ABSTRACT
Introduction: Obstetric emergencies that occur during labor, often present as a major indication for prompt completion of labor by instrumental methods or emergency cesarean section. The purpose of this study was to present the clinical features of emergencies, the evolution of labor, maternal and fetal or neonatal complications at patients with SARS-COV-2 infection.
Materials and methods: We performed a retrospective study that included 150 pregnant women who gave birth in Bucur Maternity, St John Hospital, Bucharest, between 2018-2020 that fulfilled the features of obstetrical emergency during labor and SARS-CoV-2 infection. The study group was divided in patients positive for SARS-CoV-2 and negative for SARS-CoV-2.
Results: Following PCR testing for SARS-CoV-2 were 26.67% of patients positive and 73.33% had a negative result. Analyzing the data obtained from this group of patients, it resulted that the average hospitalization is higher in the positive group (7.05 days) versus the negative group (5.47 days). The average gestational age at birth of SARS-CoV-2 positive patients was 37.26 weeks, lower than the gestational age of neonates from uninfected mothers (38.41 weeks). The average of the APGAR scores in the COVID group is 8.41, and for the negative group is 8.90.
Conclusions: The associated SARS-CoV-2 infection played a significant role in terms of the APGAR score and the early peripartum outcomes of new-borns, negatively influencing the value of the APGAR index. Gestational age was considerably lower in patients diagnosed with the infection. The SARS-CoV-2 virus infection has a significant influence in unsatisfactory neonatal outcomes compared to new-borns of healthy mothers.
Keywords: SARS-CoV-2, COVID-19, obstetrical emergencies
REZUMAT
Introducere: Urgențele obstetricale care apar în timpul travaliului, se prezintă adesea ca o indicație majoră pentru finalizarea promptă a naşterii prin metode instrumentale sau operație cezariană de urgență. Scopul acestui studiu a fost de a prezenta caracteristicile clinice ale acestor urgenţe, evoluția travaliului, complicațiilor materne și fetale sau neonatale la gravide cu infecție SARS-CoV-2.
Materiale și metode: Am realizat un studiu retrospectiv care a inclus 150 de gravide care au născut în Maternitatea Bucur, Spitalul Sfântul Ioan, București în perioada 2018-2020. Toate pacientele incluse în studiu au îndeplinit caracteristicile urgențelor obstetricale în timpul travaliului și infecției cu SARS-CoV-2. Grupul de studiu a fost împărțit în paciente cu infecție SARS-COV-2 și gravide cu viremie SARS-CoV-2 negativă.
Rezultate: În urma testării PCR pentru SARS-CoV-2, 26,67% dintre paciente au fost pozitive și 73,33% au avut un rezultat negativ. Analizând datele obținute, a rezultat că media zilelor de spitalizare a fost mai mare în grupul diagnosticat cu SARS-CoV-2. Vârsta gestațională medie la naștere a gravidelor pozitive pentru SARSCoV-2 a fost de 37,26 săptămâni, mai mică decât vârsta gestațională a nou-născuților din mame neinfectate. Media scorurilor APGAR la lotul COVID este 8,41, iar pentru grupa negativă 8,90.
Concluzii: Infecția SARS-CoV-2 a jucat un rol semnificativ în ceea ce privește scorul APGAR și evoluţiile peripartum ale nou-născuților, influențând negativ valoarea indicelui APGAR. Vârsta gestațională a fost considerabil mai mică la gravidele pozitive. Infecția cu SARS-CoV-2 are un impact semnificativ asupra rezultatelor neonatale nesatisfăcătoare în comparație cu nou-născuții cu mame sănătoase.
Cuvinte-cheie: SARS-CoV-2, COVID-19, urgențe obstetricale
1. INTRODUCTION
Pregnancy is a physiological process of maternal adaptation to the presence of the fetus and fetal adnexa. The mother's body is constantly changing during pregnancy in order to provide the product of conception with the nutrients and factors that are required for the integrity of the fetal development process [1]. Thus, maternal adaptations occur from early pregnancy and involve almost all systems [2].
Vaginal delivery is the process of expulsion of the fetus through the genital tract, between 24 and 42 weeks of gestation. It is preferred over cesarean section because the latter has higher morbidity and mortality compared to vaginal birth [3]. However, when there is an increased maternal or fetal risk or vaginal delivery is not possible, an emergency caesarean section is indicated [4].
Obstetrical emergencies during labor occur whenever the balance between maternal adaptations for pregnancy and childbirth and fetal development is disrupted, with a variety of causes, such as fetal distress [5], placental abnormalities [6], umbilical cord abnormalities [7], dystocia [8], or severe forms of pregnancyassociated hypertension [9] or other medical conditions [10].
