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Fox TP, Timpani E, Green A, Parange A, Sinha R, Kelly TL, Hodyl NA, Froessler B. Association between routine cell salvage use for lower segment caesarean section and post-operative iron infusion and anemia. Arch Gynecol Obstet 2024; 309:1935-1941. [PMID: 37233809 PMCID: PMC10214331 DOI: 10.1007/s00404-023-07082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Intraoperative cell salvage is central to Patient Blood Management including for lower segment caesarean section. Prior to April 2020, we initiated intraoperative cell salvage during caesarean section based on risk assessment for hemorrhage and patient factors. As the pandemic broadened, we mandated intraoperative cell salvage to prevent peri-partum anemia and potentially reduce blood product usage. We examined the association of routine intraoperative cell salvage on maternal outcomes. METHODS We conducted a single-center non-overlapping before-after study of obstetric patients undergoing lower segment caesarean section in the 2 months prior to a change in practice ('usual care = selective intraoperative cell salvage', n = 203) and the 2 months following ('mandated intraoperative cell salvage', n = 228). Recovered blood was processed when a minimal autologous reinfusion volume of 100 ml was expected. Post-operative iron infusion and length of stay were modelled using logistic or linear regression, using inverse probability weighting to account for confounding. RESULTS More emergency lower-segment caesarean sections occurred in the Usual Care group. Compared to the Usual Care group, post-operative hemoglobin was higher and anemia cases fewer in the Mandated intraoperative cell salvage group. Rates of post-partum iron infusion were significantly lower in the Mandated intraoperative cell salvage group (OR = 0.31, 95% CI = 0.12 to 0.80, P = 0.016). No difference was found for length of stay. CONCLUSION Routine cell salvage provision during lower segment caesarean section was associated with a significant reduction in post-partum iron infusions, increased post-operative hemoglobin and reduced anemia prevalence.
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Affiliation(s)
- Tom P Fox
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, 5112, SA, Australia
| | - Evelyn Timpani
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, 5112, SA, Australia
| | - Amanda Green
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, 5112, SA, Australia
| | - Anupam Parange
- Department of Obstetrics and Gynecology, Lyell McEwin Hospital, Elizabeth Vale, 5112, SA, Australia
| | - Romi Sinha
- Department of Health and Wellbeing, Blood Organ and Tissue Programs, Adelaide, 5000, SA, Australia
| | - Thu-Lan Kelly
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, 5000, SA, Australia
| | - Nicolette A Hodyl
- Hunter Medical Research Institute, New Lampton Heights, 2305, NSW, Australia
| | - Bernd Froessler
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, 5112, SA, Australia.
- Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, 5000, SA, Australia.
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Affiliation(s)
- B Froessler
- Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - L Clarke
- Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - K O Schubert
- Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
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3
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Froessler B, Schubert KO, Palm P, Church R, Aboustate N, Kelly TL, Dekker GA, Hodyl NA. Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial. BJOG 2022; 130:15-23. [PMID: 36047598 PMCID: PMC10087028 DOI: 10.1111/1471-0528.17288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test equivalence of two doses of intravenous iron (ferric carboxymaltose) in pregnancy. DESIGN Parallel, two-arm equivalence randomised controlled trial with an equivalence margin of 5%. SETTING Single centre in Australia. POPULATION 278 pregnant women with iron deficiency. METHODS Participants received either 500 mg (n=152) or 1000mg (n=126) of intravenous ferric carboxymaltose in the second or third trimester. MAIN OUTCOME MEASURES The proportion of participants requiring additional intravenous iron (500mg) to achieve and maintain ferritin >30ug/L (diagnostic threshold for iron deficiency) at 4 weeks post-infusion, and at 6 weeks, and 3-, 6- and 12-months postpartum. Secondary endpoints included repeat infusion rate, iron status, birth, and safety outcomes. RESULTS The two doses were not equivalent within a 5% margin at any timepoint. At 4 weeks post infusion, 26/73 (36%) participants required a repeat infusion in the 500 mg group compared with 5/67 (8%) in the 1000 mg group (difference in proportions, 0.283 95% confidence interval (0.177, 0.389)). Overall, participants in the 500 mg arm received twice the repeat infusion rate (0.81 (SD= 0.824 vs 0.40 (SD= 0.69), rate ratio 2.05, 95% CI (1.45, 2.91)). CONCLUSIONS Administration of 1000 mg ferric carboxymaltose in pregnancy maintains iron stores and reduces the need for repeat infusions. A 500 mg dose requires ongoing monitoring to ensure adequate iron stores are reached and sustained.
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Affiliation(s)
- B Froessler
- Department of Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Vale, Elizabeth, SA, Australia.,Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, SA, Australia
| | - K O Schubert
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Northern Adelaide Mental Health Services, Lyell McEwin Hospital, Vale, Elizabeth, SA.,Robinson Research Institute
| | - P Palm
- Department of Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Vale, Elizabeth, SA, Australia.,Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, SA, Australia
| | - R Church
- Department of Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Vale, Elizabeth, SA, Australia.,Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, SA, Australia
| | - N Aboustate
- University of South Australia, Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, SA, Australia
| | - T-L Kelly
- Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, SA, Australia
| | - G A Dekker
- Adelaide Medical School, The University of Adelaide, SA, Australia
| | - N A Hodyl
- Adelaide Medical School, The University of Adelaide, SA, Australia.,Hunter Medical Research Institute, Newcastle, NSW
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Froessler B, Malek M, Jila M, Parange A, Kelly TL. The impact of withholding nitrous oxide in labour during the COVID-19 pandemic on maternal and neonatal outcomes. Aust N Z J Obstet Gynaecol 2022; 62:910-914. [PMID: 35781873 PMCID: PMC10083960 DOI: 10.1111/ajo.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
Nitrous oxide is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID-19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. We aimed to determine the impact of withholding nitrous oxide for labour analgesia, during the COVID-19 pandemic, on epidural rates, opioid analgesia use, and maternal and neonatal outcomes. Withholding nitrous oxide for labour analgesia did not alter epidural rates but did significantly increase opioid analgesia use. Caesarean section rates, post-partum blood loss and neonatal APGAR scores did not change.
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Affiliation(s)
- Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michaela Malek
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Mathonsi Jila
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Anupam Parange
- Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Thu-Lan Kelly
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
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Wawer AA, Hodyl NA, Fairweather-Tait S, Froessler B. Are Pregnant Women Who Are Living with Overweight or Obesity at Greater Risk of Developing Iron Deficiency/Anaemia? Nutrients 2021; 13:1572. [PMID: 34067098 PMCID: PMC8151407 DOI: 10.3390/nu13051572] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
Low-grade inflammation is often present in people living with obesity. Inflammation can impact iron uptake and metabolism through elevation of hepcidin levels. Obesity is a major public health issue globally, with pregnant women often affected by the condition. Maternal obesity is associated with increased pregnancy risks including iron deficiency (ID) and iron-deficiency anaemia (IDA)-conditions already highly prevalent in pregnant women and their newborns. This comprehensive review assesses whether the inflammatory state induced by obesity could contribute to an increased incidence of ID/IDA in pregnant women and their children. We discuss the challenges in accurate measurement of iron status in the presence of inflammation, and available iron repletion strategies and their effectiveness in pregnant women living with obesity. We suggest that pre-pregnancy obesity and overweight/obese pregnancies carry a greater risk of ID/IDA for the mother during pregnancy and postpartum period, as well as for the baby. We propose iron status and weight gain during pregnancy should be monitored more closely in women who are living with overweight or obesity.
