Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21 st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2...

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Sedation-Agitation Scale and BIS are valid measures of wakefulness after cardiac surgery, but EMG interference may affect the accuracy of BIS for a small percentage of patients not receiving neuromuscular blockade.

SAS and BIS work well to describe the depth of sedation for ventilated ICU patients. Deeper sedation and intermittent neuromuscular blockade were used for patients with greater ventilatory requirements and more severe lung disease. The correlation between subjective and objective scales varied in medical, surgical, and trauma patients. Further research with SAS and BIS may facilitate the development of quantitative sedation guidelines for the ICU.

We found a low prevalence of SARS-CoV-2 (2.7% [5/188]) among pregnant and postpartum patients after initiating universal testing. Prevalence among symptomatic patients (22.2% [4/18]) was similar to initial targeted screening approaches (19.1% [8/42]). Among 170 asymptomatic patients, two were positive or inconclusive, respectively; repeat testing at 24 hours was negative.

We recently demonstrated whole genome sequencing of a human fetus using only parental DNA samples and plasma from the pregnant mother. This proof-of-concept study demonstrated how samples obtained noninvasively in the first or second trimester can be analyzed to yield a highly accurate and substantially complete genetic profile of the fetus, including both inherited and de novo variation. Here, we revisit our original study from a clinical standpoint, provide an overview of the scientific approach, and describe opportunities and challenges along the path towards clinical adoption of noninvasive fetal whole genome sequencing (NIFWGS).

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Summary:The delivery of a 25-year-old Jehovah's Witness was complicated by postpartum haemorrhage with a nadir haematocrit of 3%. To improve oxygen delivery without blood transfusion, FiO 2 was increased to maximize dissolved oxygen delivery. Central venous oxygen saturation was used to assess tissue oxygenation. When blood products are refused, successful management of severe anaemia is possible with supportive medical care to achieve haemostasis, optimize oxygen delivery and promote haematopoiesis.Keywords: postpartum haemorrhage, ScvO 2 , blood product refusal CASE HISTORYA 25-year-old primipara dedicated to Jehovah's Witness faith developed preeclampsia at 37 weeks with a haematocrit of 35%. She received magnesium sulphate and delivered a 2555 g infant via vacuum. Her postpartum course was complicated by postpartum haemorrhage due to uterine atony and retained products of conception for which she was treated with operative curettage and uterotonics. Her postoperative haematocrit was 6.2%. She was transferred to the ICU and received vitamin K, iron sucrose and hespan. She became increasingly hypotensive and received norepinephrine, dopamine and albumin. She demonstrated acute neurological changes, was intubated and transferred to our facility.The patient's record documented a 21-year recognition of Jehovah's Witness practice and an advanced directive executed during pregnancy. Her family confirmed these sentiments. The office of the Attorney General reviewed the directive and concluded its execution while pregnant acted as a surrogate expression of her preferences including her consideration of her pregnancy. Medical providers approached her case respecting her advanced directive.Initial laboratory values included an elevation of troponin of 5.43 ng/mL (,0.4), ALT of 266 U/L (8 -49), AST of 210 U/L (10 -44) and serum creatinine of 1.2 mg/dL (0.3-1.2), venous lactate of 10.7 mmol/L (0.5-2.1), platelet count of 156,000/mL (150-400) and HCO 3 of 17 mEq/L (22 -32). Blood draws were obtained from peripheral and peripherally inserted central catheter (PICC) line access. Her electrocardiogram demonstrated sinus tachycardia with a heart rate of 130 beats per minute. A transthoracic echo obtained on postpartum day 3 revealed normal ventricular size and function without detectable regional wall motion abnormality, normal valve function and a very small, circumferential pericardial effusion.To decrease oxygen consumption, she remained mechanically ventilated with spontaneous assist control and positive end-expiratory pressure of 5 cm H 2 O. Her FiO 2 (fraction of inspired oxygen) was increased from 50% to 100% despite O 2 saturations of 100% to optimize oxygen carrying capacity (Figure 1). Tissue oxygenation was assessed with central venous oxygen saturations (ScvO 2 ) obtained via a PICC with the line tip in the superior vena cava just above the cavoatrial junction. At a FiO 2 of 100%, ScvO 2 improved from 40% to 90%, lactate and HCO 3 normalized, each suggesting improved oxygen delivery. Her PaO 2 ranged from 126 to 1...