Abstract: 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 healthcare settings, combining prenatal tests in the same visit, restricting visitors during the visits, providing a safe environment in healthcare facilities, strict hygiene 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 taken. In conclusion, an individualized approach should be provided by a multidisciplinary team for the management of pregnant women with COVID-19 to achieve favorable outcomes. Key words: COVID-19, obstetric complications, pregnancy, SARS-CoV-2, vaccines
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Koronavirüs hastalığı 2019 (COVID-19) tüm dünyayı etkisi altına almış olan bir pandemidir. İlk ortaya çıktığı 2019 yılı sonundan günümüze kadar çok hızlıbir yayılım göstermiş, ülkelerdeki sağlık sistemleri üzerinde ciddi bir yük oluşturmuştur. Öte yandan enfekte ettiği hastaların %15’ine yakınında pnömonitablosu yaratmış, %5’ine yakınında da mortal olarak seyretmiştir. Virüsün ana bulaş yolu enfekte solunum damlacıklarının göz, burun ve ağızdaki müközmembranlar ile temasıdır. Daha çok komorbit hastalığı mevcut olan ileri yaş hastalarda kötü prognoz göstermekle beraber genç hastalarda da ağır kliniktablolara yol açabilmekte ve daha önemlisi bu hastalar üzerinden risk grubundaki bireylere bulaş göstererek ciddi bir toplum sağlığı sorunu oluşturabilmektedir. Şu an için hastalığın aktif bir tedavisi ve aşısı mevcut değildir. Enfeksiyonla mücadelede en önemli adım bulaşı önlemek olarak görünmektedir. Hidroksiklorokin, azitromisin, oseltamivir, favipravir ve lopinavir/ritonavir gibi ilaçlar üzerinde hastalığın prognozu için olumlu olabilecekleri yönünde çalışmalarmevcuttur. Bilindiği üzere gebelik pek çok immünolojik adaptif değişikliği beraberinde getirmektedir ve gebe popülasyon enfeksiyon hastalıklarına karşıdaha duyarlıdır. Bu yüzden hastalığın gebe hastalardaki gidişatı, obstetrik komplikasyonlarla ilişkisi, güvenli tedavi yaklaşımları, prenatal takip ve intrapartum yönetim gibi konular üzerinde tartışmalar devam etmektedir. Virüsün gebelerde genel popülasyon ile benzer semptomlara yol açtığı düşünülmektedir.Çoğunlukla soğuk algınlığı ve grip benzeri bir klinik tablo mevcuttur. Buna karşın bazı çalışmalarda fetal distres ve preterm eylem riskini arttırabileceğigösterilmiştir. Yine bu vakalarda artmış sezaryen oranları dikkat çekmektedir. Vertikal geçiş ile ilgili net bilgi olmamakla beraber literatürde şüpheli vakalarmevcuttur. Sadece 30 hafta 3 günlük gebeliği olan bir vakada maternal ölüm bildirilmiştir. Gebe hastaların tedavisinde hidroksiklorokin ve lopinavir/ritonavirkombinasyonu tercih edilmektedir. Gebe popülasyonu korumak amacı ile prenatal takip sayısının ve muayene süresinin azaltılması önerilmektedir. Ayrıcahem sağlık personeli hem de muayene olan gebeler bulaş riskini azaltmak için gerekli kişisel önlemlerini almalıdır. Yine sağlık kuruluşları personelini vediğer hasta popülasyonu korumak amacı ile uygun yönetim şeması oluşturmalıdır.Şüpheli vakaların yönetimi multidisipliner bir ekip tarafından sağlanmalıdır. Doğum yapacak hastalarda maternal sağlığın yanında sağlık personelininde korunması hedeflenmeli, hastaneler bu hastaların doğumu için negatif basınçlı izole özel alanlar belirlemelidir. Kişisel koruyucu ekipman kullanımıkonusunda gerekli bilgilendirme yapılmalı, bu hastaların yönetiminde belirlenmiş olan kurallara titizlikle uyulmalıdır. Postpartum dönemde neonatal bulaşriski ile beraber emzirmenin önemi de göz önünde bulundurulmalı, gerekli önlemler alınarak anne-bebek bağlanması sağlanmalıdır. Bu derlemeyi yazmamızdaki amaç COVID-19 enfeksiyonu olan gebelerin sonuçlarını uluslararası literatür bazında gözden geçirmek ve bahsi geçen gebelerin obstetrik olarakyönetiminde klinisyenlere katkıda bulunmaktır.
