Characteristics and Outcomes of Pregnant Women Admitted to Hospital With Confirmed SARS-CoV-2 Infection in UK: National Population Based Cohort Study

Acesse o original: https://pubmed.ncbi.nlm.nih.gov/32513659/

Characteristics and Outcomes of Pregnant Women Admitted to Hospital With Confirmed SARS-CoV-2 Infection in UK: National Population Based Cohort Study

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Free PMC article

Abstract

Objectives: To describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants.

Design: Prospective national population based cohort study using the UK Obstetric Surveillance System (UKOSS).

Setting: All 194 obstetric units in the UK.

Participants: 427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020.

Main outcome measures: Incidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission.

Results: The estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth.

Conclusions: Most pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation.

Study registration: ISRCTN 40092247.

Preeclampsia-like Syndrome Induced by Severe COVID-19: A Prospective Observational Study

Preeclampsia-like Syndrome Induced by Severe COVID-19: A Prospective Observational Study

Abstract

Objectives: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to preeclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19.

Design: A prospective, observational study.

Setting: Tertiary referral hospital.

Participants: Singleton pregnancies with COVID-19 at >20+0 weeks.

Methods: 42 consecutive pregnancies were recruited and classified into two groups: severe and nonsevere COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE.

Main outcome measures: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF.

Results: 34 cases were classified as nonsevere and 8 as severe COVID-19. Six (14.3%) women presented signs and symptoms of PE, all six being among the severe COVID-19 cases (75.0%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. Two cases remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome.

Conclusions: Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Health care providers should be aware of its existence and monitor pregnancies with suspected preeclampsia with caution.

Keywords: COVID-19; PlGF; SARS; SARS-CoV-2; angiogenic factors; preeclampsia; preeclampsia-like syndrome; pregnancy; sFlt-1.

Association Between Mode of Delivery Among Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain

Publicado originalmente no JAMA Network. Acesse o original (em inglês)
JAMA. Published online June 8, 2020. doi:10.1001/jama.2020.10125
Data from China found severe complications in 8% of pregnant women with coronavirus disease 2019 (COVID-19).1 However, the high rate of cesarean deliveries (>90%) in Chinese reports is concerning,2 and whether mode of delivery is associated with maternal complications or neonatal transmission is unknown.3 We assessed births to women with COVID-19 by mode of delivery.

Caring for Women Who Are Planning a Pregnancy, Pregnant, or Postpartum During the COVID-19 Pandemic

Caring for Women Who Are Planning a Pregnancy, Pregnant, or Postpartum During the COVID-19 Pandemic

JAMA. Published online June 5, 2020. doi:10.1001/jama.2020.8883

Acesse o original
AB – Since its recognition in China in December 2019, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world and become a pandemic. Although considerable data on COVID-19 are available, much remains to be learned about its effects on pregnant women and newborns.No data are currently available to assess whether pregnant women are more susceptible to COVID-19. Pregnant women are at risk for severe disease associated with other respiratory illnesses (eg, 2009 H1N1 influenza), but thus far, pregnant women with COVID-19 do not appear to be at increased risk for severe disease compared with the general population. Data from China showed that among 147 pregnant women, 8% had severe disease and 1% had critical illness, which are lower rates than observed in the nonpregnant population (14% with severe disease and 6% with critical illness). Case series from China consisting primarily of women with third-trimester infection have shown that clinical findings in pregnant women are similar to those seen in the general population. Conversely, a small Swedish study reported that pregnant and postpartum women with COVID-19 were 5 times more likely to be admitted to an intensive care unit compared with nonpregnant women of similar age.

