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Yamada EJ, Petró GDS, Rohden GB, Marques CT, Schwarzbold AV, Backes DS. Safety of spinal anesthesia in pregnant vaccinated with one or two doses of the BNT162b2 vaccine: A retrospective observational cohort study. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2023; 32:100323. [PMID: 37260912 PMCID: PMC10199485 DOI: 10.1016/j.pcorm.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/12/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
Purpose To evaluate the safety of spinal anesthesia in pregnant women who underwent cesarean section during the Covid-19 pandemia and were immunized with the BNT162b2 vaccine. Methods Historical cohort study that included three groups: non-vaccinated pregnant with no history of acute or previous Covid-19 [NV (n = 70)], vaccinated with one dose [1D (n = 65)] or two doses of BNT162b2 [2D (n = 45)], who underwent cesarean section with spinal anesthesia. Variables with normal distribution were analyzed with ANOVA. When one or more groups had non-normal distribution, the Kruskal-Wallis test was used. For categorical variables, the chi-square test or Kruskal-Wallis test was performed. When any variable had a frequency of less than five, the two-tailed Fisher's exact test with the Freeman-Halton extension was used. The significance level considered was p < .05. Results Apparently there is no interaction between BNT162b2 and the drugs most commonly used in spinal anesthesia for cesarean delivery. Conclusion: Performing spinal anesthesia in patients immunized with BNT162b2 does not seem to result in significant differences in outcomes compared to those not vaccinated. Apparently there is no need to change the standards of performing spinal anesthesia in patients vaccinated with the BNT162b2 vaccine.
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Affiliation(s)
- Eduardo J Yamada
- Mestrado Profissional em Saúde Materno Infantil, Universidade Franciscana (UFN), Santa Maria-RS, Brazil. CET Manoel Alvarez, Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Gabriel dS Petró
- CET Manoel Alvarez, Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Guilherme B Rohden
- CET Manoel Alvarez, Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Clandio T Marques
- Mestrado Profissional em Saúde Materno Infantil, Universidade Franciscana (UFN), Santa Maria, RS, Brazil
| | - Alexandre V Schwarzbold
- Chief of Clinical Research Unity (UPC), Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Dirce S Backes
- Mestrado Profissional em Saúde Materno Infantil, Universidade Franciscana (UFN), Santa Maria, RS, Brazil
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Abstract
Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.
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Affiliation(s)
- Stephen E Lapinsky
- Faculty of Medicine, University of Toronto, Canada,Intensive Care Unit, Mount Sinai Hospital, Canada,Interdepartmental Division of Critical Care Medicine, University of Toronto,
Canada,Stephen Lapinsky, Faculty of Medicine, University
of Toronto, 600 University Ave, #18-214, Toronto, ON M5G1X5, Canada
| | - Maha Al Mandhari
- Interdepartmental Division of Critical Care Medicine, University of Toronto,
Canada
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Rojas-Suarez J, Miranda J. COVID-19 in Pregnancy. Clin Chest Med 2022; 44:373-384. [PMID: 37085226 PMCID: PMC9682053 DOI: 10.1016/j.ccm.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Coronavirus disease-2019 (COVID-19) infection during pregnancy is associated with severe complications and adverse effects for the mother, the fetus, and the neonate. The frequency of these outcomes varies according to the region, the gestational age, and the presence of comorbidities. Many COVID-19 interventions, including oxygen therapy, high-flow nasal cannula, and invasive mechanical ventilation, are challenging and require understanding physiologic adaptations of pregnancy. Vaccination is safe during pregnancy and lactation and constitutes the most important intervention to reduce severe disease and complications.
