No abstract

Limited data are available on pregnant women with COVID-19 and their neonates. We aimed to evaluate the epidemiological and clinical characteristics of newborns born to women infected with COVID-19. A multicenter cohort study was conducted among newborns born to mothers with COVID-19 in 34 neonatal intensive care units (NICUs) in Turkey. Pregnant women ( n = 125) who had a positive RT-PCR test and their newborns were enrolled. Cesarean section, prematurity, and low-birthweight infant rates were 71.2%, 26.4%, and 12.8%, respectively. Eight of 125 mothers (6.4%) were admitted to an intensive care unit for mechanical ventilation, among whom six died (4.8%). Majority of the newborns (86.4%) were followed in isolation rooms in the NICU. Four of 120 newborns (3.3%) had a positive RT-PCR test result. Although samples taken on the first day were negative, one neonate became positive on the second day and the other two on the fifth day. Sample from deep tracheal aspirate was positive on the first day in an intubated case. Conclusion : COVID-19 in pregnant women has important impacts on perinatal and neonatal outcomes. Maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission, and low rate of breastfeeding show that family support should be a part of the care in the NICU. Trial registration : ClinicalTrials.gov identifier: NCT04401540 What is Known: • The common property of previous reports was the conclusions on maternal outcomes, rather than neonatal outcomes. • Published data showed similar outcomes between COVID-19 pregnant women and others. What is New: • Higher maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission especially in a case with deep tracheal aspiration during the intubation, and the possible role of maternal disease severity on the outcomes are remarkable findings of this study. • In contrast to recommendation for breastfeeding, parents’ preference to formula and expressed breast milk due to anxiety and lack of information shows that family support should be a part of the care in the NICU.

Amaç: İn vitro fertilizasyon (İVF) ve embriyonik manipülasyonlar yoluyla gebe kalan kadınlarda hormon kullanımı, pulmoner hipertansiyon olasılığı da dahil olmak üzere yenidoğanların sağlığıyla ilgili endişeleri artırmıştır. Bu nedenle bu çalışma, term İVF yenidoğanlarında pulmoner arter basıncını değerlendirmeyi amaçlamıştır. Gereç ve Yöntemler: Bu prospektif kesitsel çalışma Mart 2013 ile Ekim 2017 arasında gerçekleştirilmiştir ve 160 İVF yenidoğanı (grup 1) 160 doğal yolla olan yenidoğanla (grup 2) karşılaştırmaktadır. Her iki gruptaki yenidoğanlar, gebelik ve yenidoğan yaşı açısından eşleştirilmiş sezaryen ile doğan yenidoğanlardı. Yenidoğanlar üç-yedi günlük idi, 37-39 hafta ve 6 günlük tam dönem gebelik yaşına sahipti ve yenidoğanların doğum ağırlığı normal sınırlarda (2500-4000 g) idi. Sistolik pulmoner arter basıncı (SPAB), triküspit yetersizlik jetinin pik akış hızını temel alan gerçek zamanlı ekokardiyografi kullanılarak tahmin edildi. Bulgular: İki grup arasındaki ortalama SPAB açısından anlamlı bir fark gözlendi (p<0,001). Her ne kadar gestasyonel yaşın SPAB'yi düşürücü etkisi grup 1'de daha fazla ve istatistiksel olarak anlamlı olsa da, doğumdan sonra PAB'de kademeli azalma bu grupta daha yavaş gözlenmiştir. Ayrıca, her iki grupta da gebelik yaşının SPAB'yi düşürücü etkisi yenidoğan yaşına göre daha belirgindi. Ayrıca, her iki grupta da SPAB ile yenidoğan ağırlığı arasında anlamlı bir ters korelasyon gözlendi; ancak bu korelasyonun grup 1'de daha kuvvetli olduğu görüldü. Sonuç: Çalışmamız, İVF'yi yenidoğanlarda pulmoner hipertansiyon insidansında artış ile ilişkili bulmuştur. Bu nedenle, İVF yenidoğanlarında pulmoner