The purpose of the present study was to evaluate the clinical outcome of patients, with emergency cesarean section performed for pregnancy anomalies. We observed the correlations between SARS-CoV-2 infection and the type of obstetrical emergencies that occurred during labor, hospitalization days and maternal complications. The maternal and fetal outcome during the postpartum period in association with SARS-CoV-2 virus infection was also evaluated.
2. MATERIAL AND METHODS
We performed a retrospective study that included 150 pregnant women who delivered in "Bucur" Maternity, St John Hospital, Bucharest between 2018-2020 and experienced and obstetrical emergency during labor.
The evaluated parameters included 1. Patient age, 2. Gestational age, 3. Number of days of hospitalization, 4. APGAR score accorded to each newborn and 5. Fetal weight at birth.
The study cohort was divided in two groups - positive for SARS-CoV-2 and negative for SARS-CoV-2.
The analysis was performed using IBM SPSS Statistics version 28 and Microsoft Excel version 16.50; we researched the characteristics of the study group.
3. RESULTS
According to a non-randomized distribution the patients diagnosed with COVID-19 disease, following PCR testing for SARS-CoV-2 were 26.67% of patients positive and 73.33% had a negative result (Fig. 1). Thus, within the two groups we analyzed the correlation between the presence of the virus and: the age of patients, gestational age, number of days of hospitalization, APGAR score accorded to each newborn and fetal weight at birth.
Fig. 2 shows the difference between the two groups in terms of average age of patients. The positive SARS-CoV-2 group has an average age of 29.35 years, and the non-COVID-19 group, 28.88 years. The p value is 0.340, and there is no correlation between the presence of the virus and the age of the patients.
We analyzed the relationship between the positive SARS-CoV-2 result and the average gestational age in these patients, the test of statistical significance p = 0.001, suggesting that the average gestational age of patients infected with SARS-CoV-2 virus is lower than the average gestational age of patients without this pathology. Thus, the average gestational age at birth of SARS-CoV-2 positive patients was 37.26 weeks, and in the case of the second group, 38.41 weeks (Fig. 3).
Regarding the average days of hospitalization within the two groups (Fig. 4), for SARS-CoV-2 group was 7.05 days, and for the negative SARS-CoV-2 of 5.47 days of hospitalization. The significant difference suggests that there is a correlation between COVID-19 impairment of pregnant patients and an increase in the number of days of hospitalization, as demonstrated by the p < 0.05 value of the statistically significant test (p = 0.003).
Regarding the APGAR score (Fig. 5), it can be observed a correlation between the scores lower than 9 in the case of new-borns of patients with SARS-CoV-2 patients and the almost constant higher score in the case of new-borns of non-SARS-CoV-2 patients. The average of the scores in the COVID group is 8.41, and for the negative group is 8.90 with statistically significant difference, p < 0.001. Also, the case with APGAR 5 score can be seen in the SARS-CoV-2 positive group.
Fig. 6 shows a small difference between the two averages of new-born weights, so the positive SARS-CoV-2 group has an average weight equal to 3200 grams, and the negative, 3230.18 grams. This difference is not statistically significant because the statistically significant test has a value of p = 0.379, which shows that there is no link between the presence of maternal SARS-CoV-2 infection and the lower birth weight of these patients.
Fig. 7 shows the distribution of hospitalization days after emergency caesarean section (the average period of hospitalization days - 5.89 days).
A total of 131 patients in the study group did not require special postpartum care or postoperatively, during the post-partum period, of which, 33 were infected with SARSCoV-2 on admission
4. DISCUSSION
Coronaviruses represent a class of pathogens that are highly contagious causing mild to severe respiratory infections. The recent COVID-19 pandemic represents the greatest health crisis of the century [11]. The impact that SARS-CoV-2 infection has on obstetrical population has yet to be reported [12]. Our study grants information on the traits of this highly infectious pathology on obstetric patients and brings forward the comparison between SARS-CoV-2 diagnosed mothers and healthy patients.
Due to their immune system being affected during pregnancy, pregnant patients were anticipated to develop complications as a consequence of respiratory infections [13]. Furthermore, regarding maternal adaptations to pregnant state, the oxygen consumption during pregnancy increases to 20% as a result of increased metabolic needs and the reduced functional residual capacity induces rapid desaturation and respiratory compromise [14].