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Rabaan AA, Bakhrebah MA, Mutair AA, Alhumaid S, Al-Jishi JM, AlSihati J, Albayat H, Alsheheri A, Aljeldah M, Garout M, Alfouzan WA, Alhashem YN, AlBahrani S, Alshamrani SA, Alotaibi S, AlRamadhan AA, Albasha HN, Hajissa K, Temsah MH. Systematic Review on Pathophysiological Complications in Severe COVID-19 among the Non-Vaccinated and Vaccinated Population. Vaccines (Basel) 2022; 10:985. [PMID: 35891149 PMCID: PMC9318201 DOI: 10.3390/vaccines10070985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
COVID-19, caused by SARS-CoV-2, is one of the longest viral pandemics in the history of mankind, which have caused millions of deaths globally and induced severe deformities in the survivals. For instance, fibrosis and cavities in the infected lungs of COVID-19 are some of the complications observed in infected patients post COVID-19 recovery. These health abnormalities, including is multiple organ failure-the most striking pathological features of COVID-19-have been linked with diverse distribution of ACE2 receptor. Additionally, several health complications reports were reported after administration of COVID-19 vaccines in healthy individuals, but clinical or molecular pathways causing such complications are not yet studied in detail. Thus, the present systematic review established the comparison of health complication noted in vaccinated and non-vaccinated individuals (COVID-19 infected patients) to identify the association between vaccination and the multiorgan failure based on the data obtained from case studies, research articles, clinical trials/Cohort based studies and review articles published between 2020-2022. This review also includes the biological rationale behind the COVID-19 infection and its subsequent symptoms and effects including multiorgan failure. In addition, multisystem inflammatory syndrome (MIS) has been informed in individuals post vaccination that resulted in multiorgan failure but, no direct correlation of vaccination with MIS has been established. Similarly, hemophagocytic lymphohistiocytosis (HLH) also noted to cause multiorgan failure in some individuals following full vaccination. Furthermore, severe complications were recorded in elderly patients (+40 years of age), indicates that older age individuals are higher risk by COVID-19 and post vaccination, but available literature is not sufficient to comply with any conclusive statements on relationship between vaccination and multiorgan failure.
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Affiliation(s)
- Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Muhammed A. Bakhrebah
- Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia;
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia;
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia
- Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran 33048, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia;
| | - Jumana M. Al-Jishi
- Internal Medicine Department, Qatif Central Hospital, Qatif 32654, Saudi Arabia;
| | - Jehad AlSihati
- Internal Medicine Department, Gastroenterology Section, King Fahad Specialist Hospital, Dammam 31311, Saudi Arabia;
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh 7790, Saudi Arabia; (H.A.); (A.A.)
| | - Ahmed Alsheheri
- Infectious Disease Department, King Saud Medical City, Riyadh 7790, Saudi Arabia; (H.A.); (A.A.)
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39524, Saudi Arabia;
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Wadha A. Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait;
- Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait
| | - Yousef N. Alhashem
- Department of Clinical Laboratory Sciences, Mohammed AlMana College of Health Sciences, Dammam 34222, Saudi Arabia;
| | - Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 31932, Saudi Arabia;
| | - Saleh A. Alshamrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia;
| | - Sultan Alotaibi
- Molecular Microbiology Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Abdullah A. AlRamadhan
- Laboratory and Toxicology Department, Security Forces Specialized Comprehensive Clinics, Al-Ahsa 36441, Saudi Arabia;
| | - Hanadi N. Albasha
- Department of Infection Prevention and Control, Obeid Specialized Hospital, Riyadh 12627, Saudi Arabia;
| | - Khalid Hajissa
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
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Ghafoor H, Abdus samad A, Bel Khair AOM, Ahmed O, Khan MNA. Critical Care Management of Severe COVID-19 in Pregnant Patients. Cureus 2022; 14:e24885. [PMID: 35572463 PMCID: PMC9097928 DOI: 10.7759/cureus.24885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 12/15/2022] Open
Abstract
Since December 2019, the coronavirus disease (COVID-19) pandemic has had a disastrous impact worldwide. COVID-19 is caused by the SARS-CoV-2 virus and was declared a pandemic by the WHO on March 11, 2020. The virus has been linked to a wide range of respiratory illnesses, ranging from mild symptoms to acute pneumonia and severe respiratory distress syndrome. Pregnant women are more vulnerable to COVID-19 complications owing to the physiological and immunological changes caused by pregnancy. According to the CDC, pregnant patients with COVID-19 are commonly hospitalized and often require admission to ICUs and ventilator support. Therefore, it is especially important for pregnant women to adhere to disease prevention measures to lower the risk of contracting the disease. In addition, the guidelines of several clinical societies and local health authorities should be followed when caring for pregnant women with suspected or confirmed COVID-19. In this review article, we discuss the epidemiology of COVID-19 during delivery, its effect on the physiological and immunological changes during pregnancy, the classification of COVID-19 severity, maternal and fetal risks, antenatal care, respiratory management, treatment/medication safety, timing and mode of delivery, anesthetic considerations, and the outcome of critically ill pregnant patients with COVID-19, as well as their post-delivery care and weaning from mechanical ventilation.
