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OBJECTIVE: To provide clinical management guidelines for novel coronavirus (COVID-19) in pregnancy. METHODS: On February 5, 2020, a multidisciplinary teleconference comprising Chinese physicians and researchers was held and medical management strategies of COVID-19 infection in pregnancy were discussed. RESULTS: Ten key recommendations were provided for the management of COVID-19 infections in pregnancy. CONCLUSION: Currently, there is no clear evidence regarding optimal delivery timing, the safety of vaginal delivery, or whether cesarean delivery prevents vertical transmission at the time of delivery; therefore, route of delivery and delivery timing should be individualized based on obstetrical indications and maternal-fetal status.

ispartof: Ultrasound In Obstetrics & Gynecology vol:56 pages:634-655 status: published

ispartof: Prenatal Diagnosis vol:36 issue:13 pages:1161-1166 ispartof: location:England status: published

BackgroundInvasive fetal cardiac intervention (FCI) has been reported in single-institution series, promoting technical and physiologic success.ObjectivesThis study describes the creation of an international registry of cases presenting for FCI, intended to compile technical and outcome data from a multicenter cohort.MethodsFor this initial analysis, the entire database of the International Fetal Cardiac Intervention Registry (IFCIR) was queried for details of diagnoses, procedures, and outcomes. Maternal-fetal dyads from January 2001 through June 2014 were included.ResultsEighteen institutions submitted data by data harvest. Of 370 cases entered, 245 underwent FCI: 100 aortic valvuloplasties from a previous single-center report (excluded from additional reporting here), an additional 86 aortic and 16 pulmonary valvuloplasties, 37 atrial septal cases, and 6 unclassified cases. FCI did not appear to affect overall survival to hospital discharge. Among live-born infants with a fetal diagnosis of aortic stenosis/evolving hypoplastic left heart syndrome, more than twice as many were discharged with biventricular circulation after successful FCI versus those meeting institutional criteria but without any or successful FCI (42.8% vs. 19.4%, respectively). When fetal deaths were counted as treatment failures, the percentages were similar: biventricular circulation at discharge was 31.3% versus 18.5% for those discharged with univentricular palliation. Survival to discharge for live-born fetuses with atrial restriction was similar to that of those undergoing technically successful versus unsuccessful FCI (63.6% vs. 46.7%, respectively), although criteria for diagnosis were nonuniform.ConclusionsWe describe the contents of the IFCIR and present post-natal data to suggest potential benefit to fetal therapy among pregnancies considered for possible intervention and support proposals for additional work.

BackgroundTo evaluate the normal range of blood flow velocity in the maternal anterior (ACA) and posterior cerebral arteries (PCA) along the normal pregnancy and postpartum period. MethodsTranscranial Doppler ultrasound was used to measure the systolic, diastolic, and mean blood velocities in the ACA and PCA during normal gestation. The resistance and pulsatility indices were calculated. Data were analyzed using multilevel modeling, incorporating random effects models, to construct mean and percentile curves. ResultsWe performed 355 measurements on 59 patients, which showed that systolic and mean velocity in the ACA decreased, whereas diastolic velocity increased in the PCA during normal pregnancy. Resistance and pulsatility indices in both vessels increased to a maximum in the second trimester, decreased during the third trimester, and increased during the postpartum period. ConclusionsThis study provides normative data for ACA and PCA velocity and indices during pregnancy and postpartum, demonstrating changes in velocity that suggest a shift of cerebral blood flow from the anterior to the posterior cerebral circulation. (c) 2013 Wiley Periodicals, Inc. J Clin Ultrasound41:532-537, 2013.