Provider: Silverchair
Database: AmericanMedicalAssociation

Pesquisa inédita da UFC revela níveis elevados de estresse e risco de depressão em gestantes no distanciamento

Publicado originalmente no Portal da UFC – Universidade Federal do Ceará

Imagem: Mais de mil mulheres grávidas em isolamento social participaram da pesquisa (Foto: Marcello Casal Jr./ABr)

Pesquisa inédita da Universidade Federal do Ceará revelou níveis elevados de estresse e risco de depressão em mulheres grávidas de Fortaleza, no período de distanciamento social decorrente da COVID-19. Coordenado pela Profª Márcia Machado, da Faculdade de Medicina da UFC, o estudo mostrou que cerca de 43% das gestantes demonstram medo, ansiedade e transtornos do comportamento, índice considerado alto, se comparado com a média de 25% detectada em pesquisas realizadas em outros períodos, a exemplo da Pesquisa de Saúde Materno-Infantil no Ceará/UFC (PESMIC).

O estudo “Gravidez durante a COVID-19 em Fortaleza, Ceará: percepção materna sobre saúde, expectativas, medo e os cuidados prestados ao filho”, realizado de forma on-line durante o período de distanciamento, contou com a participação de 1.041 mulheres, abrangendo todas as regionais administrativas da Capital. A pesquisa utilizou como parâmetros duas escalas sobre saúde mental (SRQ e “Fear of COVID-19”).

As gestantes responderam aos questionários enviados pelo WhatsApp e outras redes sociais, com apoio de lideranças comunitárias e de serviços do Estado e do Município. Resultados preliminares apontam que 84,3% sentem desconforto ao pensar na COVID-19; 74,6% sentem-se assustadas ao pensar no coronavírus; 18,7% não conseguem dormir; 75,3% sentem-se nervosas ao assistir a notícias na televisão; 49,8% têm chorado mais do que o costume; e 57,9% têm se sentido triste ultimamente.

Das 1.041 mulheres, 335 afirmaram ter filhos de 1 a 5 anos completos. Perguntadas sobre como agiram com os filhos nos 15 dias anteriores ao preenchimento do questionário, 18,8% disseram ter batido no filho; 70,6% ter gritado; 20,1% ter puxado a orelha, dado tapa ou batido na mão. Para a Profª Márcia Machado, os dados são reveladores do nível de estresse no período de isolamento, se comparados com outros estudos que costumam avaliar a saúde mental de grávidas em períodos “normais”.

Imagem: A Profª Márcia Machado, da Faculdade de Medicina, é a coordenadora da pesquisa (Foto: Viktor Braga/UFC)

A pesquisadora chama a atenção para o fato de a maioria das respondentes ser casada (ou viver em união estável) e ter pelo menos o ensino médio concluído: “Se essa população que tem níveis de escolaridade maior e vive com um companheiro apresentou nível elevado de estresse, podemos imaginar como estão as mulheres que vivem em situação de extrema pobreza“, reflete a Profª Márcia.

Transtornos psicológicos ou psiquiátricos na gravidez podem trazer consequências para a saúde da mulher e do bebê. Segundo a pesquisadora, há relação entre esses fatores e a maior incidência de partos prematuros ou de crianças nascidas com baixo peso, por exemplo.

Além disso, o nível de estresse pode acarretar maiores níveis de agressividade com filhos e parceiros, o que também prejudica o desenvolvimento infantil. Márcia aponta, portanto, para a necessidade da criação de protocolos especiais de atenção básica que garantam o acompanhamento de mulheres durante a gravidez e no pós-parto, neste período de pandemia.

Os dados completos da pesquisa deverão, em breve, ser publicados em periódicos nacionais e internacionais. Segundo a Profª Márcia, não há estudos semelhantes concluídos sobre essa situação específica de mulheres grávidas durante o distanciamento social. A proposta é ampliar essa pesquisa e acompanhar aquelas mulheres e seus bebês após o parto, por um período de três anos.

A pesquisa foi financiada pela Fundação Maria Cecília Souto Vidigal e contou com a participação de estudantes de pós-graduação da UFC (Camila Machado de Aquino, Jordan Prazeres Freitas, Francisco Ariclene Oliveira, Edgar Sampaio); de professores dos departamentos de Saúde Pública e de Saúde Materno-Infantil da UFC (Luciano Lima Correia, Hermano Lima Rocha, Herlânio Costa Carvalho); da presidente da Associação de Ginecologistas e Obstetras do Ceará, Liduina de Albuquerque Rocha de Sousa; da professora da Universidade de Ribeirão Preto Elisa Altafim; e da professora da Harvard T.H Chan School of Public Health, Marcia C. Castro.

