment, and outcome of the infection.Conclusion: HCV may be encountered in pregnancy. Although most acute-phase illness will be self limiting, some patients will manifest liver failure during gestation. Because vertical transmission to the fetus is possible, the pediatrician should be informed of the maternal disease. Chronic hepatitis is almost the rule rather than the exception, so patients require close postpartum follow-up. Interferon, which may alter the course of the chronic disease, has been used on rare occasions in pregnancy.

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

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009650 ◽

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.

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Pregnancy and Delivery with Cardiac Disease in Dr. Soetomo Hospital 2018

International Islamic Medical Journal ◽

10.33086/iimj.v2i2.1822 ◽

2021 ◽

Vol 2 (2) ◽

pp. 61-66

Author(s):

Ana Puji Rahayu ◽

Khanisyah Erza Gumilar

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Cardiac Disease ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Number Of Patients ◽

Pregnancy And Delivery ◽

Maternal And Neonatal Outcomes ◽

In Pregnancy

Background: Cardiac disease is one of the non obstetric problems causing mortality both in pregnancy and labor due to the complications. Preventions for the complications have not been implemented, thus the number of patients which have cardiac disease with complications and perinatal outcome with low birth weight is still high. Objective : To identify maternal and neonatal outcome of pregnant women with cardiac disease in dr. Soetomo Surabaya hospital in 2018. Method: Descriptive retrospective study using medical records in dr. Soetomo Surabaya hospital 2018. Result: We found 1433 pregnancy cases with 51 (3,6 %) patients were having cardiac disease and included in this research. The most common maternal complication was pulmonary hypertension 16 cases. A dead case was found 1 case (1,9 %) with eissenmenger syndrome. We found the perinatal outcome of 30 babies (58.8%) born with a weight of 2500 gram and under. There are 7 patients with cardiac disease that have been corrected (13,7%). Among those 7 patients, 6 had a perinatal outcome with a birth weight of more than 2500 gram. Conclusion : Most pregnant patients with cardiac disease in dr. Soetomo Surabaya hospital 2018 are already having some complications with perinatal outcomes of low birth weight. Therefore, management of cardiac disease in pregnancy to prevent complications by means of preconception counseling, good antenatal care, and appropriate referrels are still needed to improve the quality of maternal and neonatal outcomes.

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Appendicitis in Pregnancy: Clinical Presentation and Perinatal Outcome

Journal SOGC ◽

10.1016/s0849-5831(16)30054-4 ◽

1999 ◽

Vol 21 (14) ◽

pp. 1328-1333 ◽

Cited By ~ 1

Author(s):

Vincent Wu ◽

B. Anthony Armson

Keyword(s):

Perinatal Outcome ◽

Clinical Presentation ◽

In Pregnancy

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Perinatal outcome in context of the social determinants of health

Archives of Public Health ◽

10.3889/aph.2018.2246 ◽

2018 ◽

Vol 10 (2) ◽

pp. 71-81

Author(s):

Elizabeta Zisovska

Keyword(s):

Relative Risk ◽

Social Determinants Of Health ◽

Preterm Delivery ◽

Social Determinants ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Level Of Education ◽

Academic Level ◽

The Social ◽

In Pregnancy

The importance of recognition of the social determinants and the degree to which they influence the perinatal health is of utmost significance for the reproductive epidemiology and therefore they are important causes of the health inequalities within and between the countries. These facts have implied the aims of this study, to evaluate four frequent social determinants (level of education, employment status, parity and antenatal controls) and their influence on the two adverse perinatal outcomes – preterm/near term newborn of 35-37 gestational weeks, and small for gestational age baby (SGA). The research is a part of very extensive study, and by design it was prospective cohort study during which validated Questionnaire was used and extracted data from the maternal and neonatal history. As very relevant, the statistical parameters Relative Risk and Numbers Needed to Treat (NNT) were used for risk analysis. The Results have shown strong influence of the maternal education on the both perinatal outcomes. The Relative risk for preterm delivery in 35-37th gestational week in mother of uneducated mother is 14,963 (95%CI 4,54-49,27) compared to mother of academic level of education; the relative risk for SAG newborn is 3,204 (95%CI 2,12-4,84); in unemployed mother, the relative risk for preterm delivery is 4,585 of that in mother of academic level (95%CI 2,27-9,28), whereas for SGA baby is 4,799 (95%CI 3,17-7,26). No antenatal control in pregnancy is high risk for bad outcome, but in this study the Relative risk for preterm delivery was 1,293 (95%CI 0,67-2,47), and for SGA babies it was very low compared to full control in pregnancy, and was 1,041 (95%CI 0,84-1,29). According to these findings, it is obvious that the understanding of the social determinants of health priorities are the first and the most important step towards their gradual reduction, and this action is an entry point for global action to reach the health goals. Therefore, it is recommended such types of research studies to be conducted in extensive sample size, considering as much as possible social determinants, and performing multivariate analysis, in order to get higher statistical significance, which will help in creating strategies and activities for reduction of the most influential social determinants and improvement of the perinatal outcome of the newborns.