Objective: The purpose of this study was to determine if the prevalence of neonatal and maternal infectious morbidity in patients with preterm premature rupture of membranes (PROM) who received ampicillin prophylaxis for presemptive group B streptococcal colonization is increased compared to those who received no prophylaxis. Methods: The charts of all patients with preterm PROM who delivered between January 1988 and December 1993 were retrospectively reviewed. The routine use of ampicillin prophylaxis was initiated in January 1991. Patients with singleton gestations were included in the analysis only if chorioamnionitis was excluded on admission. Variables used in the final analysis included gestational age at the time of preterm PROM, gestational age at delivery, duration of rupture of membranes, birth weight, method of delivery, use of steroids, tocolytics, or antibiotics for group B streptococcus prophylaxis, neonatal sepsis, neonatal mortality, and postpartum endomyometritis. Data were analyzed using Student's t-test, chi-square test, Fisher's exact test, and stepwise logistic regression analysis to evaluate the effect of chemoprophylaxis for group B streptococcus on the incidence of neonatal sepsis and maternal postpartum endomyometritis. A two-tailed P < 0.05 was used to denote statistical significance. Results: The charts of 206 patients were reviewed; 146 patients received ampicillin for group B streptococcal prophylaxis and 60 patients did not. There was a significantly higher incidence of postpartum endomyometritis among the patients who received ampicillin (62% vs. 22%; P < 0.01). The association between postpartum endomyometritis and chemoprophylaxis remained significant even after controlling for other confounding variables. There was no significant difference in the incidence of neonatal sepsis (5% vs. 7%; P = 0.7) or death (5% vs. 3%; P = 0.9) between both groups. Conclusions: Group B streptococcal prophylaxis with a short course of intravenous ampicillin increases the risk of postpartum endomyometritis in patients with premature PROM.

Objective. To analyze typical maternal heart rate (MHR) patterns in the first and second stages of labor. Design. Observational study. Setting. Tertiary care community hospital. Population. Normal term parturients with epidural anesthesia. Methods. Confirmed MHR and uterine activity were simultaneously recorded. The average MHR was analyzed 10 seconds before, as well as at the peak of, each contraction and/or pushing effort. Each woman contributed one datapoint at each time point to the analysis. Main outcome measure. Change in MHR during contractions. Results. First stage: 7.6 +/- 2.1 contractions per woman (n=18) were analyzed. Average MHR decreased during contractions: from 83 +/- 13 to 74 +/- 10bpm; p100bpm in three women (17%) in the first stage, and in four women (27%) in the second stage. Peak MHR >140bpm occurred during pushing in 20%. Conclusion. Decreases in MHR during contractions in the first stage of labor can mimic fetal heart rate (FHR) accelerations as well as early type decelerations. Thus, first stage tracings with a low baseline and early type decelerations may be maternal in origin and FHR should be independently confirmed in such tracings. Because second stage MHR accelerations generally show greater amplitude than FHR accelerations, tracings with repetitive accelerations during contractions (especially when ? >20bpm) should be considered MHR until proven otherwise.

OBJECTIVE: The purpose of this study was to analyze reasons for postpartum readmission. STUDY DESIGN: We conducted a database analysis of readmissions within 6 weeks after delivery during 2007, with extended (180 day) analysis for pneumonia, appendicitis, and cholecystitis. Linear regression analysis, survival curve fitting, and Gehan-Breslow statistic with Holm-Sidak all-pairwise analysis for multiple comparisons were used. Probability values of

During pregnancy, approximately 6-25% of women are diagnosed with some form of hypertension. These disorders are among the leading causes of maternal mortality and severe morbidity. While multiple maternal organs can be affected, cerebral involvement is one of the most feared complications as it can lead to death or significant short- or long-term morbidity. The pathophysiology of these cerebrovascular complications remains poorly understood, but it is thought that the blood vessels in the brain malfunction. Normally, the blood flow in the brain does not change despite changes in blood pressure. This is called ‘cerebral autoregulation’. This mechanism protect the brain from bleeding when the blood pressure is high, and protects from fainting when the blood pressure is low. In this thesis, we show that in normal pregnancy, more blood flows to the posterior part of the brain. This may explain why women with preeclampsia have symptoms, which mainly originate from the posterior part of the brain, such as the vision. The cerebral autoregulation improves when a women is pregnant, but is worsened in pregnant women with preeclampsia or chronic hypertension. Autoregulation in pregnancy is not affected by diabetes, overweight or pregnancy induced hypertension. Breath holding also causes a reaction of the brain vessel. This reaction is different in preeclampsia from healthy pregnant women. This also shows that these vessels malfunction. Finally, in this thesis we show that examination of the brain vessels may be used as a screening tool to identify those women who are at risk for developing preeclampsia.