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Although hydrothorax may accompany abdominal ascites in women with severe ovarian hyperstimulation syndrome (OHSS), there are few cases reported with isolated pleural effusion. Herein, we report two patients with isolated hydrothorax without any significant abdominal fluid following infertilitytreatment, along with a systematic review of the literature to describe risk factors for this rare entity. Two women with isolated pleural effusion withoutsignificant abdominal ascites were reported. The available literature was screened from Ovid-SP and PubMed to review OHSS cases with isolated hydrothorax. Two women aged 28 and 31 years were admitted to hospital with chest pain, tachypnea, and tachycardia after infertility treatment. They had right pleural effusion without abdominal fluid and the symptoms relieved after thoracentesis. Similar to our cases, we identified 24 case reports (n=41 women) in the literature according to eligible criteria. On the day of triggering, estradiol (E2) level was <4000 pg/mL in 81% of reported cases and hematocrit (HCT) was <45% in 44% of cases at the time of diagnosis. Isolated hydrothorax is an unpredictable event, which may even complicate women with low E2 levels or HCT concentrations. Physicians should keep in mind the possibility of isolated hydrothorax when respiratory symptoms are significant but abdominalascites is not evident.
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Purpose: The aim of this studywas to evaluate theobstetric outcomes of women with rheumatoid arthritis(RA)Materials and Methods: This retrospective studyconsisted of 39 women with RA. Patients were evaluatedin terms of seropositivity, having disease >5 years or notand use of any medication.Results: Rate of preterm delivery and intrauterine growthretardation was 33.3% and 21.2%, respectively.Comparisons between seropositive and seronegativewomen did not show any significant difference. Havingdisease more or less than 5 years did not show anysignificant difference in terms of obstetric outcomes.Women with a coexisting disease had a similar rate ofmiscarriage rate compared to remainders (16.6% vs14.8%). Women followed up without any medication hasalso higher rates of miscarriage despite lack of statisticalsignificance.Conclusion: Pregnancies of women with RA must beconsidered as high risk due to increased rates of adversepregnancy outcomes such as preterm delivery andintrauterine growth retardation.
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Objective: Our goal was to highlight the prenatal diagnosis and management of central nervous system (CNS) anomalies through sharing ourclinic’s experience.Material and Methods: We evaluated prenatal findings and postnatal outcomes of neonates who had a CNS anomaly diagnosis in our clinicover a ten-year period. A total of 183 cases with various CNS anomalies were included in the study. Birth or termination preferences of motherswere recorded in all cases, and postnatal diagnosis concordance and prognosis after surgical procedures were evaluated in mothers who choseto continue the pregnancy.Results: The mean maternal age was 28.2±5.5 years, mean gravida was 2.2±1.3, and the mean gestational age at diagnosis was 30.5±5.5 weeks.Seventy-five out of 183 (41%) patients chose to terminate their pregnancy. Twenty babies (26.6%) in the termination of pregnancy group hadadditional anomalies. One hundred eight patients gave birth at our institution. The mean birth weight was 3060±647.5 g, the mean gestationalweek at delivery was 37.9±1.7 weeks, and mean APGAR score (5th minute) was 8.8±2.3. Four neonates died on the postpartum first day. Thepostnatal diagnosis of 60 of the 108 (55.5%) patients who gave birth was concordant with the prenatal diagnosis, and 32 of the 108 (29.6%) babiesunderwent surgical interventions.Conclusion: CNS anomalies have a broad spectrum and variable prognoses. This study highlights the limitations of prenatal diagnoses, andthe need for parents to have this information in order to determine the course of their pregnancy and prepare themselves for the postnatalchallenging treatment/rehabilitation process. (J Turk Ger Gynecol Assoc 2019; 20: 170-7)
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Objective: This study aimed to compare the first trimester complete blood count (CBC) indices of pregnancies complicated by early-onset preeclampsia(EOPE) or late-onset preeclampsia (LOPE).Material and Methods: A retrospective case-control study was conducted with 186 patients. Patients were classified into three subgroups: EOPE,LOPE, and control groups. First trimester CBC results were obtained for each patient. Hemoglobin, hematocrit, red blood cell distribution width, meancorpuscular volume, white blood cell (WBC) count, neutrophil, eosinophil, basophil, lymphocyte, monocyte, mean platelet volume, platelet distributionwidth, plateletcrit, and platelet count were compared. The neutrophil lymphocyte ratio was calculated by dividing the absolute lymphocyte count by theabsolute neutrophil count. The platelet lymphocyte ratio was calculated by dividing the absolute lymphocyte count by the absolute platelet count.Results: The total number of cases was 21, 42, and 123, in the EOPE, LOPE, and control groups, respectively. There were statistically significant differencesin the total WBC and neutrophil counts between the three groups (both p<0.05). WBC and neutrophil counts were found to be highest in the EOPE group,and the LOPE group had higher levels compared with controls. The optimal cut-off values to predict EOPE for WBC and neutrophil counts were 9.55×103/μL (sensitivity 71.4% and specificity 70.7%) and 6.45×103/μL (sensitivity 66.7% and specificity 74.8%), respectively.Conclusion: Increased first trimester WBC and neutrophil counts may be predictive for EOPE.
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