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Affiliation(s)
- Anna A. Wawer
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia;
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Nicolette A. Hodyl
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Susan Fairweather-Tait
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia;
- Discipline of Acute Care Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
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Jayasuriya P, Richards T, Froessler B. Rapid increase in intravenous iron therapy for women of reproductive age in Australia. Med J Aust 2021; 214:285-285.e1. [PMID: 33713442 DOI: 10.5694/mja2.50980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Froessler B, Murphy E, Hodyl N. Iron deficiency in PREVENTT. Lancet 2021; 397:668. [PMID: 33610207 DOI: 10.1016/s0140-6736(21)00227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia.
| | - Elizabeth Murphy
- Department of Surgery, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
| | - Nicolette Hodyl
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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8
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D'Antonio F, Sen C, Mascio DD, Galindo A, Villalain C, Herraiz I, Arisoy R, Ovayolu A, Eroğlu H, Canales MG, Ladella S, Cojocaru L, Turan O, Turan S, Hadar E, Brzezinski-Sinai NA, Dollinger S, Uyaniklar O, Ocakouglu SR, Atak Z, Premru-Srsen T, Kornhauser-Cerar L, Druškovič M, Ples L, Gündüz R, Ağaçayak E, Schvartzman JA, Malbran MN, Liberati M, Sebastiano FD, Oronzi L, Cerra C, Buca D, Cagnacci A, Ramone A, Barra F, Carosso A, Benedetto C, Cosma S, Pintiaux A, Daelemans C, Costa E, Özel A, Muhçu M, Lopez JSJ, Alvarado C, Piqueras AL, Oliva DE, Schera GBL, Volpe N, Frusca T, Samardjiski I, Simeonova S, Papestiev IA, Hojman J, Turkcuoglu I, Cromi A, Laganà AS, Ghezzi F, Sirico A, Familiari A, Scambia G, Sukhikh ZKGT, Gorina KA, de Sa RAM, Vaz M, Feuerschuette OHM, Gatta AND, Youssef A, Donna GD, Martinez-Varea A, Loscalzo G, Morales Roselló J, Stefanovic V, Nupponen I, Nelskylä K, Ayala R, Molpeceres RG, Vázquez AP, Sandri F, Cataneo I, Lenzi M, Haberal ET, Huertas E, Sanchez A, Arango P, Bermejo A, Alcantara MMG, Göynümer G, Okuyan E, Madalina C, Guisan AC, Schulte AM, Esposito V, De Robertis V, Zdjelar S, Lackovic M, Mihajlovic S, Jekova N, Saccone G, Aslan MM, Dedda MCD, Chalid M, Canache JEM, Daskalakis G, Antsaklis P, Vega EC, Cueto E, Taccaliti C, Aykanat Y, Özlem Genç Ş, Froessler B, Radulova PA, Morano D, Bianchi B, Marino MGL, Meccariello G, Rohatgi B, Schiattarella A, Morlando M, Colacurci N, Villasco A, Biglia N, Marques ALS, Gatti A, Luvero D, Angioli R, Pittaro A, Lila A, Zlatohlávková B. Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019. Am J Obstet Gynecol MFM 2021; 3:100329. [PMID: 33621713 PMCID: PMC7896113 DOI: 10.1016/j.ajogmf.2021.100329] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
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Affiliation(s)
- Francesco D'Antonio
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr D'Antonio).
| | - Cihat Sen
- Perinatal Medicine Foundation, Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey (Dr Sen)
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Dr Mascio)
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain (Dr Galindo, Dr Villalain, and Dr Herraiz)
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain (Dr Galindo, Dr Villalain, and Dr Herraiz)
| | - Ignacio Herraiz
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain (Dr Galindo, Dr Villalain, and Dr Herraiz)
| | - Resul Arisoy
- Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey (Dr Arisoy)
| | - Ali Ovayolu
- Cengiz Gokcek Women's and Children's Hospital, Gaziantep, Turkey (Dr Ovayolu and Dr Eroğlu)
| | - Hasan Eroğlu
- Cengiz Gokcek Women's and Children's Hospital, Gaziantep, Turkey (Dr Ovayolu and Dr Eroğlu)
| | | | - Subhashini Ladella
- Community Medical Centers, University of California, San Francisco Fresno, Fresno, CA (Dr Ladella)
| | - Liviu Cojocaru
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland Medical Center, Baltimore, MD (Dr Cojocaru, Dr O Turan, and Dr S Turan)
| | - Ozhan Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland Medical Center, Baltimore, MD (Dr Cojocaru, Dr O Turan, and Dr S Turan)
| | - Sifa Turan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland Medical Center, Baltimore, MD (Dr Cojocaru, Dr O Turan, and Dr S Turan)
| | - Eran Hadar
- Petach-Tikva and Sackler Faculty of Medicine, Rabin Medical Center, Helen Schneider Hospital for Women, Tel-Aviv University, Tel-Aviv, Israel (Dr Hadar, Dr Brzezinski-Sinai, and Dr Dollinger)
| | - Noa A Brzezinski-Sinai
- Petach-Tikva and Sackler Faculty of Medicine, Rabin Medical Center, Helen Schneider Hospital for Women, Tel-Aviv University, Tel-Aviv, Israel (Dr Hadar, Dr Brzezinski-Sinai, and Dr Dollinger)
| | - Sarah Dollinger
- Petach-Tikva and Sackler Faculty of Medicine, Rabin Medical Center, Helen Schneider Hospital for Women, Tel-Aviv University, Tel-Aviv, Israel (Dr Hadar, Dr Brzezinski-Sinai, and Dr Dollinger)
| | - Ozlem Uyaniklar
- Bursa City Hospital, Bursa, Turkey (Dr Uyaniklar, Dr Ocakouglu, and Dr Atak)
| | | | - Zeliha Atak
- Bursa City Hospital, Bursa, Turkey (Dr Uyaniklar, Dr Ocakouglu, and Dr Atak)
| | - Tanja Premru-Srsen
- Medical Faculty, Department of Perinatology, University Medical Center, University of Ljubljana, Ljubljana, Slovenia (Dr Premru-Srsen, Dr Kornhauser-Cerar, and Dr Druškovič)
| | - Lilijana Kornhauser-Cerar
- Medical Faculty, Department of Perinatology, University Medical Center, University of Ljubljana, Ljubljana, Slovenia (Dr Premru-Srsen, Dr Kornhauser-Cerar, and Dr Druškovič)
| | - Mirjam Druškovič
- Medical Faculty, Department of Perinatology, University Medical Center, University of Ljubljana, Ljubljana, Slovenia (Dr Premru-Srsen, Dr Kornhauser-Cerar, and Dr Druškovič)
| | - Liana Ples
- Department of Obstetrics and Gynecology, Saint John Hospital, Carol Davila University of Medicine and Pharmacy, Romania (Dr Ples)
| | - Reyhan Gündüz
- Department of Obstetrics and Gynecology, University of Dicle, Diyarbakır, Turkey (Dr Gündüz and Dr Ağaçayak)
| | - Elif Ağaçayak
- Department of Obstetrics and Gynecology, University of Dicle, Diyarbakır, Turkey (Dr Gündüz and Dr Ağaçayak)
| | - Javier Alfonso Schvartzman
- Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno," Buenos Aires, Argentina (Dr Schvartzman and Dr Malbran)
| | - Mercedes Negri Malbran
- Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno," Buenos Aires, Argentina (Dr Schvartzman and Dr Malbran)
| | - Marco Liberati
- Department of Obstetrics and Gynecology, Centre for High-Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy (Dr Liberati, Dr Sebastiano, Dr Oronzi, Dr Cerra, and Dr Buca)
| | - Francesca Di Sebastiano
- Department of Obstetrics and Gynecology, Centre for High-Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy (Dr Liberati, Dr Sebastiano, Dr Oronzi, Dr Cerra, and Dr Buca)
| | - Ludovica Oronzi
