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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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Maisonneuve E, de Bruin O, Favre G, Goncé A, Donati S, Engjom H, Hurley E, Al-Fadel N, Siiskonen S, Bloemenkamp K, Nordeng H, Sturkenboom M, Baud D, Panchaud A. Evolution of National Guidelines on Medicines Used to Treat COVID-19 in Pregnancy in 2020-2022: A Scoping Review. J Clin Med 2023; 12:4519. [PMID: 37445553 DOI: 10.3390/jcm12134519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The lack of inclusion of pregnant women in clinical trials evaluating the effectiveness of medicines to treat COVID-19 has made it difficult to establish evidence-based treatment guidelines for pregnant women. Our aim was to provide a review of the evolution and updates of the national guidelines on medicines used in pregnant women with COVID-19 published by the obstetrician and gynecologists' societies in thirteen countries in 2020-2022. Based on the results of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, the national societies successively recommended against prescribing hydroxychloroquine, lopinavir-ritonavir and azithromycin. Guidelines for remdesivir differed completely between countries, from compassionate or conditional use to recommendation against. Nirmatrelvir-ritonavir was authorized in Australia and the UK only in research settings and was no longer recommended in the UK at the end of 2022. After initial reluctance to use corticosteroids, the results of the RECOVERY trial have enabled the recommendation of dexamethasone in case of severe COVID-19 since mid-2020. Some societies recommended prescribing tocilizumab to pregnant patients with hypoxia and systemic inflammation from June 2021. Anti-SARS-CoV-2 monoclonal antibodies were authorized at the end of 2021 with conditional use in some countries, and then no longer recommended in Belgium and the USA at the end of 2022. The gradual convergence of the recommendations, although delayed compared to the general population, highlights the importance of the inclusion of pregnant women in clinical trials and of international collaboration to improve the pharmacological treatment of pregnant women with COVID-19.
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Affiliation(s)
- Emeline Maisonneuve
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, 3012 Bern, Switzerland
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Odette de Bruin
- Department of Obstetrics, WKZ Birthcentre, Division Woman and Baby, UMC Utrecht, 3584 CX Utrecht, The Netherlands
- Julius Global Health, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Anna Goncé
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Hilde Engjom
- Department of Health Promotion, Department of Health Registry Research and Development, Norwegian Institute of Public Health, N-5808 Bergen, Norway
| | - Eimir Hurley
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway
| | - Nouf Al-Fadel
- Saudi Food and Drug Authority, Riyadh 13513-7148, Saudi Arabia
| | - Satu Siiskonen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, WKZ Birthcentre, Division Woman and Baby, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway
| | - Miriam Sturkenboom
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
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3
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Poisson M, Sibiude J, Mosnino E, Koual M, Landraud L, Fidouh N, Mandelbrot L, Vauloup-Fellous C, Luton D, Benachi A, Vivanti AJ, Picone O. Impact of variants of SARS-CoV-2 on obstetrical and neonatal outcomes. J Gynecol Obstet Hum Reprod 2023; 52:102566. [PMID: 36870417 PMCID: PMC9979701 DOI: 10.1016/j.jogoh.2023.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND SARS-CoV-2 can lead to several types of complications during pregnancy. Variant surges are associated with different severities of disease. Few studies have compared the clinical consequences of specific variants on obstetrical and neonatal outcomes. Our goal was to evaluate and compare disease severity in pregnant women and obstetrical or neonatal complications between variants of SARS-CoV-2 that have circulated in France over a two-year period (2020-2022). METHOD This retrospective cohort study included all pregnant women with a confirmed SARS-CoV-2 infection (positive naso-pharyngeal RT-PCR test) from March 12, 2020 to January 31, 2022, in three tertiary maternal referral obstetric units in the Paris metropolitan area, France. We collected clinical and laboratory data for mothers and newborns from patients' medical records. Variant identification was either available following sequencing or extrapolated from epidemiological data. RESULTS There were 234/501 (47%) Wild Type (WT), 127/501 (25%) Alpha, 98/501 (20%) Delta, and 42/501 (8%) Omicron. No significative difference was found regarding two composite adverse outcomes. There were significantly more hospitalizations for severe pneumopathy in Delta variant than WT, Alpha and Omicron respectively (63% vs 26%, 35% and 6%, p<0.001), more frequent oxygen administration (23% vs 12%, 10% and 5%, p = 0,001) and more symptomatic patients at the time of testing with Delta and WT (75% and 71%) versus Alpha and Omicron variants (55% and 66% respectively, p<0.01). Stillbirth tended to be associated with variants (p = 0.06): WT 1/231 (<1%) vs 4/126 (3%), 3/94 (3%), and 1/35 (3%) in Alpha, Delta and Omicron cases respectively. No other difference was found. CONCLUSION Although the Delta variant was associated with more severe disease in pregnant women, we found no difference regarding neonatal and obstetrical outcomes. Neonatal and obstetrical specific severity may be due to mechanisms other than maternal ventilatory and general infection.