PALESTRA NOS EU2019 – A Profª Marcia Machado, coordenadora da pesquisa, será a mediadora da palestra magna dos Encontros Universitários 2019, nesta quarta-feira (20), às 10h. A palestra “Pandemia e a saúde coletiva” será realizada pela Profª Marcia C Castro, da Harvard T.H. Chan School of Public Health, membra do Programa de Estudos Brasileiros no Centro David Rockefeller para Estudos Latino-Americanos e membra do comitê de direção do Centro de Análises Geográficas.

OS EU2019 ocorrerão em formato virtual. O link para a transmissão ao vivo da palestra magna será disponibilizado em breve.

Fonte: Profª Márcia Machado, do Departamento de Saúde Comunitária da Faculdade de Medicina da UFC – e-mail: marciamachadoufc@gmail.com

Gravidez, nascimento e a pandemia de COVID-19 nos Estados Unidos

Acesse o original (em inglês)

Pregnancy, Birth and the COVID-19 Pandemic in the United States

Published online: 14 May 2020

How quickly and in what ways are US maternity care practices changing due to the COVID-19 pandemic? Our data indicate that partners and doulas are being excluded from birthing rooms leaving mothers unsupported, while providers face lack of protective equipment and unclear guidelines. We investigate rapidly shifting protocols for in- and out-of-hospital births and the decision making behind them. We ask, will COVID-19 cause women, families, and providers to look at birthing in a different light? And will this pandemic offer a testing ground for future policy changes to generate effective maternity care amidst pandemics and other types of disasters?

Choque hiperinflamatório em crianças durante a pandemia de COVID-19

O South Thames Retrieval Service, em Londres, Reino Unido, fornece apoio e recuperação em terapia intensiva pediátrica a 2 milhões de crianças no sudeste da Inglaterra. Durante um período de 10 dias, em meados de abril de 2020, foi observado um grupo sem precedentes de oito crianças com choque hiperinflamatório, mostrando características semelhantes à doença atípica de Kawasaki, síndrome de choque da doença de Kawasaki, ou síndrome do choque tóxico (o número típico é de uma ou duas crianças por semana). Esse cluster de casos formou a base de um alerta nacional.

Acesse o artigo original no The Lancet

Hyperinflammatory shock in children during COVID-19 pandemic

Published: May 07, 2020  DOI:https://doi.org/10.1016/S0140-6736(20)31094-1

Síndrome inflamatória multissistêmica em crianças e adolescentes associada à COVID-19 (MS)

BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Coordenação-Geral do Programa Nacional de Imunizações. SEI/MS – 0014893980 – Anexo. Nota de Alerta: Síndrome inflamatória multissistêmica em crianças e adolescentes associada à COVID-19. 22 Mai.2020.

O Ministério da Saúde, por intermédio do Programa Nacional de Imunizações e da Coordenação de Saúde da Criança e Aleitamento Materno, assim como a Sociedade Brasileira de Pediatria, representada neste documento pelos Departamentos Científicos de Infectologia e Reumatologia, e a Sociedade Brasileira de Reumatologia, bem como a Organização Pan Americana de Saúde, reconhecem a necessidade deste alerta à comunidade pediátrica, reforçando a importância do diagnóstico e tratamento precoces.

Publicado originalmente no Portal de Boas Práticas em Saúde da Mulher, da Criança e do Adolescente do IFF-Fiocruz, acesse o original.

Oedipus and the Coronavirus Pandemic

Oedipus and the Coronavirus Pandemic (acesse o original)

JAMA. Published online May 21, 2020. doi:10.1001/jama.2020.8594

Last week I faced the task of telling brand-new parents that their 2-lb premature son needed emergency surgery. The conversation was all the more difficult because, surgery or no surgery, odds were he would die. They agreed to the procedure with one request: that we allow his grandparents and uncles the chance to meet him first. They didn’t want their son to die alone.