- Department of Obstetrics and Gynecology, Centre for High-Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy (Dr Liberati, Dr Sebastiano, Dr Oronzi, Dr Cerra, and Dr Buca)
| | - Chiara Cerra
- Department of Obstetrics and Gynecology, Centre for High-Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy (Dr Liberati, Dr Sebastiano, Dr Oronzi, Dr Cerra, and Dr Buca)
| | - Danilo Buca
- Department of Obstetrics and Gynecology, Centre for High-Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy (Dr Liberati, Dr Sebastiano, Dr Oronzi, Dr Cerra, and Dr Buca)
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy (Dr Cagnacci, Dr Ramone, and Dr Barra)
| | - Arianna Ramone
- Academic Unit of Obstetrics and Gynaecology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy (Dr Cagnacci, Dr Ramone, and Dr Barra)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy (Dr Cagnacci, Dr Ramone, and Dr Barra)
| | - Andrea Carosso
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Turin, Turin, Italy (Dr Carosso, Dr Benedetto, and Dr Cosma)
| | - Chiara Benedetto
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Turin, Turin, Italy (Dr Carosso, Dr Benedetto, and Dr Cosma)
| | - Stefano Cosma
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Turin, Turin, Italy (Dr Carosso, Dr Benedetto, and Dr Cosma)
| | - Axelle Pintiaux
- Department of Obstetrics and Gynecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium (Dr Pintiaux, Dr Daelemans, and Dr Costa)
| | - Caroline Daelemans
- Department of Obstetrics and Gynecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium (Dr Pintiaux, Dr Daelemans, and Dr Costa)
| | - Elena Costa
- Department of Obstetrics and Gynecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium (Dr Pintiaux, Dr Daelemans, and Dr Costa)
| | - Ayşegül Özel
- University Of Health Sciences, Umraniye Training And Research Hospital, Turkey, Istanbul (Dr Özel and Dr Muhçu)
| | - Murat Muhçu
- University Of Health Sciences, Umraniye Training And Research Hospital, Turkey, Istanbul (Dr Özel and Dr Muhçu)
| | | | | | - Anna Luengo Piqueras
- Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (Dr Piqueras and Dr Oliva)
| | - Dolores Esteban Oliva
- Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (Dr Piqueras and Dr Oliva)
| | | | - Nicola Volpe
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (Dr Schera, Dr Volpe, and Dr Frusca)
| | - Tiziana Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy (Dr Schera, Dr Volpe, and Dr Frusca)
| | - Igor Samardjiski
- University Clinic of Obstetrics and Gynecology, Skopje, North Macedonia (Dr Samardjiski, Dr Simeonava, and Dr Papestiev)
| | - Slagjana Simeonova
- University Clinic of Obstetrics and Gynecology, Skopje, North Macedonia (Dr Samardjiski, Dr Simeonava, and Dr Papestiev)
| | - Irena Aleksioska Papestiev
- University Clinic of Obstetrics and Gynecology, Skopje, North Macedonia (Dr Samardjiski, Dr Simeonava, and Dr Papestiev)
| | - Javier Hojman
- División Obstetricia/Hospital de Clínicas "José de San Martín," Buenos Aires, Argentina (Dr Hojman)
| | - Ilgin Turkcuoglu
- Department of Obstetrics and Gynecology, Sanko University School of Medicine, Gaziantep, Turkey (Dr Turkcuoglu)
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy (Dr Cromi, Dr Laganà, and Dr Ghezzi)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy (Dr Cromi, Dr Laganà, and Dr Ghezzi)
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy (Dr Cromi, Dr Laganà, and Dr Ghezzi)
| | - Angelo Sirico
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy (Dr Sirico, Dr Familiari, and Dr Scambia)
| | - Alessandra Familiari
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy (Dr Sirico, Dr Familiari, and Dr Scambia)
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy (Dr Sirico, Dr Familiari, and Dr Scambia)
| | | | - Ksenia A Gorina
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia (Dr Sukhikh and Dr Gorina)
| | | | - Mariana Vaz
- Assistência Obstétrica do Grupo Perinatal, Rio de Janeiro, Brazil (Dr de Sa and Dr Vaz)
| | | | - Anna Nunzia Della Gatta
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy (Dr Gatta, Dr Youssef, and Dr Donna)
| | - Aly Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy (Dr Gatta, Dr Youssef, and Dr Donna)
| | - Gaetana Di Donna
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy (Dr Gatta, Dr Youssef, and Dr Donna)
| | - Alicia Martinez-Varea
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain (Dr Martinez-Varea, Dr Loscalzo, and Dr Roselló)
| | - Gabriela Loscalzo
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain (Dr Martinez-Varea, Dr Loscalzo, and Dr Roselló)
| | - José Morales Roselló
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain (Dr Martinez-Varea, Dr Loscalzo, and Dr Roselló)
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Dr Stefanovic, Dr Nupponen, and Dr Nelskylä)
| | - Irmeli Nupponen
- Department of Obstetrics and Gynecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Dr Stefanovic, Dr Nupponen, and Dr Nelskylä)
| | - Kaisa Nelskylä
- Department of Obstetrics and Gynecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (Dr Stefanovic, Dr Nupponen, and Dr Nelskylä)
| | | | | | - Asunción Pino Vázquez
- University Clinic Hospital of Valladolid, Valladolid, Spain (Dr Molpeceres and Dr Vázquez)
| | - Fabrizio Sandri
- Unit of Obstetrics and Gynecology, Ospedale Maggiore, Bologna, Italy (Dr Sandri, Dr Cataneo, and Dr Lenzi)
| | - Ilaria Cataneo
- Unit of Obstetrics and Gynecology, Ospedale Maggiore, Bologna, Italy (Dr Sandri, Dr Cataneo, and Dr Lenzi)
| | - Marinella Lenzi
- Unit of Obstetrics and Gynecology, Ospedale Maggiore, Bologna, Italy (Dr Sandri, Dr Cataneo, and Dr Lenzi)
| | | | - Erasmo Huertas
- Instituto Nacional Materno Perinatal, Lima, Peru (Dr Huertas, Dr Sanchez, and Dr Arango)
| | - Amadeo Sanchez
- Instituto Nacional Materno Perinatal, Lima, Peru (Dr Huertas, Dr Sanchez, and Dr Arango)
| | - Pedro Arango
- Instituto Nacional Materno Perinatal, Lima, Peru (Dr Huertas, Dr Sanchez, and Dr Arango)
| | - Amanda Bermejo
- Hospital Universitario de Móstoles, Mostoles, Spain (Dr Bermejo)
| | | | - Gökhan Göynümer
- Düzce University Medicine Faculty, Department of Perinatology, Düzce, Turkey (Dr Göynümer)
| | - Erhan Okuyan
- Batman Maternity and Child Health Hospital, Batman, Turkey (Dr Okuyan)
| | - Ciuhodaru Madalina
- Universitatea de Medicină și Farmacie Grigore T. Popa Iași, Iasi, Romania (Dr Madalina)
| | | | | | | | | | - Snezana Zdjelar
- KBC Dr Dragisa Misovic Dedinje Belgrade, Serbia (Dr Zdjelar, Dr Lackovic, and Dr Mihajlovic)
| | - Milan Lackovic
- KBC Dr Dragisa Misovic Dedinje Belgrade, Serbia (Dr Zdjelar, Dr Lackovic, and Dr Mihajlovic)
| | - Sladjana Mihajlovic
- KBC Dr Dragisa Misovic Dedinje Belgrade, Serbia (Dr Zdjelar, Dr Lackovic, and Dr Mihajlovic)
| | - Nelly Jekova
- Department of Neonatology, Obstetrics and Gynecology, University Hospital, Sofia, Bulgaria (Dr Jekova)
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Saccone)
| | - Mehmet Musa Aslan
- Sakarya University Education and Research Hospital, Sakarya, Turkey (Dr Aslan)
| | | | - Maisuri Chalid
