Early reports suggested that pregnant women were not at an increased risk for severe disease or death from coronavirus disease 2019 (COVID-19). 1 However, few publications have described critical illness in pregnant patients with COVID-19. This study describes the clinical characteristics and outcomes of critically ill mothers and their neonates within our health network since the onset of the COVID-19 pandemic in New Jersey. STUDY DESIGN:This institutional review boardeapproved, retrospective case series describes all pregnant women and their neonates requiring critical care for severe COVID-19 within our network's 2 largest hospitals in March 2020 and April 2020. Maternal demographic information, delivery method and indication, clinical symptomatology, imaging and laboratory findings, and treatment data were collected. Neonatal outcomes were also collected, including real-time polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Appendicitis in pregnancy is the most common nonobstetric surgical emergency. Pregnancy causes changes in anatomy, which could lead to uncertainty regarding the diagnosis of appendicitis. This case report describes a case of appendicitis presenting with peritoneovaginal fistula in a pregnant woman in the second trimester, with interesting finding of isolated appendiceal endometriosis on pathology. The importance of complete physical examination, including speculum examination, is emphasized in the pregnant patient presenting with acute-onset abdominal pain. Imaging criteria for diagnosis of appendicitis should be adjusted to account for the gravid uterus, which may cause appendiceal abscess to appear in a variety of locations, such as posterior to the cervix, as in this case.
INTRODUCTION: Pregnancy is a risk factor for venous thromboembolism (VTE). Several VTE risk assessment models (RAM) have been created but not validated in obstetrics. It is unclear which factors confer greater risk of VTE and at what point VTE risk assessment should occur. Our goal was to determine which RAM is most effective at capturing high risk patients while excluding low risk patients and to determine how delivery-related factors (such as mode of delivery, blood loss, transfusion, length of stay) affect RAM scores. METHODS: IRB-approved cross-sectional study evaluating 507 deliveries during November 2018 at an urban academic center. 5 VTE cases were identified from 2013-2018. RAM scores (ACOG, CMQCC, ACCP, RCOG, Caprini, Padua) were calculated for all subjects at admission and discharge. Descriptive statistics and T-tests were utilized to investigate the relationships between mode of delivery, blood loss, blood transfusion, length of stay and RAM score. RESULTS: The Caprini score stratified 40% of VTE cases as high risk pre-delivery whereas 80% were high risk post-delivery. RCOG stratified 80% of cases as high risk pre-delivery and 100% post-delivery. ACCP stratified 80% of cases as high risk pre-delivery and 100% post-delivery. CMQCC stratified 0% of cases as high risk pre-delivery and 80% of cases post-delivery. Further analysis of Caprini, Padua, and RCOG scores demonstrated a significant association between postpartum hemorrhage and higher score. CONCLUSION: RCOG and ACCP models categorized most controls and cases as low- and high-risk, respectively. VTE assessment should be performed at hospitalization and prior to discharge because delivery-related factors affect risk of VTE.
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