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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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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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