Objective Clinical trials evaluating pharmacological and non-pharmacological treatment of COVID-19, either excluded pregnant women or included very few women. Unlike the numerous systematic reviews on prevalence, symptoms and adverse outcomes of COVID-19 in pregnancy, there are very few on the effects of treatment on maternal and neonatal outcomes in pregnancy. We undertook a systematic review of all published and unpublished studies on the effects of pharmacological and non-pharmacological interventions for COVID-19 on maternal and neonatal pregnancy outcomes. Data sources We performed a systematic literature search of the following databases: Medline, Embase, Cochrane database, WHO (World Health Organization) COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 1 December 2020. Study eligibility criteria Studies were only included if they involved pregnant or postnatal women who were exposed to pregnancy specific interventions like the mode of delivery and type of anaesthesia, pharmacological or non-pharmacological interventions. Study appraisal and synthesis methods We first screened the titles and abstracts of studies and then assessed the full text of the selected studies in detail for eligibility. Data on study design, population, type of screening for COVID-19, country, hospital, country status (high or low and middle income), treatment given (mode of delivery, type of anaesthesia, type of pharmacological and non-pharmacological treatment was extracted. The pre-defined maternal outcomes we collected were mode of delivery (vaginal or by caesarean section), severe or critical COVID-19 (as defined by the authors), symptomatic COVID-19, maternal death, maternal hospital admission, ICU admission, mechanical ventilation, ECMO and maternal pneumonia. The pre-defined neonatal outcomes we extracted were preterm birth (<37 weeks), stillbirth, neonatal death, NICU admission, neonatal COVID-19 positive, neonatal acidosis (pH<7.0) and Apgar scores (<8 after 5 minutes). Study quality assessment was performed. Results From a total of 342 potential eligible studies, we included 27 studies in our systematic review, including 4943 pregnant women (appendix 3). Sixteen studies had a retrospective cohort design and 11 a prospective cohort design. There were no randomised controlled trials. There was a significant association between caesarean section and admission to ICU (OR 4.99, 95% CI 1.24 to 20.12; 4 studies, 153 women, I 2 =0%), and diagnosis of maternal COVID-19 pneumonia as defined by study authors (OR 3.09, 95% CI 1.52 to 6.28; 2 studies, 228 women, I 2 =0%). Women who had a preterm birth were more likely to have the baby via caesarean section (OR 3.03, 95% CI 1.71 to 5.36, 12 studies; 314 women, I 2 =0%). For pharmacological and non-pharmacological ...

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Background: In April 2011, the National Institute of Clinical Excellence (NICE) in the UK introduced the guidance 122. The key recommendation was "GPs should perform a blood test to measure serum CA125 levels in women who present with symptoms that might indicate ovarian cancer". Objective: To investigate how the introduction of the NICE guideline in April 2011 has affected the number of serum CA125 levels being taken in primary care, the financial implications of this, and whether it has affected the number of cases of ovarian cancer being diagnosed per year in the South East of Scotland. Data analysis and collection: Retrospective study based on data collected from the database of the biochemistry laboratories in South East Scotland for 48 months prior to 2011 and 36 months after 2011. Ovarian cancer incidence data for the said periods were obtained from the South East Scotland Cancer Network (SCAN). We excluded data for the year 2011 from our analysis as we considered this a transitional year following the guideline introduction. Results: The number of CA125 requests after the introduction of the guideline has more than doubled from an average of 3782 per year before 2011 to an average of 8631 per year after 2011. However the number of ovarian cancers detected remained essentially the same with 195 cases per year before 2011 and 189 cases per year after 2011. Conclusion: The increase in CA125 requests has not resulted in an increase in the number ovarian cancer cases detected. In addition there are financial implications (cost of tests, ultrasound and possible CT imaging). Furthermore this can cause unnecessary patient anxiety in false positive tests.

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