- Department of Obstetrics and Gynecology, Hasanuddin University, Makassar, Indonesia (Dr Chalid)
| | - Jose Enrique Moros Canache
- Departamento De Ginecologia Y Obstetricia, Centro Medico La Paz De Bata, Bata, Guinea Ecuatorial (Dr Canache)
| | - George Daskalakis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece (Dr Daskalakis and Dr Antsaklis)
| | - Panos Antsaklis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece (Dr Daskalakis and Dr Antsaklis)
| | - Enrique Criado Vega
- Division of Neonatology, Hospital Clínico "San Carlos," Madrid, Spain (Dr Vega)
| | - Elisa Cueto
- Hospital Virgen De La Luz, Cuenca, Spain (Dr Cueto)
| | - Chiara Taccaliti
- Ospedale Generale Regionale "F. Miulli," Acquaviva delle Fonti, Italy (Dr Taccaliti)
| | - Yeliz Aykanat
- Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa Medical School, Istanbul, Turkey (Dr Aykanat)
| | | | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia (Dr Froessler)
| | | | - Danila Morano
- Section of Obstetrics and Gynecology, Department of Medical Sciences, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy (Dr Morano, Dr Bianchi, and Dr Marino)
| | - Beatrice Bianchi
- Section of Obstetrics and Gynecology, Department of Medical Sciences, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy (Dr Morano, Dr Bianchi, and Dr Marino)
| | - Maria Giulia Lombana Marino
- Section of Obstetrics and Gynecology, Department of Medical Sciences, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy (Dr Morano, Dr Bianchi, and Dr Marino)
| | - Gabriella Meccariello
- Ostetricia e Ginecologia Universitaria - Ospedale S.Anna e S.Sebastiano, Caserta, Italy (Dr Meccariello)
| | | | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy (Dr Schiattarella, Dr Morlando, and Dr Colacurci)
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy (Dr Schiattarella, Dr Morlando, and Dr Colacurci)
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy (Dr Schiattarella, Dr Morlando, and Dr Colacurci)
| | - Andrea Villasco
- Academic Division of Obstetrics and Gynecology, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy (Dr Villasco and Dr Biglia)
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynecology, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy (Dr Villasco and Dr Biglia)
| | | | - Alessandra Gatti
- Campus Bio Medico, University of Rome, Rome, Italy (Dr Gatti, Dr Luvero, and Dr Angioli)
| | - Daniela Luvero
- Campus Bio Medico, University of Rome, Rome, Italy (Dr Gatti, Dr Luvero, and Dr Angioli)
| | - Roberto Angioli
- Campus Bio Medico, University of Rome, Rome, Italy (Dr Gatti, Dr Luvero, and Dr Angioli)
| | | | - Albert Lila
- Regional Hospital Gjakova, Kosovo, Republic of Kosovo (Dr Lila)
| | - Blanka Zlatohlávková
- Division of Neonatology, Department of Obstetrics and Gynecology, General Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic (Dr Zlatohlávková)
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9
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Di Mascio D, Sen C, Saccone G, Galindo A, Grünebaum A, Yoshimatsu J, Stanojevic M, Kurjak A, Chervenak F, Rodríguez Suárez MJ, Gambacorti-Passerini ZM, Baz MDLAA, Aguilar Galán EV, López YC, De León Luis JA, Hernández IC, Herraiz I, Villalain C, Venturella R, Rizzo G, Mappa I, Gerosolima G, Hellmeyer L, Königbauer J, Ameli G, Frusca T, Volpe N, Luca Schera GB, Fieni S, Esposito E, Simonazzi G, Di Donna G, Youssef A, Della Gatta AN, Di Donna MC, Chiantera V, Buono N, Sozzi G, Greco P, Morano D, Bianchi B, Lombana Marino MG, Laraud F, Ramone A, Cagnacci A, Barra F, Gustavino C, Ferrero S, Ghezzi F, Cromi A, Laganà AS, Laurita Longo V, Stollagli F, Sirico A, Lanzone A, Driul L, Cecchini D F, Xodo S, Rodriguez B, Mercado-Olivares F, Elkafrawi D, Sisti G, Esposito R, Coviello A, Cerbone M, Morlando M, Schiattarella A, Colacurci N, De Franciscis P, Cataneo I, Lenzi M, Sandri F, Buscemi R, Gattei G, Sala FD, Valori E, Rovellotti MC, Done E, Faron G, Gucciardo L, Esposito V, Vena F, Giancotti A, Brunelli R, Muzii L, Nappi L, Sorrentino F, Vasciaveo L, Liberati M, Buca D, Leombroni M, Di Sebastiano F, Di Tizio L, Gazzolo D, Franchi M, Ianniciello QC, Garzon S, Petriglia G, Borrello L, Nieto-Calvache AJ, Burgos-Luna JM, Kadji C, Carlin A, Bevilacqua E, Moucho M, Pinto PV, Figueiredo R, Morales Roselló J, Loscalzo G, Martinez-Varea A, Diago V, Jimenez Lopez JS, Aykanat AY, Cosma S, Carosso A, Benedetto C, Bermejo A, May Feuerschuette OH, Uyaniklar O, Ocakouglu SR, Atak Z, Gündüz R, Haberal ET, Froessler B, Parange A, Palm P, Samardjiski I, Taccaliti C, Okuyan E, Daskalakis G, Moreira de Sa RA, Pittaro A, Gonzalez-Duran ML, Guisan AC, Genç ŞÖ, Zlatohlávková B, Piqueras AL, Oliva DE, Cil AP, Api O, Antsaklis P, Ples L, Kyvernitakis I, Maul H, Malan M, Lila A, Granese R, Ercoli A, Zoccali G, Villasco A, Biglia N, Madalina C, Costa E, Daelemans C, Pintiaux A, Cueto E, Hadar E, Dollinger S, Brzezinski Sinai NA, Huertas E, Arango P, Sanchez A, Schvartzman JA, Cojocaru L, Turan S, Turan O, Di Dedda MC, Molpeceres RG, Zdjelar S, Premru-Srsen T, Cerar LK, Druškovič M, De Robertis V, Stefanovic V, Nupponen I, Nelskylä K, Khodjaeva Z, Gorina KA, Sukhikh GT, Maruotti GM, Visentin S, Cosmi E, Ferrari J, Gatti A, Luvero D, Angioli R, Puri L, Palumbo M, D'Urso G, Colaleo F, Chiara Rapisarda AM, Carbone IF, Mollo A, Nazzaro G, Locci M, Guida M, Di Spiezio Sardo A, Panici PB, Berghella V, Flacco ME, Manzoli L, Bifulco G, Scambia G, Zullo F, D'Antonio F. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. J Perinat Med 2020; 48:950-958. [PMID: 32975205 DOI: 10.1515/jpm-2020-0355] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cihat Sen
- Perinatal Medicine Foundation and Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Amos Grünebaum
- Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jun Yoshimatsu
- Department of Perinatology and Gynaecology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Milan Stanojevic
- Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
| | - Asım Kurjak
- Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
| | - Frank Chervenak
- Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | | | - María de Los Angeles Anaya Baz
- Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
- University of Castilla-La Mancha, Ciudad Real, Spain
| | - Esther Vanessa Aguilar Galán
- Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
- University of Castilla-La Mancha, Ciudad Real, Spain
| | - Yolanda Cuñarro López
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Juan Antonio De León Luis
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Cueto Hernández
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Roberta Venturella
- Department of Obstetrics and Gynaecology, School of Medicin, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Rizzo
- University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
- Department of Obstetrics and Gynaecology The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
| | - Giovanni Gerosolima
- Department of Obstetrics and Gynaecology, Ospedale AOSG Moscati, Avellino, Italy
| | - Lars Hellmeyer
