Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Objective The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia.Design Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998(recruitment in -2001, which compared magnesium sulphate with placebo for pre-eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the followup centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources.Results Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). ConclusionsThe reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years.

Background Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence. Objective To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients. Materials and methods A total of 122 patients with risk factors for uterine atony were allocated to receive either 600µg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour. Post-partum blood loss was measured using differential delivery towel and pad weighing. Results There was similarity in the estimated post-partum blood loss, with no significant difference in the mean post-partum hematocrit levels between the adjunctive rectal misoprostol group and oxytocin infusion group (P=0.712). There was no difference in the need for additional intervention of uterotonics between the two groups. There were however, higher incidences of shivering and pyrexia among those that received misoprostol compared with the oxytocin group. Conclusion Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in preventing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour.

The role of calcium supplementation in pregnancy to prevent preeclampsia is conflicting. The goal was to determine if there was significant difference between plasma calcium levels in women with preeclampsia and normotensive pregnant women. This was a cross-sectional study of 90 consecutive preeclamptic and 90 normotensive pregnant. Blood samples were taken from them and the plasma isolated from each was analyzed using colorimetric method for calcium and albumin employing calcium kit, albumin kit and spectrum lab 7225 spectrophotometer set (Bran Scientific and Instrument Company, England). The data was analysed using SPSS version 16. Their mean ages were 28.67 ± 5.23 and 28.33 ± 5.06 years respectively (preeclamptic vs. normotensive women respectively; P = 0.688). Majority of them were nullipara (48, 53.3% and 46, 51.1% of preeclamptic and normotensive women respectively). The mean gestational age of the preeclamptic women was 36.38 ± 2.54 weeks while that of the normotensive women was 36.24 ± 2.34 years, (P = 0.715). The plasma calcium level in preeclamptic women was significantly lower than in normotensive pregnant women (2.07 ± 0.318 mmol/L vs.2.41 ± 0.224 mmol/L, P \ 0.001). Preeclamptic women have significantly lower plasma calcium levels than normotensive pregnant women in our community. Routine calcium supplementation for pregnant women at risk of developing preeclampsia is therefore recommended.