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Affiliation(s)
- M Poisson
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France
| | - J Sibiude
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France; Université Paris Cité, IAME, INSERM, Paris, France; Groupe de Recherche sur les Infections pendant la Grossesse, Colombes, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France
| | - E Mosnino
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - M Koual
- Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France; AP-HP, Hôpital Bichat, Department of Gynecology and Obstetrics, Paris, France
| | - L Landraud
- Université Paris Cité, IAME, INSERM, Paris, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France; AP-HP, Hôpital Louis Mourier, Department of Hygiene and Microbiology, Colombes, France
| | - N Fidouh
- AP-HP, Hôpital Bichat, Department of Virology, Paris, France
| | - L Mandelbrot
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France; Université Paris Cité, IAME, INSERM, Paris, France; Groupe de Recherche sur les Infections pendant la Grossesse, Colombes, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France
| | - C Vauloup-Fellous
- Saclay University, Gif-sur-Yvette, France; AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France
| | - D Luton
- AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France; APHP, Hôpital Bicêtre, Department of Gynecology and Obstetrics, Le Kremlin-Bicêtre, France
| | - A Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP 157 rue de la Porte de Trivaux, 92140, Clamart, France; AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France
| | - A J Vivanti
- Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France; AP-HP, Division of Virology, Paul Brousse Hospital, Paris Saclay University Hospitals, INSERM U1193, Villejuif, France
| | - O Picone
- AP-HP, Hôpital Louis Mourier, Department of Gynecology and Obstetrics, Colombes, France; Université Paris Cité, IAME, INSERM, Paris, France; Groupe de Recherche sur les Infections pendant la Grossesse, Colombes, France; Fédération Hospitalo-Universitaire PREMA (FHU), Paris, France.
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Ahmed AK, Sijercic VC, Sayad R, Ruthig GR, Abdelwahab SF, El-Mokhtar MA, Sayed IM. Risks and Preventions for Pregnant Women and Their Preterm Infants in a World with COVID-19: A Narrative Review. Vaccines (Basel) 2023; 11:vaccines11030640. [PMID: 36992224 DOI: 10.3390/vaccines11030640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/05/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
(1) Background and Aim: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is linked to increasing cases of coronavirus disease 2019 (COVID-19) around the world. COVID-19 infections have an important impact on pregnancy, preterm birth (PTB) and delivery. Although several complications have been reported in infected pregnant women, the effect of infection on PTB is controversial. The purpose of this study was to summarize the existing literature on the effects and complications of COVID-19 on the health of pregnant women and preterm babies and its impact on the incidence of PTB. We also discuss the effect of current COVID-19 vaccines during pregnancy. (2) Methods: We carried out a systematic search of MEDLINE, Embase, and PubMed for studies on preterm births associated with COVID-19. (3) Results and Conclusions: We discovered contradictory results regarding the prevalence of PTB during the pandemic compared to earlier years. While most studies indicated an increase in PTBs with COVID-19, some indicated a decline in the preterm delivery rate during this time. During pregnancy, COVID-19 infection can increase the incidence of cesarean section, stillbirth, ICU admission, preeclampsia/eclampsia, and mortality rates. In the treatment of pregnant women with severe COVID-19, methylprednisolone was favored over prednisolone, and a brief course of dexamethasone is advised for pregnant women with anticipated PTB to accelerate the development of the fetal lung. Generally, vaccination for COVID-19 in pregnant and lactating women stimulates anti-SARS-CoV2 immune responses, and it does not result in any noteworthy negative reactions or outcomes for the mother or baby.