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Josefine Königbauer
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Giada Ameli
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Tiziana Frusca
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Nicola Volpe
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | | | - Stefania Fieni
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Eutalia Esposito
- Department of Obstetrics and Gynaecology, Ospedale di San Leonardo, Castellammare di Stabia, Italy
| | - Giuliana Simonazzi
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Gaetana Di Donna
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Aly Youssef
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Anna Nunzia Della Gatta
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | | | - Vito Chiantera
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Natalina Buono
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Giulio Sozzi
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Danila Morano
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Beatrice Bianchi
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Lombana Marino
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Federica Laraud
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Arianna Ramone
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Claudio Gustavino
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Valentina Laurita Longo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
- Queen Margaret University,Institute for Global Health and Development, Edinburgh, UK
| | - Francesca Stollagli
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Sirico
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy
| | | | - Serena Xodo
- Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy
| | - Brian Rodriguez
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Felipe Mercado-Olivares
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Deena Elkafrawi
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Giovanni Sisti
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Rosanna Esposito
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Coviello
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marco Cerbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ilaria Cataneo
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Marinella Lenzi
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Fabrizio Sandri
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Riccardo Buscemi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Giorgia Gattei
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesca Della Sala
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Eleonora Valori
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Hospital Castelli, Verbania, Italy
| | | | - Elisa Done
- UZ Brussel, Universitair Ziekenhuis, Brussel, Belgium
| | - Gilles Faron
- UZ Brussel, Universitair Ziekenhuis, Brussel, Belgium
| | | | | | - Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Nappi
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Felice Sorrentino
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lorenzo Vasciaveo
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Marco Liberati
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Danilo Buca
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Martina Leombroni
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Francesca Di Sebastiano
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Luciano Di Tizio
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, University of Chieti, ChietiItaly
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | | | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Giuliano Petriglia
- Maternal and Child Health Department, Santa Maria Hospital, Terni, Italy
| | - Leonardo Borrello
- Maternal and Child Health Department, Santa Maria Hospital, Terni, Italy
| | - Albaro Josè Nieto-Calvache
- Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
- Postgraduate Department, Universidad Icesi, Cali, Colombia
| | - Juan Manuel Burgos-Luna
- Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
- Postgraduate Department, Universidad Icesi, Cali, Colombia
| | - Caroline Kadji
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Bevilacqua
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marina Moucho
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Pedro Viana Pinto
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Rita Figueiredo
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - José Morales Roselló
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alicia Martinez-Varea
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vincente Diago
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Alicia Yeliz Aykanat
- Department of Obstetrics and Gynaecology, Istanbul University-Cerrahpasa Medical School, Istanbul, Turkey
| | - Stefano Cosma
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Andrea Carosso
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | | | | | | | | | | | - Reyhan Gündüz
- Department of Obstetrics and Gynaecology, University of Dicle, Diyarbakır, Turkey
| | | | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Anupam Parange
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Peter Palm
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Igor Samardjiski
- University Clinic of Obstetrics and Gynaecology, Skopje, North Macedonia
| | - Chiara Taccaliti
- Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Italy
| | - Erhan Okuyan
- Batman Maternity and Child Health Hospital, Batman, Turkey
| | - George Daskalakis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece
| | | | | | | | | | | | - Blanka Zlatohlávková
- Department of Obstetrics and Gynaecology, Division of Neonatology, General Hospital in Prague and First Faculty of Medicine,Charles University, Prague, Czech Republic
| | | | | | | | - Olus Api
- American Hospital, Istanbul, Turkey
| | - Panos Antsaklis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece
| | - Liana Ples
- Department of Obstetrics and Gynaecology, Saint John Hospital, UMF Carol Davila, Bucharest, Romania
| | | | - Holger Maul
- Asklepios Hospital Barmbek, Hamburg, Germany
| | | | - Albert Lila
- Regional Hospital Gjakova, Kosovo, Republic of Kosovo
| | - Roberta Granese
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Giuseppe Zoccali
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Andrea Villasco
- Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Ciuhodaru Madalina
- Universitatea de Medicină și Farmacie Grigore T. Popa Iași, Iasi, Romania
| | - Elena Costa
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | - Caroline Daelemans
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | - Axelle Pintiaux
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | | | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sarah Dollinger
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noa A Brzezinski Sinai
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Pedro Arango
- Instituto Nacional Materno Perinatal, Lima, Peru
| | | | | | - Liviu Cojocaru