Ordinarily, I could facilitate such a reasonable request. Even in normal times, the hospital isolates patients from home, family, and community, so this seemed like a small sliver of grace. Yet even this was now precluded; in response to the ongoing pandemic, our hospital has instituted a necessarily stringent visitor policy.

The most inflexible policies are reserved for the COVID-19 unit, which only allows one parent, clothed in gown, gloves, mask, and goggles, to stay per sick child. This parent cannot leave the hospital room until the child is discharged. Knowing they too will likely get infected, parents choose to enter in so their child does not suffer alone.

The isolation we have experienced during the current pandemic has refocused our attention on the tendency of modern medicine to isolate individual patients. There lies a strict barrier, for example, between my operating room and the world outside. Only a select few are permitted to enter. And patients are often left alone in our ICUs, lulled by the rumbling of machines while in a semiconscious state. Pandemic-era policies have simply intensified the isolation that has already established itself as routine in medicine: we isolate the sick to make them well.

To be sure, in our current moment, the isolation and physical distancing so many endure are an acute necessity. But these severe measures should impassion us to lessen the isolation of those we care for once the pandemic is behind us. As we look forward, can we reimagine communal health, the practice of medicine, and the more subtle ways our systems and procedures might change?

Before the current pandemic, poet-farmer and cultural critic Wendell Berry reflected on the isolating effects of medicine in the wake of his brother’s massive heart attack. John, Berry’s brother, required emergency surgery and lengthy intensive care, which necessarily removed him from his daily life and community. During his hospitalization, Berry recalls, “the world of specialization, machinery, and abstract procedure” seemed incompatible with the world John came from—the world of love—embodied in the family, friends, and neighbors who gathered at his bedside. This community attempted to preserve John’s connection to the outside world and more importantly, to his humanity. Despite medicine’s seemingly necessary focus on the individual patient, Berry claims that community is “the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms.”1

Our current scenario and the isolation it requires contains haunting echoes of Oedipus’ Thebes when it was ravaged by plague. In the opening scene of the classic Greek tragedy Oedipus Rex, the contagion’s effects are evident as the streets lie empty, children are ripped from their parents, and citizens from their polis. A priest laments:

A blight is on the fruitful plants of the earth,
a blight is on the cattle in the fields,
a blight is on our women that no children
are born to them; a god that carries fire,
a deadly pestilence, is on our town,
strikes us and spares not, and the house of Cadmus
is emptied of its people while black Death
grows rich in groaning and in lamentation.”2
Eugene-Ernest Hillemacher (1818-1887), Oedipus and Antigone Exiled From Thebes, circa 1843, French. Oil on canvas.
Eugene-Ernest Hillemacher (1818-1887), Oedipus and Antigone Exiled From Thebes, circa 1843, French. Oil on canvas. Musée des Beaux-Arts, Orleans, France. Bridgeman Images.

As the play continues, we learn that the pestilence is divine retribution for the murder of the late King Laius and that only by finding and banishing the one guilty of his murder will Thebes be saved from calamity. So the city turns to its new king Oedipus, a wise leader beloved by all who was crowned after his wit and intelligence earlier saved Thebes from the deadly Sphinx by solving her riddle.

It is to Oedipus’ (and our) shock and horror that he discovers he killed his father. Apollo’s oracle had prophesied Laius’ murder at Oedipus’ birth. Attempting to defy the prophecy, Laius leaves Oedipus to die on a hillside. The child is rescued and raised in Corinth and, learning of the prophecy when he comes of age, flees. During this flight Oedipus meets Laius at a crossroad and is forced off the path. Enraged, he kills the old man not knowing him to be both his father and king. Oedipus also unknowingly takes his mother Jocasta as his wife—a reward for freeing Thebes from the Sphinx. The climax of the tragedy is Oedipus’ recognition of these transgressions, and that his greatest strength—his proverbial sight, his wit and wisdom—are the source of plague on the entire city of Thebes. So humbled, he pierces his eyes that he might not ever deceive himself or harm others again and leaves the city in order to redeem it, sightless and never to return.