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Affiliation(s)
| | | | - Reem Sayad
- Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Gregory R Ruthig
- Department of Biology, North Central College, Naperville, IL 60540, USA
| | - Sayed F Abdelwahab
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Mohamed A El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Microbiology and Immunology Department, Faculty of Pharmacy, Sphinx University, Assiut 71515, Egypt
| | - Ibrahim M Sayed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
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5
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Four Waves of the COVID-19 Pandemic: Comparison of Clinical and Pregnancy Outcomes. Viruses 2022; 14:v14122648. [PMID: 36560652 PMCID: PMC9783983 DOI: 10.3390/v14122648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
During the last two and a half years, clinical manifestations, disease severity, and pregnancy outcomes have differed among pregnant patients with SARS-CoV-2 infection. These changes were preceded by the presence of new variants of SARS-CoV-2, known in the literature as variants of concern. The aim of this study is to describe the differences between maternal clinical characteristics and perinatal outcomes among pregnant women with COVID-19 during four waves of the COVID-19 epidemic in Serbia. This retrospective study included a series of 192 pregnant patients who were hospitalized due to the severity of their clinical status of SARS-CoV-2 infection. During four outbreaks of COVID-19 infection in Serbia, we compared and analyzed three sets of variables, including signs, symptoms, and characteristics of COVID-19 infection, clinical endpoints, and maternal and newborn parameters. During the dominance of the Delta variant, the duration of hospitalization was the longest (10.67 ± 1.42 days), the frequency of stillbirths was the highest (17.4%), as well as the frequency of progression of COVID infection (28.9%) and the requirement for non-invasive oxygen support (37%). The dominance of the Delta variant was associated with the highest number of prescribed antibiotics (2.35 ± 0.28), the most common presence of nosocomial infections (21.7%), and the highest frequency of corticosteroid therapy use (34.8%). The observed differences during the dominance of four variants of concern are potential pathways for risk stratification and the establishment of timely and proper treatments for pregnant patients. Early identification of the Delta variant, and possibly some new variants with similar features in the future, should be a priority and, perhaps, even an opportunity to introduce more accurate and predictive clinical algorithms for pregnant patients.
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Franquet N, Pierart J, Defresne A, Joachim S, Fraipont V. Veno-venous Extracorporeal Membrane Oxygenation for pregnant women with Acute Respiratory Distress Syndrome: a narrative review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Acute respiratory distress syndrome remains an uncommon condition during pregnancy. In patients with severe acute respiratory distress syndrome, when oxygenation or ventilation cannot be supported sufficiently using best practice conventional mechanical ventilation and additional therapies, veno-venous extracorporeal membrane oxygenation may be considered. In the past two decades, there has been increasing adoption of this technique to support adult patients with refractory acute respiratory distress syndrome. However, its use for the management of pregnant women is rare and remains a challenge. This narrative review addresses acute respiratory distress syndrome and its management during pregnancy, and then focuses on indications, contraindications, challenges, potential complications, and outcomes of the use of veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the pregnant patient.
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7
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Hosseini MS, Jahanshahlou F, Mahmoodpoor A, Sanaie S, Naseri A, Kuchaki Rafsanjani M, Seyedi-Sahebari S, Vaez-Gharamaleki Y, ZehiSaadat M, Rahmanpour D. Pregnancy, peripartum, and COVID-19: An updated literature review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Pregnant women with covid-19 are at greater risk of severe disease than their non-pregnant peers, and yet they are frequently denied investigations or treatments because of unfounded concerns about risk to the fetus. The basic principles of diagnosing and managing covid-19 are the same as for non-pregnant patients, and a multidisciplinary, expert team approach is essential to ensure optimal care. During pregnancy, treatment with corticosteroids should be modified to use non-fluorinated glucocorticoids. Il-6 inhibitors and monoclonal antibodies, together with specific antiviral therapies, may also be considered. Prophylaxis against venous thromboembolism is important. Women may require respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position (either awake or during invasive ventilation), intubation and ventilation, and extracorporeal membrane oxygenation (ECMO). Pregnancy is not a contraindication for any of these supportive therapies, and the criteria for providing them are the same as in the general population. Decisions regarding timing, place, and mode of delivery should be taken with a multidisciplinary team including obstetricians, physicians, anesthetists, and intensivists experienced in the care of covid-19 in pregnancy. Ideally these decisions should take place in consultation with centers that have experience and expertise in all these specialties.