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COVID-19 in pregnancy: placental pathological patterns and effect on perinatal outcome in five cases

Diagnostic Pathology ◽

10.1186/s13000-021-01148-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Giovanna Giordano ◽

Chiara Petrolini ◽

Emilia Corradini ◽

Nicoletta Campanini ◽

Susanna Esposito ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Outcome ◽

Case Reports ◽

Placental Tissue ◽

Late Pregnancy ◽

The Novel ◽

Novel Coronavirus ◽

The Impact ◽

Intermediate Density ◽

In Pregnancy

Abstract Introduction COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, is a severe systemic thrombotic syndrome that emerged in 2019, with an ensuing pandemic. To evaluate the impact of this disease on placental tissue and perinatal outcome, histological, immunohistochemical and ultrastructural analyses of placental tissue were performed for five cases of pregnant women with COVID-19. Case reports All five pregnant women in this series developed COVID-19 in late pregnancy. Two patients experienced respiratory distress, and computed tomography revealed signs of pneumonia, with bilateral involvement, multiple lobular and subsegmental areas of consolidation and ground-glass opacities. Histological studies of placental tissue revealed the presence of slight signs of maternal vascular underperfusion (MVUs) or foetal vascular underperfusion (FVUs) lesions and mild inflammatory lesions. CD15 immunoreactivity in the placental tissue was low in all cases, demonstrating that in these cases there was not severe foetal hypoxia/asphyxia risk for newborns or distal vascular immaturity. In all cases examined, ultrastructural analyses showed spherical-like coronavirus particles with an electron intermediate-density core as well as projections from the surface as spike-like structures in the syncytiotrophoblasts. At term, all of the women delivered newborns who were negative for SARS-CoV-2 by nasopharyngeal testing in their first day of life. All newborns were exclusively breastfed and were discharged on the 3rd day of life. Conclusions In conclusion, placental patterns in pregnancy due to COVID-19 in the late stage of gestation indicate no evidence of vertical trans-placental SARS-CoV-2 transmission or a significant impact on the perinatal outcome of newborns, in both mild and more severe cases.

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Umbilical cord coiling index as a marker of perinatal outcome

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.068 ◽

2021 ◽

Vol 8 (3) ◽

pp. 323-327

Author(s):

Pragati Jain ◽

Monika Aggarwal ◽

Meenu V Ahuja ◽

Surbhi Gupta

Keyword(s):

Umbilical Cord ◽

Apgar Score ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Well Being ◽

Ponderal Index ◽

Amniotic Fluid Index ◽

Meconium Staining ◽

Nicu Admission ◽

In Pregnancy

The umbilical cord is very important for the well-being and survival of the fetus, however this is susceptible to compressions, kinking, traction and torsion which may influence the perinatal outcome and an abnormal umbilical coiling index has been related to adverse fetal and pregnancy outcomes. To determine the umbilical cord coiling index (UCI) and compare its association with perinatal outcome in normal and complicated pregnancies.It was a prospective observational study done on 200 patients at term (after 37 weeks) pregnancy, delivered either vaginally or by cesarean section. The umbilical cord coiling index was calculated. The mean coiling index of our study was 0.256+0.07 per cm. The outcomes measured were maternal age, parity, body mass index, hypertension in pregnancy, diabetes in pregnancy, amniotic fluid index, meconium staining of liquor, neonatal birth weight, Apgar score at birth, ponderal index, NICU admission. The coils were then divided into three categories on the basis of UCI and their association with the maternal and fetal outcomes were analyzed. Hypocoiled cords were those having UCI less than 10th centile, and hypercoiled cords those having UCI more than 90th centile. Statistical analysis was done by chi square test, Fishers exact test and the t test where applicable. Hypocoiled cords (UCI <10th centile) were associated with pregnancy induced hypertension (PIH), diabetes mellitus, meconium staining of liquor, low Apgar score, growth restricted fetus and NICU admission. Hypercoiled cords were associated with liquor abnormalities and low ponderal index. Abnormal umbilical cord coiling index was associated with adverse perinatal outcomes.

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Coronavirus in pregnancy and delivery: rapid review and expert consensus

10.1101/2020.03.06.20032144 ◽

2020 ◽

Cited By ~ 13

Author(s):

E Mullins ◽

D Evans ◽

RM Viner ◽

P O’Brien ◽

E Morris

Keyword(s):

