Coronavirus disease 2019 (COVID-19) caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has alarmed the world since its first emergence. As pregnancy is characterized by significant changes in cardiovascular, respiratory, endocrine and immunological systems, there are concerns on issues like the course of disease in pregnant women, safety of medications, route of delivery and risk of obstetric complications. The aim of this review is to summarize the current literature in the management of pregnant women during the COVID-19 pandemic. Although more than 90% of pregnant women with COVID-19 recover without serious morbidity, rapid deterioration of disease and higher rates of obstetric complications may be observed. The risk of vertical transmission has not been clearly revealed, yet. Decreasing the number of prenatal visits, shortening the time allocated for the examinations, active use of telemedicine services, limiting the number of persons in health-care settings, combining prenatal tests in the same visit, restricting visitors during the visits, providing a safe environment in health-care facilities, strict hygene control and providing personal protective equipment during the visits are the main strategies to control the spread of disease according to current guidelines. Although new medication alternatives are being proposed every day for the treatment of COVID-19, our knowledge about the use of most of these drugs in pregnancy is limited. Preliminary results are promising for the administration of SARS-CoV-2 vaccines in the pregnant population. Timing of delivery should be decided based on maternal health condition, accompanying obstetric complications and gestational age. Cesarean delivery should be performed for obstetric indications. Breast feeding should be encouraged as long as necessary precautions for viral transmission are
The worldwide incidence of tuberculosis (TB) is rising and is linked to immigration patterns and the rise in incidence of HIV. Extra-pulmonary disease, in particular, can lead to diagnostic dilemmas. Because the total number of cases of TB in pregnancy in developed countries is small and often concentrated in specific urban areas with large immigrant populations, clinicians may rarely encounter the problem. This paper provides actual clinical experience of one recent case.
Background
There is a continuing debate regarding optimal timing and mode of delivery in twins.
Aim
To describe neonatal mortality rates (NMR) and factors influencing mode of delivery in twins following induced or spontaneous labour.
Methods
We used data from the population-based Northern Survey of Twin and Multiple Pregnancy on twins delivered in the North of England during 1998–2007. Stillbirths and neonatal deaths were identified from the Northern Perinatal Mortality Survey. Factors associated with mode of delivery in twins with spontaneous and induced labour were explored by logistic regression.
Results
There were 4203 twin pairs alive at the onset of labour or prior to planned caesarean section (CS) of which 29.7% (n=1250) underwent elective CS, 43.9% (n=1843) laboured spontaneously, and 20.6% (n=862) were induced. For spontaneous labours, the NMR was 40.3 and 44.0 per 1000 live births for first and second twins respectively (p=0.6), and for induced labours, 1.2 and 7.0 per 1000 live births respectively (p=0.12). Twins delivered following spontaneous labour were born at significantly earlier gestation than following induction: 34.2 (SD±3.7) versus 37.2 weeks (SD±1.4) (p<0.001). There was a higher rate of vaginal delivery of both twins following induced labour: 68.6% versus 63.3% following spontaneous labour (p<0.01). Presentation of both twins, maternal age and parity were associated with mode of delivery in both groups.
Conclusion
There was a higher rate of vaginal delivery of both twins after induced compared with spontaneous labour. The higher NMR in twins after spontaneous labour was associated with earlier gestation at delivery.
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