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Affiliation(s)
- Melanie Nana
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Kenneth Hodson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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9
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Bui TN, Huynh NM, Do-Tran NH, Ngo HA, Tran H, Nguyen NT, Pham TT, Le KD, Nguyen TA. Severe COVID-19 during pregnancy treated with pulse corticosteroid therapy and mid-trimester termination: A case report. Case Rep Womens Health 2022; 34:e00396. [PMID: 35165651 PMCID: PMC8826598 DOI: 10.1016/j.crwh.2022.e00396] [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] [Received: 01/31/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background At the early stage of the pandemic, severe COVID-19 was thought to be rare among pregnant women. However, cumulating data showed that gestational state is a risk factor for severe pneumonia, particularly due to the hyperinflammatory state. Recent reports suggested the efficacy of pulse corticosteroids in stopping the cytokine storm in people infected with SARS-CoV-2, but limited data exists regarding its use in pregnant women. Moreover, pregnancy termination is a treatment option in this population, but it has been reported mainly in the third trimester and rarely in the second trimester. Case Presentation A 37-year-old woman infected with SARS-CoV-2 at 23 weeks of gestation presented with fatigue and dyspnea but soon deteriorated to severely acute respiratory failure and cytokine storm requiring mechanical ventilation combined with hemodialysis just one day after hospitalization. Low-dose corticosteroids and antibiotics were initiated, followed by antiviral therapy, anticoagulant and high-dose corticosteroid therapy. On hospital day 3, a decision to terminate her pregnancy was made; termination led to significant improvement in her clinical condition and a gradual decrease in demand for oxygen supplementation as well as the corticosteroid dose. She was discharged two weeks after admission. Conclusions Due to the specific immune response, pregnant women with COVID-19 may differ from others in their clinical presentation, especially the probability of classic acute respiratory distress syndrome (ARDS). This report provides evidence related to the efficacy of pulse corticosteroids on this group and the influence of the mid-trimester termination on recovery. COVID-19 pneumonia can present as acute respiratory distress syndrome in pregnancy. Successful treatment of COVID-19 pneumonia with pulse corticosteroids and mid-trimester medical abortion is reported. The case highlights the need for prompt multidisciplinary team management.
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Affiliation(s)
- Thinh N. Bui
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Nhat M. Huynh
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Nguyen-Huy Do-Tran
- School of Medicine, Vietnam National University Ho Chi Minh City, Viet Nam
| | - Hoang-Anh Ngo
- Woolcock Institute of Medical Research, Hanoi, Viet Nam
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Corresponding author at: Woolcock Institute of Medical Research Vietnam, 298 Kim Ma, Ba Dinh, Hanoi, Viet Nam.
| | - Hung Tran
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Nhan T. Nguyen
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Tung T. Pham
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Kha D. Le
- COVID-19 Intensive Care Unit 2, Thu Duc City Hospital, Ho Chi Minh City, Viet Nam
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Viet Nam
- Sydney School of Medicine, The Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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10
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Giorgini C, Simonte R, Cammarota G, DE Robertis E. What's new on the management of obstetric patients who tested positive for Covid-19? Minerva Anestesiol 2022; 88:516-523. [PMID: 35199974 DOI: 10.23736/s0375-9393.22.16283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To date, there is still partial data on the effects of COVID-19 on pregnant women. The constant collection of information results in a continuous updating of the knowledge about the best management of pregnant patients affected by COVID-19. This work aims to summarize the state of the art on prevention and management of SARSCoV-2 infection in obstetric patients. This was enabled by a comprehensive literature search for the most recent and relevant publications on the subject, including guidelines and recommendations. Management of these women by a multidisciplinary team is of crucial importance, given the extreme clinical complexity of this condition. Every health worker involved must put in place all possible procedures to protect themselves from contagion. Neuraxial anesthesia should be favored in the management of labor and caesarean section over other modalities, unless there are contraindications based on the patient's status. There is still no standardized drug treatment in pregnant women with COVID-19 due to their exclusion from studies conducted to evaluate pharmacological therapies. Nevertheless, various drugs have been used to treat this disease in pregnancy, although the data at our disposal are still few. As regards mRNA vaccines, it seems that their immunogenicity, safety and tolerability in pregnant women are comparable to those of non-pregnant women of the same age. More studies are certainly needed in infected pregnant women to establish treatment and prevention protocols for this special category of patients.