Objectives Currently, there is little evidence related to the effects of the Omicron variant on pregnancy outcomes, particularly in unvaccinated women. This study aims to compare pregnancy outcomes of SARS‐CoV‐2 infected, unvaccinated women during the pre‐Delta, Delta, and Omicron waves. Methods This was a retrospective cohort study at two tertiary care facilities: Sancaktepe Training and Research Hospital, Istanbul, Turkey, and St. George's University Hospitals NHS Foundation Trust, London, UK. Included were people testing RT‐PCR positive for SARS‐CoV‐2 during pregnancy, between April 01, 2020 and February 14, 2022, and divided into three epochs: (i) pre‐Delta , 1 Apr 2020 to 8 Jun 2021 in Turkey, and 1 Apr 2020 to 31 Jul 2021 in the UK; (ii) Delta , 9 Jun 2021 to 27 Dec 2021 in Turkey, and 1 Aug 2021 to 27 Dec 2021 in the UK; and (iii) Omicron , after 27 Dec 2021 in each of Turkey and the UK, according to the date of their positive RT‐PCR test. Baseline data collected included maternal age, parity, body mass index (BMI), smoking status, gestational age at diagnosis, and comorbidities. The primary outcome was the need for oxygen supplementation, classified as oxygen support via nasal cannula or breather mask, non‐invasive mechanical ventilation with continuous positive airway pressure (CPAP) or high‐flow oxygen, mechanical ventilation with intubation, or extracorporeal membrane oxygenation (ECMO). Inferences were made after balancing of confounders, using an evolutionary search algorithm. Results 1285 RT‐PCR‐proven SARS‐CoV‐2 infections of unvaccinated pregnant women were identified during the pre‐Delta (N=870), Delta (N=339), and Omicron (N=77) epochs. In the confounder‐balanced cohort, infection during the Delta wave was associated with increased need for nasal oxygen support (RR 2.53, 95% confidence interval [CI] 1.75‐3.65, P<.001), CPAP or high‐flow oxygen (RR 2.50, 95% CI 1.37‐4.56, P=.002), mechanical ventilation (RR 4.20, 95% CI 1.60‐11.0, P=.003), and ECMO (RR 11.0, 95% CI 1.43‐84.7, P=.021). The maternal mortality rate was also 3‐4 fold higher during the Delta wave compared to pre‐Delta (5.3% vs 1.5%, P=0.010). An infection during the Omicron wave was not associated with an increased need for nasal oxygen support (RR 0.62, 95% CI 0.25‐1.55, P=0.251), CPAP or high‐flow oxygen (RR 1.07, 95% CI 0.36‐3.12, P=0.906), or mechanical ventilation (RR 0.44, 95% CI 0.06‐3.45, P=0.438). The maternal mortality rate was similar during the Omicron wave and the pre‐Delta period (1.3% vs 1.3%, P=0.999). Nasal oxygen support during the Omicron wave was significantly lower compared to Delta‐wave infection (RR 0.26, 95% CI 0.11‐0.64, P=0.003). Perinatal outcomes were available for a subset of the confounder‐balanced cohort. Preterm birth below 34 weeks’ gestation was significantly increased (P<0.001) during the Delta wave compared with...

Lung ultrasound (LUS) is an effective tool to detect and monitor patients infected with 2019 coronavirus disease (COVID-19). The use of LUS on pregnant women is an emerging trend, considering its effectiveness during the outbreak. Eight pregnant women with a diagnosis of COVID-19 confirmed by nasal/throat real-time reverse transcription polymerase chain reaction testing who underwent point-of-care LUS examinations after routine obstetric ultrasound are described. A routinely performed LUS examination revealed serious lung involvement in 7 cases: 2 were initially asymptomatic; 3 have chest computed tomography; 1 had initial negative real-time reverse transcription polymerase chain reaction results; and 1 had initial negative computed tomographic findings. Treatment for COVID-19 was either commenced or changed in 87.5% of the patients (n = 7 of 8) on LUS findings. Among patients with abnormal LUS findings, treatment was commenced in 5 patients (71.5%) and changed in 2 patients (28.5%). One normal and 7 abnormal LUS cases indicate the impact of routine LUS on the clinical outcome and treatment of pregnant women.