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ozhan Turan
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | | | | | | | - Tanja Premru-Srsen
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druškovič
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Vedran Stefanovic
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Irmeli Nupponen
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Nelskylä
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Zulfiya Khodjaeva
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Ksenia A Gorina
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Gennady T Sukhikh
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Silvia Visentin
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Erich Cosmi
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Jacopo Ferrari
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | | | | | | | - Ludovica Puri
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giusella D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Colaleo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | | | | | - Giovanni Nazzaro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Attilio Di Spiezio Sardo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Berghella
- Maternal Fetal Medicine Division, Sidney Kimmel Medical College at Thomas Jefferson University, Obstetrics and Gynaecology Department, Philadelphia, PA, USA
| | | | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco D'Antonio
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
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10
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Froessler B, Zorron Cheng Tao Pu L, Aboustate N, Ovenden A, Singh R. Dynamic functional clot formation in patients undergoing endoscopic mucosal resection. JGH Open 2020; 4:632-635. [PMID: 32782949 PMCID: PMC7411637 DOI: 10.1002/jgh3.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 11/13/2022]
Abstract
Background and Aim Electric burns can induce fibrinolytic activity. Endoscopic mucosal resection (EMR) is a minimally invasive technique utilizing electrocautery for resection of dysplastic lesions from the gastrointestinal tract. EMR's main complication is clinically significant postendoscopic bleeding. Currently, no studies have investigated the impact of electrocautery during EMR on the coagulation cascade by viscoelastic hemostatic assay. Methods Thrombelastometry was performed and plasminogen levels were measured on blood samples taken prior to EMR, within an hour following the procedure and 2 days post‐EMR. Data were natural log‐transformed and analyzed using repeated‐measure analysis of covariance (ANCOVA) accounting for age, sex, body mass index (BMI) and site of EMR. Results Plasminogen levels decreased post‐EMR (P = 0.001) and then increased 2 days post‐EMR (P < 0.018). FIBTEM A10 and Maximum Clot Firmness, and EXTEM maximum lysis decreased an hour following EMR (P < 0.05 for all). These three measurements then increased 2 days post‐EMR (P < 0.01 for all). There were no significant differences in thrombelastometry or plasminogen measures according to sex, age, BMI, or site of EMR. One patient experienced clinically significant postendoscopic bleeding at one‐week post‐EMR, with substantially decreased FIBTEM A10 and Maximum Clot Firmness at 2 days post‐EMR. Conclusions Decreased post‐EMR plasminogen corresponds with reduced clot firmness and enhanced lysis affecting clot quality, strength, and stability. While further investigation in a larger sample is required to confirm the overall risk of clinically significant postendoscopic bleeding and mechanisms for plasminogen activation; this study highlights the potential utility of thrombelastometry in assessing fibrinolytic activity during EMR.
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Affiliation(s)
- Bernd Froessler
- Department of Anaesthesia Lyell McEwin Hospital Adelaide South Australia Australia.,Discipline of Acute Care Medicine University of Adelaide Adelaide South Australia Australia
| | - Leonardo Zorron Cheng Tao Pu
- Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia.,Department of Gastroenterology and Hepatology Nagoya University Graduate School of Medicine Nagoya Aichi Japan
| | - Natalie Aboustate
- Robinson Research Institute Lyell McEwin Hospital Adelaide South Australia Australia
| | - Amanda Ovenden
- Department of Gastroenterology and Hepatology Lyell McEwin Hospital Adelaide South Australia Australia
| | - Rajvinder Singh
- Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia.,Department of Gastroenterology and Hepatology Lyell McEwin Hospital Adelaide South Australia Australia
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11
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Shander A, Goobie SM, Warner MA, Aapro M, Bisbe E, Perez-Calatayud AA, Callum J, Cushing MM, Dyer WB, Erhard J, Faraoni D, Farmer S, Fedorova T, Frank SM, Froessler B, Gombotz H, Gross I, Guinn NR, Haas T, Hamdorf J, Isbister JP, Javidroozi M, Ji H, Kim YW, Kor DJ, Kurz J, Lasocki S, Leahy MF, Lee CK, Lee JJ, Louw V, Meier J, Mezzacasa A, Munoz M, Ozawa S, Pavesi M, Shander N, Spahn DR, Spiess BD, Thomson J, Trentino K, Zenger C, Hofmann A. Essential Role of Patient Blood Management in a Pandemic: A Call for Action. Anesth Analg 2020; 131:74-85. [PMID: 32243296 PMCID: PMC7173035 DOI: 10.1213/ane.0000000000004844] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Global health care now faces unprecedented challenges with widespread and rapid human-to-human transmission of SARS-CoV-2 and high morbidity and mortality with COVID-19 worldwide. Across the world, medical care is hampered by a critical shortage of not only hand sanitizers, personal protective equipment, ventilators, and hospital beds, but also impediments to the blood supply. Blood donation centers in many areas around the globe have mostly closed. Donors, practicing social distancing, some either with illness or undergoing self-quarantine, are quickly diminishing. Drastic public health initiatives have focused on containment and "flattening the curve" while invaluable resources are being depleted. In some countries, the point has been reached at which the demand for such resources, including donor blood, outstrips the supply. Questions as to the safety of blood persist. Although it does not appear very likely that the virus can be transmitted through allogeneic blood transfusion, this still remains to be fully determined. As options dwindle, we must enact regional and national shortage plans worldwide and more vitally disseminate the knowledge of and immediately implement patient blood management (PBM). PBM is an evidence-based bundle of care to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This multinational and diverse group of authors issue this "Call to Action" underscoring "The Essential Role of Patient Blood Management in the Management of Pandemics" and urging all stakeholders and providers to implement the practical and commonsense principles of PBM and its multiprofessional and multimodality approaches.
