Objectives: To report the maternal and neonatal results of patients infected with COVID-19 in Panama. Methods: The study is based on the analysis of pregnant women with COVID-19, in 5 hospitals in the Republic of Panama. The inclusion criteria were: Patients with or without symptoms, positive RT-PCR for SARS-CoV-2 in the period from March 23 to 6 months after, whose births were attended in one of those 5 hospitals and who signed the consent. Data was obtained at the time of diagnosis of the infection and at the time of termination of pregnancy for the mother and newborn. Results: 253 patients met the inclusion criteria. Most were diagnosed in the third trimester (89.3%). 10.3% of the patients presented in a severe form of COVID-19. The most frequent complication was pre-eclampsia and if we add gestational hypertension they represent 21.2%; most of the patients terminated the pregnancy by caesarean section (58%). 26.9% (95% CI 21.3-32.9%) of the births were premature, and perinatal mortality was 5.4% (95% CI 3.0-9.0%). There was a need for mechanical ventilation in 5.9% (95% CI 3.6-9.6%) of the cohort and there were four maternal deaths (1.6% - 95% CI 0.6-4.0%). Conclusions: This study of pregnant women infected with COVID-19 and diagnosed with RT-PCR shows serious maternal complications such as high admission to the ICU, need for mechanical ventilation and one death in every 64 infected. Frequent obstetric complications such as hypertension, premature rupture of membranes, high rate of prematurity and perinatal lethality were also seen.
INTRODUCTIONCardiovascular disease is the leading cause of death in women. 1 The hypertensive disorders of pregnancy (HDP) are the most common medical complication of pregnancy, complicating up to 10% of pregnancies worldwide. They represent a leading cause of maternal mortality and morbidity in pregnancy. The most common of these disorders is gestational hypertension (5-6%). Using population-based data, approximately 1% of pregnancies are complicated by pre-existing hypertension, 5-6% by gestational hypertension without proteinuria, and 1-2% by pre-eclampsia. 2 The HDP, and pre-eclampsia in particular, are associated with elevated cardiovascular risk. Pregnancy is a metabolic and vascular 'stress test' for women, and those who develop pre-eclampsia have revealed themselves to be at heightened cardiovascular risk. The association between pre-eclampsia and cardiovascular events has been consistent over time, in different settings, and for coronary and cerebrovascular outcomes. Pre-eclampsia increases both the absolute risk of these events, as well as the risk that these events will occur at a younger age. 3 There is a dose-response effect, in that severe pre-eclampsia (more severe hypertension or pre-eclampsia of earlier onset) or pre-eclampsia associated with additional placental complications (such as stillbirth or small for gestational age infants) is associated with higher risk of cardiovascular disease than is gestational (or "pregnancy induced", non-proteinuric) hypertension. 4 The magnitude of the risk in women with previous pre-eclampsia is similar to that of dysplipidaemia. 5 The link that underlies the association between pre-eclampsia and cardiovascular disease has been unclear. It has been thought most likely that pre-eclampsia and cardiovascular disease share a common pathogenesis rooted in shared risk "markers", and support for this is growing. 6 An alternative hypothesis is that pre-eclampsia through its endothelial damage may confer long-term vascular changes.Most women who develop pre-eclampsia return to a "normal" clinical state (from a cardiovascular point of view) in the weeks following pregnancy. Thereafter, LA Magee et al.it is unclear what to do with the knowledge that these women are at increased cardiovascular risk. Cardiovascular risk calculators are focused on short-term risk over the next decade, and even women with early, severe pre-eclampsia are still at relatively low cardiovascular risk (<10%) over the subsequent decade.This review will summarise the data associating pre-eclampsia with long-term cardiovascular risk. However, we will focus on the follow-on steps that lead from that association, namely what advice to offer clinicians and their patients about actions pertaining to cardiovascular risk marker screening and cardiovascular risk reduction.
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