An Insight on the Maternal-Fetal Outcomes of Critically Ill Pregnant Women During the Second Wave of COVID-19

Background:Juvenile idiopathic arthritis (JIA), one of the most common chronic diseases in children, can be classified in seven different categories according to its onset presentation. Concerns about pregnancy outcomes play a secondary role in disease approach. However, recent data showed an increased risk of pre-term birth in women with JIA instead the small patient samples analysed.Objectives:In this review, our aim is to describe the current available knowledge on JIA adverse, maternal and fetal, outcomes.Methods:A systematic literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases. The search was limited to articles in English language, presenting a comparator group (healthy individuals or patients without known auto-immune rheumatic diseases) and at least one clinical outcome of interest. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility.Results:Ten observational studies out of 1560 references, fulfilled the inclusion criteria, of which, 9 were retrospective and 1 prospective. A total of 6.214 women with JIA (with 6.811 pregnancies) and 18.659.513 healthy controls (with 21.339.194 pregnancies) were included in this review.Concerning maternal outcomes, delivery by caesarian section (CS) was more frequent among JIA women (in 4 out of 6 studies). Pre-eclampsia was referred in 3 out of 6 studies and a higher risk of vaginal bleeding and placenta previa in one additional study. No study found an increased risk for gestational diabetes or hypertension in pregnant women with JIA.Regarding fetal outcomes, 8 studies revealed significantly increased of pre-term birth (only in first births in one study) but one study didn’t show any increased risk. Two studies showed a higher risk of small gestational age (SGA) and in another 2, increased risk for low birth weight (LBW). No evidence of increased risk of major congenital malformations.Conclusion:This systematic review suggests an increased risk for pre-eclampsia, preterm birth, delivery by CS, SGA and LBW, among pregnant women with JIA. Conclusions should be carefully interpreted, giving the heterogeneity of studied populations regarding demography, disease type, disease activity, and prescribed medication.Disclosure of Interests:None declared

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Comparison between first and second wave among critically ill COVID-19 patients admitted to a French ICU: no prognostic improvement during the second wave?

Critical Care ◽

10.1186/s13054-020-03449-6 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Damien Contou ◽

Megan Fraissé ◽

Olivier Pajot ◽

Jo-Anna Tirolien ◽

Hervé Mentec ◽

...

Keyword(s):

Critically Ill ◽

Second Wave

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Maternal and Fetal Outcomes in Pregnant Women with COVID-19 Infection; A Case Series of 16 Patients at a Tertiary Care Hospital

2021 International Bhurban Conference on Applied Sciences and Technologies (IBCAST) ◽

10.1109/ibcast51254.2021.9393253 ◽

2021 ◽

Author(s):

Hasina Sadiq ◽

Irum Sohail ◽

Fahmia Nasir

Keyword(s):

Pregnant Women ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Case Series ◽

Care Hospital ◽

Fetal Outcomes

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Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

Annals of Intensive Care ◽

10.1186/s13613-021-00876-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ines Gragueb-Chatti ◽

Alexandre Lopez ◽

Dany Hamidi ◽

Christophe Guervilly ◽

Anderson Loundou ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Study ◽

Length Of Stay ◽

Critically Ill ◽

Invasive Mechanical Ventilation ◽

Blood Stream ◽

Hospital Length Of Stay ◽

Ventilator Associated Pneumonia ◽

Blood Stream Infections ◽

Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

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An Increased Adverse Fetal Outcome Has Been Observed among Teen Pregnant Women in Rural Eastern Ethiopia: A Comparative Cross-Sectional Study

Global Pediatric Health ◽

10.1177/2333794x21999154 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199915

Author(s):

Haymanot Mezmur ◽

Nega Assefa ◽

Tadesse Alemayehu

Keyword(s):

Pregnant Women ◽

Fetal Outcome ◽

Cross Sectional Study ◽

World Health ◽

Adult Women ◽

Sectional Study ◽

Fetal Outcomes ◽

Cross Sectional ◽

Eastern Ethiopia ◽

Adverse Fetal Outcome

Background: According to the World Health Organization, teenage pregnancies are high-risk due to increased risks of fetal and infant morbidity and mortality. This study compares adverse fetal outcomes between teen and adult pregnant women from rural Eastern Ethiopia. Methods: Institutional-based cross-sectional study was conducted among women visiting maternity units from surrounding rural areas. A total of 481 teenagers (13-19 years old) and 481 adults (20-34 years old) women with a singleton pregnancy were included in the study. Two hospitals and 3 health centers were selected in Eastern Hararghe Zone, Eastern Ethiopia. Comparative analysis was carried out using the log-binomial regression model to identify factors associated with adverse fetal outcomes in both categories. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Results: High proportion of adverse fetal outcome was observed among teenage women than adult (34.9% vs 21%). Statistically significant difference ( P < .05) in the proportion of low birth weight (21.1% vs 9.3%), preterm birth (18.7% vs 10.6%), APGAR score at 5th minute (9.3% vs 4%) were found in teenagers compared to adult women. Antenatal care attendance (APR = 0.44; 95% CI: 0.23, 0.86); eclampsia (APR = 1.96; 95% CI: 1.26, 3.06); pre-eclampsia (APR = 1.73; 95% CI: 1.12, 2.67); and wealth index (rich) (APR = 0.55; 95% CI: 0.32, 0.94) were significantly associated with adverse fetal outcomes among the teenage women. Whereas intimate partner violence (APR = 2.22; 95% CI: 1.26, 3.90); preeclampsia (APR = 3.05; 95% CI: 1.61, 5.69); antepartum hemorrhage (APR = 2.77; 95% CI: 1.73, 4.46); and hyperemesis gravderm (APR = 1.75; 95% CI: 1.09, 2.79) were significantly associated with adverse fatal outcomes among the adult women. Conclusion: teenage pregnancy is associated with a high rate of adverse fetal outcomes. Early identification and treatment of problems during antenatal follow-up should be the mainstay to avert the massive adverse fetal effects.

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Frequency of Attempted Suicide Methods and the Fetal Outcomes in Pregnant Women in Kermanshah

Journal of Women s Health Care ◽

10.4172/2167-0420.1000164 ◽

2014 ◽

Vol 03 (04) ◽

Cited By ~ 1

Author(s):

Maryam Zangeneh

Keyword(s):

Pregnant Women ◽

Attempted Suicide ◽

Fetal Outcomes ◽

Suicide Methods

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Does Prenatal Stress Management Enhance Maternal And Fetal Outcomes?

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n27p129 ◽

2016 ◽

Vol 12 (27) ◽

pp. 129

Author(s):

Ghada Mohammad Abu Shosha

Keyword(s):

Pregnant Women ◽

Stress Management ◽

Stress Reduction ◽

Maternal Stress ◽

Rapid Change ◽

Fetal Outcomes ◽

Reduction Techniques ◽

Antenatal Stress ◽

Fetal Organs ◽

The Impact

Background: Antenatal period is a time of rapid change during which fetal organs are vulnerable to various stressors. Studies have suggested that psychosocial stressors during pregnancy could adversely influence physical and behavioral outcomes of the infant. Aim: This paper aimed to discusses the importance of antenatal stress assessment and management on both mothers' and infants' health status. Method: This review aggregated evidence from various studies that examined the impact of maternal stress management and its outcomes on pregnant women and their infants. Results: Maternal stress is generally associated with unpleasant fetal outcomes. The use of stress reduction techniques was approved to reduce psychological stress in pregnant women. Conclusion: Ongoing assessment of antenatal stress using a standardized process promotes proper stress handling strategy.

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