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6
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Abstract
The purpose of this review is to describe updates following initial recommendations on best anesthesia practices for obstetric patients with coronavirus disease 2019. The first surge in the United States prompted anesthesiologists to adapt workflows and reconsider obstetric anesthesia care, with emphasis on avoidance of general anesthesia, the benefit of early neuraxial labor analgesia, and prevention of emergent cesarean delivery whenever possible. While workflows have changed to allow sustained safety for obstetric patients and health care workers, it is notable that obstetric anesthesia protocols for labor and delivery have not significantly evolved since the first coronavirus disease 2019 wave.
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Bhatia K. Obstetric analgesia and anaesthesia in SARS-CoV-2-positive parturients across 10 maternity units in the north-west of England: a retrospective cohort study. Anaesthesia 2022; 77:389-397. [PMID: 35226768 PMCID: PMC9111485 DOI: 10.1111/anae.15672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/11/2022]
Abstract
Since the start of the COVID‐19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS‐CoV‐2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS‐CoV‐2 across 10 hospitals in the north‐west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS‐CoV‐2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID‐19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64–1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6–96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64, 95%CI 1.19–2.22; p = 0.002); of Asian ethnicity (OR 1.54, 1.04–2.28; p = 0.03); to deliver prematurely (OR 2.16, 95%CI 1.47–3.19; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16–2.12; p = 0.008); and a higher critical care utilisation rate both pre‐ (8% vs. 0%, p = 0.001) and post‐delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83–6.52; p = 0.001). Eight neonates tested positive for SARS‐CoV‐2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78–1.57; p = 0.55). In women with COVID‐19, non‐neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID‐19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.
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Affiliation(s)
- K Bhatia
- Manchester University NHS Foundation Trust, Manchester, UK
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8
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Chen F, Zhu S, Dai Z, Hao L, Luan C, Guo Q, Meng C, Zhang Y. Effects of COVID-19 and mRNA vaccines on human fertility. Hum Reprod 2021; 37:5-13. [PMID: 34734259 PMCID: PMC8689912 DOI: 10.1093/humrep/deab238] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/09/2021] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has precipitated a global health crisis of unprecedented proportions. Because of its severe impact, multiple COVID-19 vaccines are being rapidly developed, approved and manufactured. Among them, mRNA vaccines are considered as ideal candidates with special advantages to meet this challenge. However, some serious adverse events have been reported after their application, significantly increasing concerns about the safety and efficacy of the vaccines and doubts about the necessity of vaccination. Although several fertility societies have announced that COVID-19 mRNA vaccines are unlikely to affect fertility, there is no denying that the current evidence is very limited, which is one of the reasons for vaccine hesitancy in the population, especially in pregnant women. Herein, we provide an in-depth discussion on the involvement of the male and female reproductive systems during SARS-CoV-2 infection or after vaccination. On one hand, despite the low risk of infection in the male reproductive system or fetus, COVID-19 could pose an enormous threat to human reproductive health. On the other hand, our review indicates that both men and women, especially pregnant women, have no fertility problems or increased adverse pregnancy outcomes after vaccination, and, in particular, the benefits of maternal antibodies transferred through the placenta outweigh any known or potential risks. Thus, in the case of the rapid spread of COVID-19, although further research is still required, especially a larger population-based longitudinal study, it is obviously a wise option to be vaccinated instead of suffering from serious adverse symptoms of virus infection.
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Affiliation(s)
- Fei Chen
- Department of Physiology, Jining Medical University, Jining, China
| | - Shiheng Zhu
- Department of Physiology, Jining Medical University, Jining, China
| | - Zhiqing Dai
- Department of Physiology, Jining Medical University, Jining, China
| | - Lanting Hao
- Department of Physiology, Jining Medical University, Jining, China
| | - Chun Luan
- Department of Physiology, Jining Medical University, Jining, China
| | - Qi Guo
- Department of Physiology, Jining Medical University, Jining, China
| | - Chaofan Meng
- Department of Physiology, Jining Medical University, Jining, China
| | - Yankun Zhang
- Department of Physiology, Jining Medical University, Jining, China
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