The story in Oedipus Rex sheds light on our current reality, accentuating some of the moral problems of modern medicine beyond the question of ventilator rationing.

What the polis finally relies on for its salvation—Oedipus himself, seemingly the greatest of its mortal hopes—is found to be the cause of its own demise. Likewise, medicine, at the same time that it brings much healing, becomes the means of patients’ isolation and intensifies the antimembership of our procedures, inadvertently in normal times, by design during this pandemic.

The plague of Thebes also speaks to the communal nature of suffering. Despite the modern fixation on “individualized medicine,” the current pandemic reveals radical individualism as a facade. We are social animals. A physician in New York recently told me, “The worst part about COVID-19 is that patients die alone, without their families by their sides.” Experts recognize that the isolation experienced by mandated physical distancing is having serious mental health consequences.3

As a genre, tragedy aims to teach citizens how to bear and respond to suffering, how and when it is proper to feel pity and fear. The original Athenian audience watching the play would have recognized that if this could happen to Oedipus, “whom all men call the Great,” the same could happen to them.2 Tragedy instructs us to accept the limits of our existence. The coronavirus is a reminder of our vulnerability and our finitude. Oedipus, despite his wit and intelligence, could not save his family or city from suffering and death. Similarly, medicine, despite its remarkable technological advances, ultimately cannot save us from the same.

Yet even in suffering there is hope. Although Oedipus leaves Thebes, he does not leave alone. Neither does he suffer alone. In Sophocles’ late play Oedipus at Colonus, he is attended by his daughters. No easy task, Antigone and Ismene suffer alongside the old blind man. Because he has not been completely isolated, his suffering can be shared and informed by love. A messenger recounts the deathbed encounter between Oedipus and his daughters:

Then the earth groaned with thunder from the god below;
and as they heard the sound, the girls shuddered
and dropped to their father’s knee, and began wailing,
beating their breasts and weeping, as if heartbroken.
And hearing them cry out so bitterly
he put his arms around them, and said to them:
“Children, this day your father is gone from you.
All that was mine is gone. You shall no longer
bear the burden of taking care of me—
I know it was hard, my children. And yet one word
frees us of all the weight and pain of life:
that word is love.”4

In my job, I feel defeated by death almost daily amidst the seemingly endless buzz of machines and procedures. Yet, as Berry reminds us, “the world of love includes death, suffers it, and triumphs over it…the world of love continues, and of this grief is the proof.”1 Perhaps one way to prevent medicine from becoming the enemy of its own kindred, as Oedipus inadvertently was to Thebes, is to ensure that love, which wills the good of the other, is present—even in a pandemic, even when supplies are short. Medicine is at its finest when it restores individual patients to the world of love. Seen from this perspective, the work of medicine itself can be an act of love.

 

And so I bring my patient back from the operating room to his expectant parents, grandparents, and uncles, back from the world of isolation, machines, and abstraction, into the world of love.

Article Information

Corresponding Author: Ryan M. Antiel, MD, MSME, Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, One Children’s Place, St Louis, MO 63110 (ryan.antiel@wustl.edu).

Published Online: May 21, 2020. doi:10.1001/jama.2020.8594

Conflict of Interest Disclosures: None reported.

References

1.

Berry  W.  Another Turn of the Crank: Essays. Counterpoint; 1995.

2.

Sophocles. Oedipus the King. In: Grene  D, Lattimore  R, Griffith  M, Most  GW, trans, eds.  Sophocles I. 3rd ed. University of Chicago Press; 1991:73-142.

3.

Galea  S, Merchant  RM, Lurie  N.  The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention.   JAMA Intern Med. Published online April 10, 2020. doi:10.1001/jamainternmed.2020.1562
ArticlePubMedGoogle Scholar

4.

Sophocles. Oedipus at Colonus. In: Grene  D, Lattimore  R, Griffith  M, Most  GW, trans, eds.  Sophocles I. 3rd ed. University of Chicago Press; 1991:145-224.