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Affiliation(s)
- Carla Giorgini
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Rachele Simonte
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Gianmaria Cammarota
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Edoardo DE Robertis
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy -
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11
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Madhavpeddi L, Hammond B, Carbone DL, Kang P, Handa RJ, Hale TM. Impact of Angiotensin II Antagonism on the Sex-Selective Dysregulation of Cardiovascular Function Induced by In Utero Dexamethasone Exposure. Am J Physiol Heart Circ Physiol 2022; 322:H597-H606. [PMID: 35179975 PMCID: PMC8934675 DOI: 10.1152/ajpheart.00587.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In utero exposure to glucocorticoids in late gestation programs changes in cardiovascular function. The objective of this study was to determine the degree to which angiotensin II mediates sex-biased changes in autonomic function as well as basal and stress-responsive cardiovascular function following in utero glucocorticoid exposure. Pregnant rats were administered the synthetic glucocorticoid dexamethasone (DEX 0.4mg/kg per day, s.c.) or vehicle on gestation days 18-21. Mean arterial pressure, heart rate, and heart rate variability (HRV) were measured via radiotelemetry in freely moving, conscious adult rats. To evaluate the impact of stress, rats were placed in a restraint tube for 20 minutes. In a separate cohort of rats, restraint stress was performed before and after chronic treatment with the angiotensin type 1 receptor antagonist, losartan (30mg/kg per day, i.p). Frequency domain analysis of HRV was evaluated, and data integrated into low frequency (LF: 0.20-0.75Hz) and high frequency (HF: 0.75-2.00Hz) bands. Prenatal DEX resulted in an exaggerated pressor and heart rate response to restraint in female offspring that was attenuated by prior losartan treatment. HF power was higher in vehicle-exposed female rats, compared to DEX females. Following losartan, HF power was equivalent between female vehicle and DEX-exposed rats. In utero exposure to DEX produced female-biased alterations in stress-responsive cardiovascular function which may be indicative of a reduction in parasympathetic activity. Moreover, these findings suggest this autonomic dysregulation may be mediated in part by long-term changes in renin-angiotensin signaling.
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Affiliation(s)
- Lakshmi Madhavpeddi
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - Bradley Hammond
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - David L Carbone
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - Paul Kang
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - Robert J Handa
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States.,Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Taben M Hale
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States
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12
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Sivanandan S, Chawla D, Kumar P. Update to Perinatal-Neonatal Management of COVID-19 Guidelines. Indian Pediatr 2021. [PMID: 34810294 PMCID: PMC8821839 DOI: 10.1007/s13312-022-2423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The guidelines for diagnosing and managing perinatal SARS-CoV-2 infection for the Indian context were last updated in May 2020. Newer evidence, the evolution of the pandemic, and its significant impact on mother-infant dyads led us to review and revise the guideline. This article summarizes the salient changes in the perinatal-neonatal management of COVID-19.
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13
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Abstract
The outbreak and spread of the coronavirus disease 2019 pandemic has led to an unprecedented wealth of literature on the impact of human coronaviruses on pregnancy. The number of case studies and publications alone are several orders of magnitude larger than those published in all previous human coronavirus outbreaks combined, enabling robust conclusions to be drawn from observations for the first time. However, the importance of learning from previous human coronavirus outbreaks cannot be understated. In this narrative review, we describe what we consider to the major learning points arising from the SARS-CoV-2 pandemic in relation to pregnancy, and where these confound what might have been expected from previous coronavirus outbreaks.
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Abstract
Pregnant women with COVID-19 are less likely to be symptomatic than non-pregnant counterparts. Risk factors for severe disease include being overweight or obese, greater than 35 years old, and having pre-existing comorbidities. Those who develop severe disease have increased rates of admission to an intensive care unit, requiring invasive ventilation and pre-term birth.Pregnant and breastfeeding women with COVID-19 should be investigated as of outside pregnancy and should receive proven therapies (such as corticosteroids and tocilizumab) on a risk/benefit basis. Admitted women should receive multidisciplinary care with input from senior decision makers and early escalation where required. There are no safety concerns -surrounding the COVID-19 vaccination and fertility or pregnancy, and so it should be offered to women based on their age and clinical risk group, in line with non-pregnant women.
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Affiliation(s)
- Melanie Nana
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Catherine Nelson-Piercy
- Guy's and St Thomas' NHS Foundation Trust, London, UK and professor of obstetric medicine, King's Health Partners, London, UK
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