Introduction The COVID19 pandemic raises a major concern about its severity in pregnancy, fetomaternal outcomes and risk of vertical transmission.The Cycle threshold indicating the viral load can be a contributory factor towards modifying the management of such pregnant women. We report a retrospective descriptive study regarding the clinical course, fetomaternal outcomes of pregnant women with COVID19. Methodology This is a single-center, retrospective study performed in a tertiary care hospital for pregnant women with COVID-19 in India. The medical records of the all women who delivered in the Covid facility from May 5th 2020 to June 5th 2020 were reviewed independently. Data extracted from the records included demography, obstetric details, co morbidities, disease severity, investigations, management and information on neonates (birthweight, Apgar score, and perinatal complications).Statistical analysis was performed by the SPSS program for Windows, version 17.0(SPSS, Chicago, Illinois) Results Amongst 348 women(suspects) tested for SARS-CoV-2, 57 women ( 57/348,16.3%) were confirmed positive based on qRT-PCR of nasopharyngeal specimen. Most women (45 /78.9 %) had mild infection with favourable fetomaternal outcomes. Three maternal mortalities were associated with co morbidities. Five neonates tested positive for SARS-CoV-2, remained haemodynamically stable and were subsequently discharged. Conclusions Majority of pregnant women with Covid-19 had mild disease and recovered subsequently with good perinatal outcomes. Women with co morbidities may have increased risk of severe morbidity and mortality.The Cycle threshold signifying the viral load and degree of infectivity can modify the management during pregnancy.Long-term outcomes and the potential mother-to-child vertical/horizontal transmission needs further study.

A 35 year old primigravida was admitted to hospital at 18 weeks of gestation with recurrent attacks of vomiting. Her symptoms first developed in the sixth week of pregnancy, and she had been admitted three times with a provisional diagnosis of hyperemesis gravidarium. On each occasion the w o r n was hyponatraemic (plasma sodium [119][120][121][122][123][124][125][126][127][128] mmol/L), with normal plasma potassium, urea, creatinine and glucose levels. During each admission she improved with anti-emetic drugs and intravenous normal saline and was then discharged. In the eight weeks before her pregnancy, the woman had experienced anorexia, weight loss and intermittent diarrhoea. On her fourth admission she appeared well, if slightly dehydrated, had a blood pressure of 100/80 mmHg with no postural hypotension and showed discolouration of skin and mucous membranes (ascribed initially to her Portuguese ancestry). Otherwise the clinical examination was normal. She was treated with intravenous normal saline, but despite this became hypotensive (blood pressure 80/40 mmHg) and remained hyponatraemic (plasma sodium 1OP-115 mmol/L). A presumptive diagnosis of Addison's disease was made. Blood was taken to estimate random cortisol and adrenocorticotrophic hormone levels, and she was treated with intravenous hydrocortisone. Her random serum cortisol concentration was 106 nrnoVL and adrenocorticotrophic hormone concentration was > 1500 ng/L, confinnng primary adrenal failure. The serum was strongly positive for 21-hydroxylase antibodies, suggesting auto-immune adrenalitis, the commonest cause of Addison's disease. Glutamic acid decarboxylase, thyroid peroxidase and thyroglobulin antibodies were also positive but glucose tolerance and thyroid function were normal. Following her intravenous steroid therapy the woman was given oral hydrocortisone and fludrocortisone and subsequently her blood pressure and plasma sodium concentration returned to normal, with restoration of her wellbeing. The remainder of her pregnancy was uneventful, and she was delivered at 41 weeks of a male infant weighing 2500 g. In herCorrespondence: Dr L. George, c/o Dr Peter's Secretary, Ward B7, University Hospital of Wales, Heath, Cardiff CF4 4XW, UK. 808 labour she was treated with 50 mg intravenous hydrocortisone eight-hourly and was re-started on her usual dose of oral hydrocortisone 24 hours after her delivery. Case report 2A 24 year old primigravida was admitted at 3 1 weeks of gestation with headache, nausea and vomiting for the previous two days. She had diabetes mellitus treated with insulin. On admission she was drowsy with no abnormal neurological signs and no abnormality on general physical examination. Her blood pressure was 115/80 d g . In view of drowsiness computed tomography and a lumbar puncture were performed, the results of which were normal. Her plasma sodium concentration was 136 mmol/L and potassium 3.8 mmol/L. Her diabetes was treated with intravenous soluble insulin and infusion of 5% dextrose.Her headache, nausea and vomiting p...

Introduction: A surge in the number of patients with acute limb ischemia (ALI) was seen during the first and second waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This has been ascribed to the hypercoagulable state seen in COVID infections. The aim of this study is to report our experience and outcomes of ALI associated with SARS-CoV-2 infection. Materials and Methods: It was a single-center observational retrospective study from a prospectively maintained database of patients with SARS-CoV-2 infection presenting with ALI between July 2020 and December 2020 with 1-year follow-up. Results: Thirty-nine acutely ischemic limbs were treated in 32 patients including three upper limbs. The mean age of patients was 55.75 (range: 27–80). There were 23 (71.87%) males and 9 (28.12%) females. Majority of the limbs were in Class IIB of ALI, whereas 20.51% had irreversible ischemia. Of the 39 affected limbs in 32 patients, 22 limbs were revascularized, 9 had primary amputation, and 8 were managed conservatively with anticoagulation. The overall limb salvage was 26 out of 39 limbs (66.7%), whereas it was 81.8% for the limbs that had an intervention. The overall mortality was 9.4%. There was no further limb loss or mortality during 1-year follow-up. Interestingly, 15 patients did not have any symptoms suggestive of SARS-CoV-2 infection other than ALI. The severity of COVID infection did not correlate with the severity of ALI. Conclusion: COVID-19 infection can be associated with arterial thrombosis and ALI, which, if treated early with appropriate intervention, can result in a satisfactory limb salvage rate. Prophylactic anticoagulation in COVID-19-infected patients may not prevent arterial thrombosis, and the clinical severity of the COVID-19 infection is not a predictor of arterial thrombosis.