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Affiliation(s)
- Aryeh Shander
- From the Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey
| | - Susan M Goobie
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew A Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matti Aapro
- Cancer Center Clinique Genolier, Genolier, Switzerland
| | - Elvira Bisbe
- Department of Anesthesiology, Perioperative Medicine Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Angel A Perez-Calatayud
- Department of Critical Care, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, Mexico
| | - Jeannie Callum
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Wayne B Dyer
- Australian Red Cross Lifeblood and Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jochen Erhard
- Department of Surgery, Evangelisches Klinikum Niederrhein, Duisburg, Germany
| | - David Faraoni
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shannon Farmer
- Medical School, Division of Surgery, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,School of Health Sciences and Graduate Studies, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Tatyana Fedorova
- Institute of Anesthesiology, Resuscitation and Transfusiology of the National Medical Research Center of Obstetrics, Gynecology and Perinatology named after Acad. V. I. Kulakov, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Bernd Froessler
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Hans Gombotz
- Department of Anesthesiology and Intensive Care, General Hospital Linz, Linz, Austria
| | - Irwin Gross
- Northern Light Health, Brewer, Maine.,Accumen, Inc, San Diego, California
| | - Nicole R Guinn
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Thorsten Haas
- Department of Anesthesiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jeffrey Hamdorf
- Medical School, The University of Western Australia, Western Australia Patient Blood Management Group, Perth, Western Australia, Australia
| | - James P Isbister
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mazyar Javidroozi
- From the Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey
| | - Hongwen Ji
- Department of Anesthesiology and Transfusion Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Young-Woo Kim
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy and Center for Gastric Cancer, National Cancer Center, Ilsandong-gu, Goyang, Korea
| | - Daryl J Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Johann Kurz
- Austrian Federal Ministry of Health, Vienna, Austria.,Department Applied Sciences, University of Applied Sciences, Vienna, Austria
| | - Sigismond Lasocki
- Département Anesthésie-Réanimation, Anesthésie Samu Urgences Réanimation, CHU Angers, Angers, France
| | - Michael F Leahy
- Department of Haematology, PathWest Laboratory Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong Special Administrative Region, China
| | - Jeong Jae Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Hospital, Seoul, Korea
| | - Vernon Louw
- Division Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jens Meier
- Clinic of Anesthesiology and Intensive Care Medicine, Johannes Kepler University Linz, Linz, Austria
| | | | - Manuel Munoz
- Department of Surgical Sciences, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| | - Sherri Ozawa
- Patient Blood Management, Englewood Health, Englewood, New Jersey
| | - Marco Pavesi
- Department of Anesthesiology and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nina Shander
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Buies Creek, North Carolina
| | - Donat R Spahn
- Institute of Anesthesiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Bruce D Spiess
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Jackie Thomson
- South African National Blood Service, Johannesburg, South Africa
| | - Kevin Trentino
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Data and Digital Innovation, East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Christoph Zenger
- Center for Health Law and Management, University of Bern, Bern, Switzerland
| | - Axel Hofmann
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Medical School, The University of Western Australia, Crawley, Western Australia, Australia.,School of Health Sciences and Graduate Studies, Curtin University, Perth, Western Australia, Australia
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12
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Meybohm P, Westphal S, Ravn HB, Ranucci M, Agarwal S, Choorapoikayil S, Spahn DR, Ahmed AB, Froessler B, Zacharowski K. Perioperative Anemia Management as Part of PBM in Cardiac Surgery – A Narrative Updated Review. J Cardiothorac Vasc Anesth 2020; 34:1060-1073. [DOI: 10.1053/j.jvca.2019.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022]
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13
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Abdullah HR, Ang AL, Froessler B, Hofmann A, Jang JH, Kim YW, Lasocki S, Lee JJ, Lee SY, Lim KKC, Singh G, Spahn DR, Um TH. Getting patient blood management Pillar 1 right in the Asia-Pacific: a call for action. Singapore Med J 2019; 61:287-296. [PMID: 31044255 DOI: 10.11622/smedj.2019037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Preoperative anaemia is common in the Asia-Pacific. Iron deficiency anaemia (IDA) is a risk factor that can be addressed under patient blood management (PBM) Pillar 1, leading to reduced morbidity and mortality. We examined PBM implementation under four different healthcare systems, identified challenges and proposed several measures: (a) Test for anaemia once patients are scheduled for surgery. (b) Inform patients about risks of preoperative anaemia and benefits of treatment. (c) Treat IDA and replenish iron stores before surgery, using intravenous iron when oral treatment is ineffective, not tolerated or when rapid iron replenishment is needed; transfusion should not be the default management. (d) Harness support from multiple medical disciplines and relevant bodies to promote PBM implementation. (e) Demonstrate better outcomes and cost savings from reduced mortality and morbidity. Although PBM implementation may seem complex and daunting, it is feasible to start small. Implementing PBM Pillar 1, particularly in preoperative patients, is a sensible first step regardless of the healthcare setting.
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Affiliation(s)
| | - Ai Leen Ang
- Department of Haematology, Singapore General Hospital, Singapore
| | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Discipline of Acute Care Medicine, University of Adelaide, Australia
| | - Axel Hofmann
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland.,Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Australia.,Faculty of Health Sciences, Curtin University Western Australia, Australia
| | - Jun Ho Jang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Woo Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, South Korea
| | - Sigismond Lasocki
- Department of Anesthesiology, Critical Care and Emergency, Angers University Hospital, France
| | - Jeong Jae Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University, South Korea
| | - Shir Ying Lee
- Department of Laboratory Medicine, Haematology Division, National University Hospital, Singapore
| | - Kar Koong Carol Lim
- Department of Obstetrics and Gynaecology, Hospital Sultan Haji Ahmad Shah, Pahang, Malaysia
| | - Gurpal Singh
- Division of Hip and Knee Surgery, National University Hospital, Singapore.,Division of Musculoskeletal Oncology, National University Hospital, Singapore
| | - Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Tae Hyun Um
- Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, South Korea
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14
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Froessler B, Gajic T, Dekker G, Hodyl NA. Response to letter to the Editor: Treatment of iron deficiency and iron deficiency anemia with intravenous ferric carboxymaltose in pregnancy. Arch Gynecol Obstet 2018; 298:1233-1234. [PMID: 30374646 DOI: 10.1007/s00404-018-4939-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/12/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Bernd Froessler
- Department of Anesthesia, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia. .,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, 5006, Australia.
| | - Tijana Gajic
- Flinders Medical Centre, Bedford Park, SA, 5042, Australia
| | - Gustaaf Dekker
- Department of Obstetrics and Gynecology, Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia.,Adelaide Medical School, The Robinson Research Institute, University of Adelaide, Adelaide, SA, 5006, Australia
| | - Nicolette A Hodyl
- Adelaide Medical School, The Robinson Research Institute, University of Adelaide, Adelaide, SA, 5006, Australia
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Froessler B, Rueger AM, Connolly MP. Assessing the costs and benefits of perioperative iron deficiency anemia management with ferric carboxymaltose in Germany. Risk Manag Healthc Policy 2018; 11:77-82. [PMID: 29731670 PMCID: PMC5923254 DOI: 10.2147/rmhp.s157379] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Perioperative administration of ferric carboxymaltose (FCM) was previously shown to reduce both the need for transfusions and the hospital length of stay in patients with preoperative iron deficiency anemia (IDA). In this study, we estimated the economic consequences of perioperative administration using FCM vs usual care in patients with IDA from the perspective of a German hospital using decision-analytic modeling. Materials and methods The model was populated with clinical inputs (transfusion rates, blood units transfused, hospital length of stay) from a previously reported randomized trial comparing FCM vs usual care for managing IDA patients undergoing elective abdominal surgery. We applied a hospital perspective to all costs, excluding surgery-related costs in both treatment arms. One-way sensitivity analyses were undertaken to evaluate key drivers of cost analysis. Results The average costs per case treated using FCM compared to usual care were €2,461 and €3,246, respectively, for resource expenses paid by hospital per case. This would suggest potential savings achieved with preoperative intravenous iron treatment per patient of €786 per case. A sensitivity analysis varying the key input parameters indicated the cost analysis is most sensitive to changes in the length of stay and the cost of hospitalization per day. Conclusion Perioperative administration of FCM results in cost savings to hospitals based on reduced blood transfusions and length of stay following elective abdominal surgery.
