Therapeutic opportunities for improving the course of coronavirus disease and reducing the frequency of gestional complications

Research objective: to study the clinical efficacy of the proposed treatment complex in pregnant women with coronavirus disease (COVID-19).Materials and methods. 60 pregnant women with a moderate COVID-19 who were treated at the Kyiv City Center for Reproductive and Perinatal Medicine were examined and selected to assess the effectiveness of the proposed treatment. Pregnant women were divided into 2 clinical groups: the main group (n = 30) were prescribed treatment complex with progestin, the comparison group consisted of 30 pregnant women with COVID-19, who did not differ in age, sex, body mass index and received only standard drug therapy. Given the immunomodulatory effect, micronized progesterone was administered orally 200 mg three times a day immediately after hospitalization for 2 weeks, regardless of gestational age. Clinical manifestations, laboratory and instrumental indicators, duration of oxygen therapy and respiratory support, duration of hospital stay and intensive care were analyzed to assess the treatment complex.Results. Therapeutic complex with progesterone helps to reduce the severity of respiratory disorders in pregnant women with COVID-19, the general condition of pregnant women improves faster and inflammatory changes in the lungs regress. The positive dynamics of pulse oximetry indicators was noted. The frequency of the additional methods of respiratory support and transfer to the intensive care unit were lower, and a more rapid normalization of laboratory parameters was noted. Incidence of gestational complications (threats of pregnancy termination, placental insufficiency, fetal growth retardation and distress, oligohydramnios, premature birth and premature rupture of membranes) was lower against the background of treatment with progesterone, children status was better at birth. The need for oxygen therapy, the length of stay in the intensive care unit and the total length of hospitalization are significantly reduced when progesterone was prescribed for pregnant women with COVID-19.Conclusions. The use of progesterone in pregnant women with coronavirus disease has a stabilizing effect, has no negative side effects which is significantly expands the scope of the proposed therapy in pregnant women at different stages of gestation.

International Academy of Perinatal Medicine (IAPM) guidelines for screening, prediction, prevention and management of pre-eclampsia to reduce maternal mortality in developing countries

Approximately 800 women die from pregnancy or childbirth-related complications around the world every day, 99% of which occur in developing countries. In majority of cases deaths are related to pre-eclampsia and eclampsia. The purpose of new adjusted and simplified IAPM guidelines is specifically lowering maternal mortality by decreasing preventable deaths in developing countries (particularly in remote rural areas) by using rather cheap medicines used to control chronic and gestational hypertension, prevent pre-eclampsia in high-risk pregnancies and treat severe pre-eclampsia and eclampsia. IAPM guidelines should be implemented and evaluated in each developing country respecting specific problems, needs and resources. It is of essential importance to: 1. Identify specific high-risk pregnancies, 2. Commence timely appropriate ASA and calcium supplementation, 3. Organize basic antenatal care and adequate referral of pregnancies with early onset of pre-eclampsia to the appropriate institutions and ensure induction of labour in well-equipped delivery facility for women with near-term and term pre-eclampsia 4. Ensure Magnesium sulphate availability to prevent severe pre-eclampsia and eclampsia-related maternal deaths, and 5. Identify specific barriers for implementation of these guidelines and correct them accordingly. Only by systematic implementations of these guidelines, we may have a chance to decrease the mortality of pre-eclampsia an its complications as a killer number one of mothers in developing countries.

On the cutting edge: key findings on maternal and neonatal outcomes in women with COVID-19 in a study by the World Association of Perinatal Medicine

The World Association of Perinatal Medicine (WAPM) study on the COrona VIrus Disease 2019 (COVID-19) was an international, retrospective cohort study that included pregnant women tested positive with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between February and April 2020. The study involved 73 centers from 22 countries. The WAPM study included 388 singletons, viable pregnancies, positive to SARS-CoV-2 at real-time reverse-transcriptase-polymerase-chain-reaction nasal and pharyngeal swab. The majority of the included women were symptomatic. The occurrence of maternal adverse events was significantly higher in symptomatic, compared with asymptomatic pregnant women. Women carrying high-risk pregnancies (either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy) were at a higher risk of hospital admission, presence of severe respiratory symptoms, admission to the intensive care unit, and invasive mechanical ventilation. As per maternal outcomes, the occurrence of fetal and neonatal adverse events was significantly higher in symptomatic, compared with asymptomatic pregnant women. The incidence of a composite adverse fetal outcome was significantly higher when the infection occurred in the first trimester, and in fetuses with lower birthweight.

Global Health Education and Best Practices for Neonatal-Perinatal Medicine Trainees

Neonatal-perinatal medicine (NPM) trainees are expressing an increased interest in global health. NPM fellowship programs are tasked with ensuring that interested fellows receive appropriate training and mentorship to participate in the global health arena. Global health engagement during fellowship varies based on a trainee’s experience level, career goals, and academic interests. Some trainees may seek active learning opportunities through clinical rotations abroad whereas others may desire engagement through research or quality improvement partnerships. To accommodate these varying interests, NPM fellows and training programs may choose to explore institutional partnerships, opportunities through national organizations with global collaborators, or domestic opportunities with high-risk populations. During any global health project, the NPM trainee needs robust mentorship from professionals at both their home institution and their partner international site. Trainees intending to use their global health project to fulfill the American Board of Pediatrics (ABP) scholarly activity requirement must also pay particular attention to selecting a project that is feasible during fellowship and also meets ABP criteria for board eligibility. Above all, NPM fellows and training programs should strive to ensure equitable, sustainable, and mutually beneficial collaborations.

Treatment status of extremely premature infants with gestational age < 28 weeks in a Chinese perinatal center from 2010 to 2019

Background There is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations. Methods We established a real-world ambispective cohort study of all live births in delivery rooms with gestational age (GA) between 24+0 and 27+6 weeks from 2010 to 2019. Results Of the 1163 EPIs included in our study, 241 (20.7%) survived, while 849 (73.0%) died in the delivery room and 73 (6.3%) died in the neonatal intensive care unit. Among all included EPIs, 862 (74.1%) died from withholding or withdrawal of care. Regardless of stratification according to GA or birth weight, the proportion of total mortality attributable to withdrawal of care is high. For infants with the GA of 24 weeks, active treatment did not extend their survival time (P = 0.224). The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). Over time, the survival rate improved, and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced significantly (P < 0.001). Conclusions The mortality rate of EPIs is still high. Withdrawal of care is common for EPIs with smaller GA, especially in the delivery room. It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities.

119 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high-risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis, because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents' retrospective perceptions of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted: 20 with the biological mother, two with both biological parents, and one with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews included parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.