An unexpected finding in this research is represented by the lack of correlation between age of mothers and the presence of infection. All of the patients underwent emergency caesarean section but older mothers with associated comorbidities did not require significant post-operatory care and did not encounter complications such as haemorrhage or infections.
The data also suggests that the period of hospitalization in patients who underwent caesarean section and had SARS-CoV-2 infection, is prolonged. These results are in line with the claims of Cruz-Lemini (2021), stating that hospitalization in infected pregnant patients was higher, especially at the beginning of the pandemic, due to the fact that most patients had to be admitted for isolation and to be kept under strict observation [15].
In line with the hypothesis, the average gestational age in these patients was lower than that of uninfected mothers. This outcome could be explained by the necessity of rapidly terminating the pregnancy in infected mothers, because the patient's condition is getting worse, due to pneumonia superimposed on the mother's high oxygen requirements [16].
Regarding the neonatal outcomes there is a clear difference between infected and uninfected groups, suggesting that it was necessary to terminate the pregnancy in the case of infected mothers because of overlapping complications present in a immunocompromised state [17]. Such being the case, the birth weight and the APGAR index, were significantly lower in the neonates from infected mothers than the SARS-CoV-2 negative group. There were no neonatal deaths. The data contributes to a clearer understanding of neonatal outcomes and possible complications. Most studies state that vertical transmission from infected mothers to neonates does not happen, our study did not focus on this particular outcome, but it represents an issue to be studied in the future [19].
The main strength of our study is the randomization of patients, which allowed a comparison between SARS-CoV-2 positive group and the SARS-CoV-2 negative group regarding maternal age, hospitalization days, gestational age, new-born weight and APGAR score. Accordingly, we analysed the correlations within the two groups of patients, as presented in the results section.
The limitations of this research are the narrow spectrum of patients due to the small sample group and that the patients included in this study belong to specific geographical borders corresponding to a single hospital.
5. CONCLUSIONS
Peripartum neonatal outcomes were not influenced by the association of gynaecological background. The associated medical background played a significant role in terms of the APGAR score and the early peripartum outcomes of new-borns, negatively influencing the value of the APGAR index. Gestational age was significantly lower in patients infected with SARS-CoV-2. SARS-CoV-2 infections have resulted in a lower APGAR score for newborns. SARS-CoV-2 is a significant factor in unsatisfactory neonatal outcomes compared to new-borns of healthy mothers. Regarding the complications during childbirth, a very small percentage of patients from the studied sample presented complications.
Conflict of Interest: The authors have no conflict of interest to disclose.
Funding: This work received no funding.
Ethical Approval: The study presented in this article was conducted following the recommendations of the Declaration of Helsinki of 1975, revised in 2013 and the Declaration of Taipei, The study was approved by the Ethics Committee of the St John Hospital 30386/16.12.2021
Informed Consent: All participants included in this study signed the informed consent.
*Corresponding author: Romina-Marina Sima; email: [email protected]; https://orcid.org/0000-0002-9541-3347
REFERENCES
1. Pereira A, Krieger BP. Pulmonary complications of pregnancy. Clin Chest Med. 2004;25(2):299310. doi: 10.1016/j.ccm.2004.01.010.
2. Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD, et al. Contemporary Patterns of Spontaneous Labor with Normal Neonatal Outcomes. Obstet Gynecol. 2010;116(6):1281-7. doi: 10.1097/ AOG.0b013e3181fdef6e.
3. Frajewicki A, Lastuvka Z, Borbélyová V, Khan S, Jandová K, Janisová K, et al. Perinatal hypoxic-ischemic damage: review of the current treatment possibilities. Physiol Res. 2020;69(Suppl 3):S379-S401. doi: 10.33549/ physiolres.934595.
4. Graves CR. Acute pulmonary complications during pregnancy. Clin Obstet Gynecol. 2002;45(2):36976. doi: 10.1097/00003081200206000-00008.
5. Dammann O, Ferriero D, Gressens P. Neonatal encephalopathy or hypoxic-ischemic encephalopathy? Appropriate terminology matters. Pediatr Res. 2011;70(1):1-2. doi: 10.1203/ PDR.0b013e318223f38d.
6. Boriboonhirunsarn D, Watananirun K, Sompagdee N. Decision-to-delivery interval in pregnant women with intrapartum nonreassuring fetal heart rate patterns. J Eval Clin Pract. 2016;22(6):998-1002. doi: 10.1111/ jep.12613.
7. Volumenie JL, Luton D, De Spirlet M, Sibony O, Blot P, Oury JF. Ultrasonographic cervical length measurement is not a better predictor of preterm delivery than digital examination in a population of patients with idiopathic preterm labor. Eur J Obstet Gynecol Reprod Biol. 2004;117(1):33-7. doi: 10.1016/j. ejogrb.2004.02.029.
