Proposal for radiologic diagnosis and follow-up of COVID-19 in pregnant women

Carbone, Luigi; Esposito, Rosanna; Raffone, Antonio; Verrazzo, Paolo; Carbone, Ilma Floriana; Saccone, Gabriele

doi:10.1080/14767058.2020.1793325

Cited by 16 publications

(11 citation statements)

References 5 publications

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“…The peculiar changes occurring in the cardiorespiratory system during pregnancy may be partially responsible of the increased burden of maternal morbidities observed in these women when compared to the non-pregnant general population. [2][3][4][5] Currently, although vaccinal programs are opened to pregnant women, there are still reports of a poor acceptance rate in this category of patients. 6,7 Indeed, SARS-CoV-2 infection has been reported to potentially affect the placenta.…”

Section: Introductionmentioning

confidence: 99%

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Girolamo

Khalil

Alameddine

et al. 2021

American Journal of Obstetrics & Gynecology MFM

126

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Objectives : To report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection. Methods : MEDLINE, EMBASE, Google Scholar and the Web of Science databases were searched up to August 11 th , 2021. Histopathological anomalies included maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute inflammatory pathology (AIP), chronic inflammatory pathology (CIP), increased perivillous fibrin and intervillous thrombosis. Sub-analyses including only symptomatic women and high-risk pregnancies were also performed. Histopathological analysis of the placenta included gross examination, histopathology on hematoxylin and eosin (H&E), immunohistochemistry (IHC), fluorescence in-situ hybridization (FISH), qRT-PCR on placental tissue, and transmission electron microscope (TEM). Random-effect meta-analyses were used to analyze the data. Results : Fifty-seven studies (1009 pregnancies) were included. MVM was reported in 31.4% (95% CI 21.0-42.8) of placentas, while FVM was observed in 26.9% of cases (95% CI 19.2-35.4). AIP and CIP were reported in 22.6% (95% CI 16.8-28.9) and 26.2% (95% CI 18.9-34.2) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% CI 24.1-42.0) of placentas undergoing histopathological analysis, while intervillous thrombosis were observed in 14.6% (95% CI 10.6-21.8) of cases. Other placental findings, including either basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated Red Blood Cells or membranes with hemorrhage were reported in 38% (95% CI 28.5-48.0) of cases, while only 17.4% (95% CI 10.9-25.0) did not present any abnormal histological findings. Sub-analyses according to maternal symptoms due to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed similar distribution of the different histopathological anomalies to that reported in the main analysis. The risk of placental histopathological anomalies was also higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls. Conclusions : A significant proportion of placentas where SARS-CoV-2 occurred during pregnancy shows histopathological findings suggesting placental hypoperfusion and inflammation. Future multicenter prospective blinded studies are needed to correlate these placental lesions with pregnancy outcomes.

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Section: Introductionmentioning

confidence: 99%

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Girolamo

Khalil

Alameddine

et al. 2021

American Journal of Obstetrics & Gynecology MFM

126

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“…[2] The COVID-19 outbreak poses significant risk to public health. [3] In obstetrics and gynecology, COVID-19 pandemic is associated with significantly higher risk of maternal and perinatal complications, [4][5][6][7][8][9][10][11][12][13][14][15] but also chal-lenges and issues about organizing labor and delivery unit, [16][17][18] training program, [19] and vaccination. [20][21][22][23] Family planning services may be also affected by COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on termination of pregnancy

Ferrara¹,

Sglavo²,

Morra³

et al. 2022

Perinat J

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Objective: To evaluate the impact of COVID-19 pandemic on termination of pregnancy. Methods: This was a retrospective study aimed to assess the impact of COVID-19 pandemic on termination of pregnancy in a single center in Italy. Consecutive data on pregnant women who requested induced termination of pregnancy (I-TOP) from February 2018 to December 2021 were included in a dedicated database. The data were divided into two groups according to the COVID-19 outbreak. Women who requested I-TOP from February 2018 to January 2020 were included into the group ‘before COVID-19 pandemic’. Women who requested I-TOP from February 2020 to January 2022 were included into the group ‘during COVID-19 pandemic’. Indications for I-TOP included elective abortion and therapeutic for fetal or maternal indication. Results: A total of 2578 women were included in the study. Of them, 1637 had I-TOP before COVID-19, and 941 had I-TOP during COVID-19. During the pandemic, the request for elective abortion decreased from 76.2% to 67.7% (p<0.01). Therapeutic abortion were performed in 141/693 cases in the first trimester, and in 552/693 cases in the second trimester. Overall, 91 were for maternal indications and 602 for fetal indications. No differences were noticed between before and during pandemic (p=0.99). Follow-up visits two weeks after abortions were offered to all women. However, only 35.5% women visited for follow-up during pandemic vs. 65.0% before COVID-19 (p<0.01). Conclusion: The COVID-19 pandemic had impact on access to abortion services, reducing request for elective abortion and post-abortion follow-up visits.

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“…The earlier is the infection the more the increase of the risk for adverse fetal outcomes [11], even though the risk of vertical transmission seems to be negligible [9,10]. Actually, no general consensus exists on the optimal management for pregnant women with SARS-COV-2 infection [12][13][14][15]; moreover, there is a huge heterogeneity among hospitals and, regarding therapy, combinations of azithromycin or other antibiotics, hydroxychloroquine, low-molecular-weight heparin and a large variety of antivirals have been used, without any significant difference between therapeutic regimes [9,16].…”

Section: Introductionmentioning

confidence: 99%

Pregnant women's perspectives on severe acute respiratory syndrome coronavirus 2 vaccine

Carbone

Mappa

Sirico

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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Proposal for radiologic diagnosis and follow-up of COVID-19 in pregnant women

Cited by 16 publications

References 5 publications

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis

Impact of COVID-19 on termination of pregnancy

Pregnant women's perspectives on severe acute respiratory syndrome coronavirus 2 vaccine

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