Prenatal screening diagnosis and management in the era of coronavirus: the Sardinian experience

Abstract

<jats:title>Abstract</jats:title><jats:p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was first identified in December 2019 in Wuhan, China and spread rapidly, affecting many other countries. The disease is now referred to as coronavirus disease 2019 (COVID-19).The Italian government declared a state of emergency on 31st January 2020 and on 11th March World Health Organization (WHO) officially declared the COVID-19 outbreak a global pandemic. Although the COVID-19 incidence remained considerably lower in Sardinia than in the North Italy regions, which were the most affected, the field of prenatal screening and diagnosis was modified because of the emerging pandemic. Data on COVID-19 during pregnancy are so far limited. Since the beginning of the emergency, our Ob/Gyn Department at Microcitemico Hospital, Cagliari offered to pregnant patients all procedures considered essential by the Italian Ministry of Health. To evaluate the influence of the COVID-19 pandemic on the activities of our center, we compared the number of procedures performed from 10th March to 18th May 2020 with those of 2019. Despite the continuous local birth rate decline, during the 10-week pandemic period, we registered a 20% increment of 1st trimester combined screening and a slight rise of the number of invasive prenatal procedures with a further increase in chorionic villi sampling compared to amniocentesis. Noninvasive prenatal testing remained unvariated. The request for multifetal pregnancy reduction as a part of the growing tendency of voluntary termination of pregnancy in Sardinia increased. The COVID-19 pandemic provides many scientific opportunities for clinical research and study of psychological and ethical issues in pregnant women.</jats:p>

Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

“…The majority of studies reported findings from a single hospital site or group of facilities relating to specific and highly variable changes in protocols made during the pandemic [13,23À39]. This ranged from the institution of new telehealth services [29,33,35,40À47], altered hospital admission and discharge protocols [27,30,48À50], variance in anaesthetic management [27,36,51,52], and harmonisation of regional antenatal screening services [32,53,54]. Only 14 of the 56 papers reported data from low-or middle-income (LMIC) countries according to World Bank classification [13,28,37,54À64].…”

“…The majority of studies reported findings from a single hospital site or group of facilities relating to specific and highly variable changes in protocols made during the pandemic [ 13 , [23] , [24] , [25] , [26] , [37] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. This ranged from the institution of new telehealth services [ 29 , 33 , 35 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ], altered hospital admission and discharge protocols [ 27 , 30 , [48] , [49] , [50] ], variance in anaesthetic management [ 27 , 36 , 51 , 52 ], and harmonisation of regional antenatal screening services [ 32 , 53 , 54 ]. Only 14 of the 56 papers reported data from low- or middle-income (LMIC) countries according to World Bank classification [ 13 , 28 , 37 , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ].…”

“…This finding raises concern that women may have been less able to access foetal anomaly screening where desired. In three studies reporting on invasive prenatal genetic testing all noted changes in the timing of presentation and type of procedures performed [ 32 , 53 , 54 ]. In one study from Turkey, fewer women took up the offer of chorionic villus sampling and amniocentesis - during ( n = 56, 434%) compared with before ( n = 88, 638%) the pandemic [54] .…”

“…Nevertheless, more invasive testing in later pregnancy was offered via cordocentesis ( n = 6, 11%), raising the possibility that screening tests had been delayed during early pregnancy. One foetal medicine centre in Sardinia, Italy, observed an increase in first trimester screening attendance (70% of population during vs. 50% pre-pandemic) and invasive procedure rates ( n = 150 during vs n = 146 pre-pandemic), attributed to increased referrals from other centres that were unable to offer COVID-secure testing [53] . Second and third trimester visits were unaffected.…”

Efficacy, safety, and success of 18‐ versus 20‐gauge needle for transabdominal chorionic villus sampling in a high‐volume training setting

“…3 The introduction of more accurate genetic screening tests, such as first trimester combined screening 4 and cellfree DNA testing, 5 has caused a notable decline in utilization of invasive prenatal diagnosis. 6 However, an increasing number of fetal anomalies are detected by first trimester ultrasound due to innovation and sophistication in ultrasound tools, leading to a greater request for invasive prenatal diagnostic procedures in the first trimester. Several maternal-fetal centers have reported a preference of women toward CVS versus amniocentesis because of the availability at an earlier gestational age for similar fetal loss rate.…”