8. Gillam-Krakauer M, Gowen Jr CW. Birth Asphyxia. In: StatPearls. [Internet]. StatPearls Publishing; 2021 [cited 2021 May 19]. Available from: http://www.ncbi.nlm.nih.gov/ pubmed/28613533.
9. Sherer DM, Abulafia O. Intrapartum assessment of fetal head engagement: Comparison between transvaginal digital and transabdominal ultrasound determinations. Ultrasound Obstet Gynecol. 2003;21(5):430-6. doi: 10.1002/uog.102.
10. Maaløe N, Sorensen BL, Onesmo R, Secher NJ, Bygbjerg IC. Prolonged labour as indication for emergency caesarean section: A quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. BJOG An Int J Obstet Gynaecol. 2012;119(5):605-13. doi: 10.1111/j.1471-0528.2012.03284.x.
11. Khan DSA, Pirzada AN, Ali A, Salam RA, Das JK, Lassi ZS. The differences in clinical presentation, management, and prognosis of laboratory-confirmed covid-19 between pregnant and non-pregnant women: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(11):5613. doi: 10.3390/ijerph18115613.
12. Antolín EM, Román J, Molanes B, Luisa De La M, Conty C, Begoña M, et al. SARSCoV-2 Infection and C-Section: A Prospective Observational Study Óscar Martínez-Pérez and on behalf of the Spanish Obstetric Emergency Group. Viruses. 2021;13(11):2330. doi: 10.3390/ v13112330.
13. Jansen JG, van Rhenen DJ, Steegers EP, Duvekot JJ. Postpartum Hemorrhage and Transfusion. Obstet Gynecol Surv. 2005;60(10):663-71. doi: 10.1097/01.ogx.0000180909.31293.cf.
14. Alijahan R, Kordi M. Risk factors of dystocia in nulliparous women. Iran J Med Sci. 2014;39(3):254-60.
15. Cruz-Lemini M, Perez EF, De La Cruz Conty ML, Aguilar AC, Pardilla MBE, Rodriguez PP, et al. Obstetric outcomes of SARS-CoV-2 infection in asymptomatic pregnant women. Viruses. 2021;13(1):1-12. doi: 10.3390/v13010112.
16. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51. doi: 10.21037/ tp.2020.02.06.
17. Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2(2):100118. doi: 10.1016/j.ajogmf.2020.100118.
18. Highley LL, Previs RA, Dotters-Katz SK, Brancazio LR, Grotegut CA. Cesarean delivery among women with prolonged labor induction. J Perinat Med. 2016;44(7):759-66. doi: 10.1515/ jpm-2014-0357.
19. Arab W, Atallah D. Cesarean section rates in the COVID-19 era: False alarms and the safety of the mother and child. Eur J Midwifery. 2021;5:14. doi: 10.18332/ejm/134998.
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
© 2022. This work is published under https://www.roami.ro (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Abstract
Introduction: Obstetric emergencies that occur during labor, often present as a major indication for prompt completion of labor by instrumental methods or emergency cesarean section. The purpose of this study was to present the clinical features of emergencies, the evolution of labor, maternal and fetal or neonatal complications at patients with SARS-COV-2 infection. Materials and methods: We performed a retrospective study that included 150 pregnant women who gave birth in Bucur Maternity, St John Hospital, Bucharest, between 2018-2020 that fulfilled the features of obstetrical emergency during labor and SARS-CoV-2 infection. The study group was divided in patients positive for SARS-CoV-2 and negative for SARS-CoV-2. Results: Following PCR testing for SARS-CoV-2 were 26.67% of patients positive and 73.33% had a negative result. Analyzing the data obtained from this group of patients, it resulted that the average hospitalization is higher in the positive group (7.05 days) versus the negative group (5.47 days). The average gestational age at birth of SARS-CoV-2 positive patients was 37.26 weeks, lower than the gestational age of neonates from uninfected mothers (38.41 weeks). The average of the APGAR scores in the COVID group is 8.41, and for the negative group is 8.90. Conclusions: The associated SARS-CoV-2 infection played a significant role in terms of the APGAR score and the early peripartum outcomes of new-borns, negatively influencing the value of the APGAR index. Gestational age was considerably lower in patients diagnosed with the infection. The SARS-CoV-2 virus infection has a significant influence in unsatisfactory neonatal outcomes compared to new-borns of healthy mothers.