Vertical Transmission ◽

Case Reports ◽

Case Series ◽

Case Fatality ◽

Service Planning ◽

Expert Consensus ◽

Rapid Review ◽

The Uk ◽

The Impact ◽

In Pregnancy

ABSTRACTBACKGROUNDPerson to person spread of COIVD-19 in the UK has now been confirmed. There are limited case series reporting the impact on women affected by coronaviruses (CoV) during pregnancy. In women affected by SARS and MERS, the case fatality rate appeared higher in women affected in pregnancy compared with non-pregnant women. We conducted a rapid, review to guide management of women affected by COVID -19 during pregnancy and developed interim practice guidance with the RCOG and RCPCH to inform maternity and neonatal service planningMETHODSSearches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies or randomised-controlled trial describing women affected by coronavirus in pregnancy and on neonates. Data was extracted from relevant papers and the review was drafted with representatives of the RCPCH and RCOG who also provided expert consensus on areas where data were lackingRESULTSFrom 9964 results on PubMed and 600 on MedRxiv, 18 relevant studies (case reports and case series) were identified. There was inconsistent reporting of maternal, perinatal and neonatal outcomes across case reports and series concerning COVID-19, SARS, MERS and other coronaviruses. From reports of 19 women to date affected by COVID-19 in pregnancy, delivering 20 babies, 3 (16%) were asymptomatic, 1 (5%) was admitted to ICU and no maternal deaths have been reported. Deliveries were 17 by caesarean section, 2 by vaginal delivery, 8 (42%) delivered pre-term. There was one neonatal death, in 15 babies who were tested there was no evidence of vertical transmission.CONCLUSIONSMorbidity and mortality from COVID-19 appears less marked than for SARS and MERS, acknowledging the limited number of cases reported to date. Pre-term delivery affected 42% of women hospitalised with COVID-19, which may put considerable pressure on neonatal services if the UK reasonable worse-case scenario of 80% of the population affected is realised. There has been no evidence of vertical transmission to date. The RCOG and RCPCH have provided interim guidance to help maternity and neonatal services plan their response to COVID-19.

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A Review of Sars-Cov-2 Infection in Pregnancy: What We Know So Far

10.47363/jmhc/2020(2)116 ◽

2020 ◽

pp. 1-10

Author(s):

Acevedo Gallegos Sandra ◽

◽

ArriagaLópez Alberto ◽

Minjarez Corral Mariana ◽

◽

...

Keyword(s):

Vertical Transmission ◽

Perinatal Outcomes ◽

Diagnostic Methods ◽

High Morbidity ◽

Transmission Method ◽

Coronavirus Infection ◽

Recommended Guidelines ◽

The Impact ◽

In Pregnancy

Coronavirus infection (COVID-19) in pregnancy is highly relevant due to the impact on maternal and fetal health, it is caused by SARS-CoV-2, which has a high morbidity and mortality rate worldwide. It is important to evaluate pregnant patients who are identified as suspicious, to make an accurate and timely diagnosis, to implement correct follow-up and adequate therapeutic management to reduce associated complications and adverse perinatal outcomes. Objective: Execute a detailed and updated review of the causal agent, pathophysiology, diagnostic methods, treatment, maternal and fetal repercussions, via of delivery and whether there is evidence of vertical transmission. Method: A search of literature published in English and Spanish was carried out in databases such as PubMed / MEDLINE, MDconsult, HSTAT, Internet Grateful Med, using the keywords: Coronavirus, pregnancy, SARS-CoV-2, treatment, vertical transmission. From the information obtained, 88 articles were selected, which were classified and used as support to do this review. Results: Studies and available evidence, reviews, and recommended guidelines for the evaluation of patients with COVID-19 are discussed, mainly those that provide valuable data regarding the diagnosis, monitoring and management of this infection. Conclusion: Information is limited and much remains to be studied about vertical transmission and perinatal outcomes. There is no evidence to support that pregnancy increases the susceptibility to get COVID-19. More studies are necessary to know the behavior of the infection in pregnancy, for a better approach, diagnosis and treatment.

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Is the Perinatal Outcome of Placental Abruption Modified by Clinical Presentation?

Journal of Pregnancy ◽

10.1155/2011/659615 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Seishi Furukawa ◽

Hiroshi Sameshima ◽

Tsuyomu Ikenoue ◽

Masanao Ohashi ◽

Yoshio Nagai

Keyword(s):

Perinatal Outcome ◽

Placental Abruption ◽

Clinical Presentation ◽

Severe Disease ◽

Perinatal Outcomes ◽

Premature Labor ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Induced Hypertension ◽

The Impact

Objective. The purpose of this study was to elucidate the impact of the clinical presentation on perinatal outcome in placental abruption.Study Design. A retrospective study was performed in 97 placental abruptions. Placental abruptions were classified according to clinical presentation: pregnancy-induced hypertension (HT,n=22), threatened premature labor and/or premature rupture of membranes (TPL/ROM,n=35), clinically low risk (LR,n=27), and others (n=13). Perinatal outcomes were compared among the HT, TPL/ROM, and LR groups.Results. The HT had significantly higher incidence of IUGR, IFUD, and low fibrinogen. The TPL/ROM had less severe disease. However, the LR had significantly higher incidence of IUFD, low UA pH < 7.1, low Apgar score of <7 at 5 min, and low fibrinogen.Conclusion. Disease severity in placental abruption is likely to depend on the clinical presentation.

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