IMPORTANCE Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). OBJECTIVES To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. EXPOSURES SARS-CoV-2 infection during pregnancy. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described.
studies should expand gender identity response options to be more inclusive of nonbinary, genderqueer, and gendernonconforming populations. Limitations to this study include possible response and self-report bias, limited generalizability (only 15 states collected gender identity data), gender identity misclassification, and unmeasured confounders.
Oesophageal atresia without distal tracheo-oesophageal fistula is a recognized cause of the absence of fluid in the fetal stomach seen on serial ultrasound examinations. It is rare not to demonstrate fluid in the fetal stomach after 15 weeks gestation. There have been several reports of the antenatal diagnosis of oesophageal atresia by ultrasound, the earliest by Farrant (1980). Oesophageal atresia occurs once in every 1500 live births and 90% of these are associated with a tracheooesophageal fistula. The fistula is usually to the distal oesophageal segment but rarely are a distal and proximal fistula found. In 1%, an H-type tracheooesophageal fistula is present without an associated oesophageal atresia. In cases of oesophageal atresia with tracheo-oesophageal fistula to the distal segment, fluid in the lungs and major airways may reach the fetal stomach by way of the fistula in spite of oesophageal interruption. Polyhydramnios may still be present. When oesophageal atresia occurs in isolation (10%) or when a single fistula is present to the proximal oesophagus (1%), no fluid can enter the stomach and none will be seen on serial ultrasound examinations. The purpose of this report is to review other abnormalities that may produce a similar appearance and to document two cases presenting in this manner, which, to our knowledge, have not been previously reported. A 31-year-old gravida 5 para 3 in her 32nd week of gestation was examined to assess the placental position. A live fetus was present in the vertex position. Mild polyhydramnios was present.
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