American journal of obstetrics & gynecology MFM
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Am J Obstet Gynecol MFM · Aug 2020
Case ReportsSevere acute respiratory distress syndrome in coronavirus disease 2019-infected pregnancy: obstetric and intensive care considerations.
Since the emergence of a novel coronavirus (severe acute respiratory syndrome coronavirus 2) in Wuhan, China, at the end of December 2019, coronavirus disease 2019 has been associated with severe morbidity and mortality and has left world governments, healthcare systems, and providers caring for vulnerable populations, such as pregnant women, wrestling with the optimal management strategy. Unique physiologic and ethical considerations negate a one-size-fits-all approach when caring for critically ill pregnant women with coronavirus disease 2019, and few resources exist to guide the multidisciplinary team through decisions regarding optimal maternal-fetal surveillance, intensive care procedures, and delivery timing. We present a case of rapid clinical decompensation and development of severe acute respiratory distress syndrome in a woman at 31 weeks' gestation to highlight these unique considerations and present an algorithmic approach to the diagnosis and management of the disease.
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Am J Obstet Gynecol MFM · Aug 2020
Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study.
The coronavirus disease 2019 pandemic has had an impact on healthcare systems around the world with 3 million people contracting the disease and 208,000 cases resulting in death as of this writing. Information regarding coronavirus infection in pregnancy is still limited. ⋯ In pregnant women with severe or critical coronavirus disease 2019, admission into the hospital typically occurred about 7 days after symptom onset, and the duration of hospitalization was 6 days (6 [severe group] vs 12 [critical group]). Women with critical disease had a high rate of acute respiratory distress syndrome, and there was 1 case of cardiac arrest, but there were no cases of cardiomyopathy or maternal mortality. Hospitalization of pregnant women with severe or critical coronavirus disease 2019 resulted in delivery during the clinical course of the disease in 50% of this cohort, usually in the third trimester. There were no perinatal deaths in this cohort.
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Am J Obstet Gynecol MFM · Aug 2020
Case ReportsFalse-negative testing for severe acute respiratory syndrome coronavirus 2: consideration in obstetrical care.
Because the obstetrical population seems to have a high proportion of asymptomatic patients who are carriers of severe acute respiratory syndrome coronavirus 2, universal testing has been proposed as a strategy to risk-stratify all obstetrical admissions and guide infection prevention protocols. Here, we describe a case of a critically ill obstetrical patient with all the clinical symptoms of coronavirus disease 2019 and 3 false-negative results of nasopharyngeal swabs for molecular testing. We review and discuss the uncertain clinical characteristics of current severe acute respiratory syndrome coronavirus 2 molecular testing and the implications of false-negative results in the obstetrical population.
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Am J Obstet Gynecol MFM · Aug 2020
Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status.
Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES). ⋯ Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB.