key: cord-0052907-rsy9fxbr
authors: Figueras, F.; Martinez‐Portilla, R.J.; Llurba, E.; Mora, J.; Crispi, F.; Gratacós, E.
title: VP45.03: COVID‐19 causing HELLP‐like syndrome in pregnancy and the role of angiogenic factors for differential diagnosis
date: 2020-10-15
journal: Ultrasound Obstet Gynecol
DOI: 10.1002/uog.23034
sha: a0a397416fc10756723da65cea7416e7d0adbd29
doc_id: 52907
cord_uid: rsy9fxbr

nan

Objectives: Coronavirus (COVID-19) is a new respiratory disease that is spreading widely throughout the world. The aim of this study was to evaluate the psychological impact of COVID-19 pandemic on pregnant women in Italy during the period of maximum spread of the virus. Methods: We considered 200 pregnancies attending the antenatal clinic of Ospedale Cristo Re Università Roma Tor Vergata. A multisection questionnaire was sent by web to each included woman in the days of maximum spread of COVID 19 in Italy (8-10 March 2020). Part A was finalised to acquire imaternal characteristics and to test the women's perception of infection and their fears of fetal structural anomalies, growth restriction and preterm birth induced by COVID-19. Part B included the State-trait anxiety inventory (STAI) 40 items validated test for scoring trait anxiety (basal anxiety, STAIT) and state anxiety (related to the ongoing pandemic, STAIS). An abnormal value of STAI was considered when ≥ 40. Results: The questionnaire was completed by 178 women (89%). Fear that COVID-19 could induce fetal structural anomalies was present in 47%, fetal growth restriction in 65% and preterm birth in 51% of the women. The median value of STAIT was 37 and in 38.2% of the study group STAIT score ≥40 was evidenced. STAIS values were significantly higher with an increase of median values of 12 points (p≤0.0001). There was a positive linear correlation between STAIT and STAIS (Pearson = 0.59; p≤0.0001). A higher educational status was associated with increased prevalence of STAIS ≥ 40(p = 0.004). Subgrouping women by the other variables considered did not show any further difference. Conclusions: Our data support how a serious stressful event significantly increases anxiety levels in pregnant women. Indeed, in our setting COVID-19 infection induces a doubling of the number of women who reached an abnormal level of anxiety. These findings validate the role of the remote use of questionnaire for identifying women at higher risk of anxiety disorders allowing support procedures on these subjects. 

Objectives: The RCOG recommends continuous fetal heart rate (cFHR) monitoring during labour in COVID-19 patients, whereas other sources do not consider this necessary if patients are asymptomatic. Vascular complications in COVID-19 are emerging; potential risks of both fetal hypoxia due to placental dysfunction and maternal disease deterioration secondary to cardiopulmonary overload may occur in labour. Our aim was to observe maternal-fetal outcomes in an unpublished series of asymptomatic pregnant patients screened for COVID-19 before admission to labour ward. Methods: COVID-19 screening with qRT-PCR on nasopharyngeal swabs was performed in patients admitted for delivery in a tertiary centre in Milan between 16 March and 2 May 2020. cFHR monitoring was performed and maternal-fetal outcomes were compared in COVID-19 positive and negative patients. Results: 195 patients were admitted for delivery at a mean gestational age of 39.4 ± 1.8 weeks. Nine (4.6%) tested positive for COVID-19 (all NIH class ''asymptomatic''); two were delivered via an emergency CS for fetal distress and one to elective CS for genital Herpes. Six out of 8 patients (75%) eligible for vaginal birth had vaginal delivery with no maternal symptoms developing thereafter. No significant differences in Apgar scores at 1 and 5 minutes (9.2 ± 1.2 vs 9.6 ± 0.5; p = 0.36; 9.9 ± 0.5 vs 10 ± 0.0; p = 0.42), umbilical artery pH at birth (7.27 ± 0.08 vs 7.26 ± 0.07; p = 0.69), and rate of urgent deliveries for fetal distress (20.3% vs 22.2%, p = 0.89) between patients testing negative and positive for COVID-19 were seen. No false-negative/positive swabs were recorded on the basis of a two week clinical follow-up. Conclusions: Screening results were comparable to the general population. Vaginal delivery appeared safe for the mother and the risk of fetal distress was not increased in our series of asymptomatic pregnant patients with COVID-19 at term. Further research is required to confirm this conclusion. Objectives: In this series, we aimed to describe the prevalence of HELLP-like syndrome and the performance of sFlt-1/PlGF ratio to rule out true pre-eclampsia. Methods: A case series was created of consecutive pregnant women of more than 20 weeks of gestation presenting with symptomatic COVID-19 between 21 March and 7 April 2020 at two hospitals in Barcelona, with symptomatic and confirmed COVID-19 infection by quantitative RT-PCR on nasopharyngeal swabs. Symptomatic disease was defined by the presence of acute respiratory tract infection with no other etiology that fully explained the clinical presentation. sFlt1/PlGF ratio was considered abnormal if it was above 85 before 34 weeks of gestation or above 110 after 34 weeks of gestation.

Results: A total of 27 pregnant women were included. Overall, 7 patients (25.9%) presented at least one sign of suspected HELLP syndrome, of which 2 (7.4%) were diagnosed clinically with pre-eclampsia because of hypertension and proteinuria or elevated transaminases; 3 (11.1%) had significant proteinuria plus elevated transaminases; and 2 had isolated abnormal transaminase levels. sFlt-1/PlGF ratio was elevated over the cut-off for pre-eclampsia in 1 of 7. Of note, magnesium sulfate was initiated in 2 patients, and discontinued in those with normal levels. There were no other obstetrical complications. Conclusions: This preliminary series suggest that the performance of angiogenic factors is high in women with COVID-19 infection, and thus measuring angiogenic factors seems critical in COVID-19 pregnancies with PE-like analytical signs to rule out true pre-eclampsia, avoiding needless interventions and iatrogenic preterm delivery.

Supporting information can be found in the online version of this abstract Objectives: To assess the sufficiency of a structured course for the use of lung ultrasound in pregnant women and provide the interrater agreement of attendees with different expertise. Methods: 10 obstetricians with different expertise working in the COVID-19 setting participated to a single day, structured course given by a radiologist and an obstetrics & gynecology consultant experienced in performing LUS on pregnant women. Following a theoretical presentation, attendees underwent a hands-on course on 10 healthy and 5 pregnant women infected with COVID-19. Success was assessed with using pre-defined criteria. Instructors scored attendees consensually with a dichotomous (pass/fail) result for the following headings: pleural integrity, lung sliding sign, consolidations, A-& B-lines, light beam, white lung and artefacts. Secondly, attendees were asked to score a total of 12 still images and 12 videoclips consisting of 3 images/videoclips for each possible score (0-3). The Krippendorff's alpha test was used to assess the interrater agreement. Results: Out of 10 obstetricians, 8 obstetricians were found successful for all 8 characteristic features defined as minimum criteria (100%); 2 obstetricians were found successful in 7 of 8 criteria (87.5%). The interrater agreement of attendees were found as moderate to good (α = 0.757, 95%CI = 0.700-0.810) for rating still images (figure 1) and good to excellent (α = 0.882, 95%CI = 0.852-0.910) for videoclips. Conclusions: An adequate level of expertise in the use of lung ultrasound can be achieved with a short training course. After the training, observers showed good interrater agreement for interpreting lung ultrasound clips of healthy women and women with COVID-19.

Supporting information can be found in the online version of this abstract VP45.05 COVID-19 effects on maternal, perinatal and neonatal outcomes Y. Wu 1 , L. Zhao 1 , X. Luo 1 , H. Ding 1 , Q. Liu 1 , M. Qin 1 , X. Chen 2 , S. Zhao 1

Gynecology and Obstetrics

The impact of COVID-19 and its complications in pregnant women and neonates, and the potential of vertical transmission remain unclear due to limited reports. Our study on COVID-19 positive pregnant women and their newborns provide insights on the imaging features, clinical characteristics and safety precautions during this pandemic. Methods: Retrospective analysis was performed on 19 women who delivered in our hospital from January 29 to March 31 2020 and were confirmed to have COVID-19 infection. Results: During the study period, a total of 4,210 pregnant women gave birth in our hospital, among which 19 were COVID-19 positive by nucleic acid, accounting for about 0.024%. There were only three symptomatic cases and the prenatal ultrasound didn't show any abnormalities for all 19 women. 18 women presented with pulmonary lesions and one case showed no abnormality on chest CT. Of the 20 neonates born to these mothers, 10 were admitted to the neonatal unit on the day of birth, and cardiac and cerebral ultrasound showed normal results. Each of the 10 newborns was tested twice for COVID-19 nucleic acid, and the results were all negative. Conclusions: In this group of pregnant women infected with COVID-19, most had no symptoms before delivery and developed symptoms during or after delivery. No evidence of COVID-19 infection was found in the newborns. Ultrasound showed no characteristic manifestations in fetuses and neonates. Chest CT was of diagnostic value in pregnant women infected with COVID-19. In light of the above characteristics, it is very important for the ultrasound department to take preventive and control measures for healthy pregnant women and the medical staff themselves.

Objectives: The purpose the study is to perform a review of the literature on the international experience of the COVID-19 pandemic and pregnancy in northen hemisphere outbreak in preparing of the arrival in South America. Methods: A search of the PubMed database (Public MEDLINE), expanded for the keywords pregnancy / pregnant / novel coronavirus / SARS-COVID-2 / COVID-19, is performed from November 2019 to May 21, 2020. Results: A total of 365 articles were initially selected according to the search strategy designed. The total of articles selected according to the criteria were 42. A total of 1098 pregnant women and COVID-19 disease were analysed. The reported complications occur