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Affiliation(s)
- Bernd Froessler
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Alexandra M Rueger
- Vifor Pharma, Munich, Germany.,Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany
| | - Mark P Connolly
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Global Market Access Solutions Sàrl, St-Prex, Switzerland
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Froessler B, Palm P, Weber I, Hodyl NA, Singh R, Murphy EM. The Important Role for Intravenous Iron in Perioperative Patient Blood Management in Major Abdominal Surgery: A Randomized Controlled Trial. Ann Surg 2016; 264:41-6. [PMID: 26817624 PMCID: PMC4902320 DOI: 10.1097/sla.0000000000001646] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine if preoperative intravenous (IV) iron improves outcomes in abdominal surgery patients. SUMMARY BACKGROUND DATA Preoperative iron deficiency anemia (IDA) occurs frequently; however if left untreated, increases the risk of blood transfusion allogeneic blood transfusion (ABT). Limited evidence supports IDA treatment with preoperative IV iron. This randomized controlled trial aimed to determine whether perioperative IV iron reduced the need for ABT. METHODS Between August 2011 and November 2014, 72 patients with IDA were assigned to receive either IV iron or usual care. The primary endpoint was incidence of ABT. Secondary endpoints were various hemoglobin (Hb) levels, change in Hb between time points, length of stay, iron status, morbidity, mortality, and quality of life 4 weeks postsurgery. RESULTS A 60% reduction in ABT was observed in the IV iron group compared with the usual care group (31.25% vs 12.5%). Hb values, although similar at randomization, improved by 0.8 g/dL with IV iron compared with 0.1 g/dL with usual care (P = 0.01) by the day of admission. The IV iron group had higher Hb 4 weeks after discharge compared with the usual care group (1.9 vs 0.9 g/dL, P = 0.01), and a shorter length of stay (7.0 vs 9.7 d, P = 0.026). There was no difference in discharge Hb levels, morbidity, mortality, or quality of life. CONCLUSIONS Administration of perioperative IV iron reduces the need for blood transfusion, and is associated with a shorter hospital stay, enhanced restoration of iron stores, and a higher mean Hb concentration 4 weeks after surgery.
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Affiliation(s)
- Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, South Australia, Australia
- Discipline of Acute Care Medicine, University of Adelaide, South Australia, Australia
| | - Peter Palm
- Department of Anaesthesia, Lyell McEwin Hospital, South Australia, Australia
| | - Ingo Weber
- Department of Anaesthesia, Lyell McEwin Hospital, South Australia, Australia
| | - Nicolette A. Hodyl
- The Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, South Australia, Australia
- Discipline of Medicine, University of Adelaide, South Australia, Australia
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Keir A, Froessler B, Stanworth S. QUESTION 2: Are intravenous fluid boluses beneficial in late preterm or term infants with suspected haemodynamic compromise? Arch Dis Child 2016; 101:201-2. [PMID: 26527487 DOI: 10.1136/archdischild-2015-309182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/10/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Amy Keir
- Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia
| | - Bernd Froessler
- Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia
| | - Simon Stanworth
- Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia
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Froessler B, Collingwood J, Hodyl NA, Dekker G. Intravenous ferric carboxymaltose for anaemia in pregnancy. BMC Pregnancy Childbirth 2014; 14:115. [PMID: 24667031 PMCID: PMC3986933 DOI: 10.1186/1471-2393-14-115] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a new treatment option that may be better tolerated.The study was designed to assess the safety and efficacy of iron deficiency anaemia (IDA) correction with intravenous ferric carboxymaltose in pregnant women with mild, moderate and severe anaemia in the second and third trimester. METHODS Prospective observational study; 65 anaemic pregnant women received ferric carboxymaltose up to 15 mg/kg between 24 and 40 weeks of pregnancy (median 35 weeks gestational age, SD 3.6). Treatment effectiveness was assessed by repeat haemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion. RESULTS Intravenous ferric carboxymaltose infusion significantly increased Hb values (p < 0.01) above baseline levels in all women. Increased Hb values were observed at 3 and 6 weeks post infusion and up to 8 weeks post-infusion. Ferritin values increased significantly after the infusion. Only 4 women had repeat ferritin values post-partum which remained above baseline levels. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. Of the 29 (44.6%) women interviewed, 19 (65.5%) women reported an improvement in their well-being and 9 (31%) felt no different after the infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 13 (20%) patients. CONCLUSIONS Our prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anaemia in pregnancy.
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Affiliation(s)
- Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale 5112, South Australia, Australia.
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Froessler B, Cocchiaro C, Saadat-Gilani K, Hodyl N, Dekker G. Intravenous iron sucrose versus oral iron ferrous sulfate for antenatal and postpartum iron deficiency anemia: a randomized trial. J Matern Fetal Neonatal Med 2012; 26:654-9. [PMID: 23130909 DOI: 10.3109/14767058.2012.746299] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare oral iron to intravenous iron administration to women in late pregnancy and/or after labor to correct iron deficiency. METHODS 271 anemic women (148 pregnant women and 123 women post lower segment caesarean section) with hemoglobin (Hb) levels below 110 g/L were enrolled over a two-year period and randomized to receive either two tablets FGF (ferrous sulfate with folic acid) or 400 mg of intravenous iron sucrose plus folic acid 600 µg. Treatment effectiveness was assessed by measuring Hb and ferritin postpartum on day 1, day 14 and day 42. Transfusions of red blood cells and adverse drug reactions were recorded. RESULTS Data of 214 women were available for analysis. Both forms of iron replacement therapy led to increased hemoglobin and ferritin levels over the testing period. Ferritin was significantly higher in the i.v. iron treatment group compared to the oral iron treatment group (p = 0.004) two weeks after delivery, while Hb values did not differ between the groups. No serious adverse drug reactions were observed. Red blood cell transfusion rate was low (1.9%), with equal rates observed in both treatment groups. CONCLUSION Intravenous and oral irons were both effective in correcting peripartum anemia, although intravenous iron restored stores faster than oral iron.
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Affiliation(s)
- Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
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Froessler B, Tufanaru C, Pearson A, Cyna A. Effectiveness and efficiency of pre-operative anaemia management with intravenous iron: A systematic review. ACTA ACUST UNITED AC 2012; 10:1-11. [PMID: 27820444 DOI: 10.11124/jbisrir-2012-272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Bernd Froessler
- 1. Lyell McEwin Hospital, Haydown Rd, Elizabeth Vale, South Australia 5112 2. The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia 5005 3. Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia 6. MScClinical Sciences Candidate 7. Research Fellow
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Froessler B, Brommundt J, Anton J, Khanduja R, Kuhlen R, Rossaint R, Coburn M. Spontaneously breathing anesthetized patients with a laryngeal mask airway. Anaesthesist 2010; 59:1003-4, 1006-7. [DOI: 10.1007/s00101-010-1764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 06/08/2010] [Accepted: 06/28/2010] [Indexed: 01/08/2023]
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Froessler B, Papendorf D. Intravenous iron sucrose--an effective and attractive modality for perioperative anaemia management. Anaesth Intensive Care 2010; 38:960-962. [PMID: 20865896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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