SARS‐CoV2 (COVID‐19) infection: is fetal surgery in times of national disasters reasonable?

Deprest, Jan; Ranst, Marc Van; Lannoo, Lore; Bredaki, Emma; Ryan, Greg; David, Anna L.; Richter, Jute; Mieghem, Tim Van

doi:10.1002/pd.5702

Cited by 18 publications

(26 citation statements)

References 22 publications

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“…Some case reports 48,51,58 have reported possible vertical transmission due to positive amniotic fluid SARS-CoV-2 PCR test results, but most of the limited patient series reported in the literature indicate a low to negligible risk. 74,75 Evidence is rapidly accumulating, and this consensus may change as more patients with COVID-19 in pregnancy are reported.…”

Section: Implications Of Covid-19 In Special Pregnant Patient Populatmentioning

confidence: 99%

“…Invasive diagnostic tests (CVS, amniocentesis, and cordocentesis) are associated with a theoretical risk of vertical transmission because these procedures may directly correlate with the risk of fetomaternal hemorrhage. 74 Chorionic villus sampling, which is usually performed between 10 0/7 and 13 6/7 weeks' gestation, may be offered to patients with a low risk of SARS-CoV-2 infection (asymptomatic or negative screening result). For symptomatic patients with suspected or confirmed SARS-CoV-2, invasive diagnostic tests can be delayed if safely feasible.…”

Section: Prenatal Diagnosismentioning

confidence: 99%

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SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

Narang

Enninga

Gunaratne

et al. 2020

Mayo Clinic Proceedings

246

210

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The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has been associated with worse outcomes in several patient populations, including the elderly and those with chronic comorbidities. Data from previous pandemics and seasonal influenza suggest that pregnant women may be at increased risk for infectionassociated morbidity and mortality. Physiologic changes in normal pregnancy and metabolic and vascular changes in high-risk pregnancies may affect the pathogenesis or exacerbate the clinical presentation of COVID-19. Specifically, SARS-CoV-2 enters the cell via the angiotensin-converting enzyme 2 (ACE2) receptor, which is upregulated in normal pregnancy. Upregulation of ACE2 mediates conversion of angiotensin II (vasoconstrictor) to angiotensin-(1-7) (vasodilator) and contributes to relatively low blood pressures, despite upregulation of other components of the reninangiotensin-aldosterone system. As a result of higher ACE2 expression, pregnant women may be at elevated risk for complications from SARS-CoV-2 infection. Upon binding to ACE2, SARS-CoV-2 causes its downregulation, thus lowering angiotensin-(1-7) levels, which can mimic/worsen the vasoconstriction, inflammation, and pro-coagulopathic effects that occur in preeclampsia. Indeed, early reports suggest that, among other adverse outcomes, preeclampsia may be more common in pregnant women with COVID-19. Medical therapy, during pregnancy and breastfeeding, relies on medications with proven safety, but safety data are often missing for medications in the early stages of clinical trials. We summarize guidelines for medical/obstetric care and outline future directions for optimization of treatment and preventive strategies for pregnant patients with COVID-19 with the understanding that relevant data are limited and rapidly changing.

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Section: Implications Of Covid-19 In Special Pregnant Patient Populatmentioning

confidence: 99%

Section: Prenatal Diagnosismentioning

confidence: 99%

SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

Narang

Enninga

Gunaratne

et al. 2020

Mayo Clinic Proceedings

246

210

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“…When looking at the data in the literature, the scope and clinical importance of the vertical transition remain uncertain. In a 2020 review published by Deprest et al, it was stated that performing an invasive procedure in a SARS-CoV2 positive woman in terms of fetal intervention would potentially increase the risk of vertical transmission, as was observed in HIV-positive women before the administration of antiviral treatments, and therefore emphasized that the transition should be avoided, especially due to the risk of intraamniotic bleeding and feto-maternal barrier deterioration [27]. However, if the infection is positive during pregnancy, the intervention should be postponed until the disease becomes asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…However, if the infection is positive during pregnancy, the intervention should be postponed until the disease becomes asymptomatic. In light of these recommendations, the conclusion from this review is that vertical transmission concerns do not prevent clinically minimally invasive procedures such as A/S or fetoscopy [27].…”

Section: Discussionmentioning

confidence: 99%

Effect of COVID-19 pandemic process on prenatal diagnostic procedures

Özalp

Demir

Akbaş

et al. 2020

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To evaluate the accessibility of pregnant women to prenatal screening and diagnostic tests during the COVID-19 pandemic process and analyze the effect of the pandemic process on acceptance-rejection rates of fetal diagnostic procedures for high risk pregnancies. Materials and methods: As part of this cross-sectional study, during the pandemic, between the dates of 11 March 2020-30 June 2020 at Karadeniz Technical University Faculty of Medicine Perinatology Clinic, fetal structural anomaly detected by ultrasonography or with increased risk in screening test in the first and second trimester of high risk pregnancies, who were therefore recommended a prenatal diagnosis test, were defined as the control group and retrospectively compared with high risk pregnancies of the same periods (11 March 2019-30 June 2019) in the previous year. Results: A total of 267 cases were evaluated within the scope of the study. The rate of pregnant women undergoing the first and second trimester screening tests was 83% in the control group and 56% for pregnant women in the study group. When the total number of prenatal diagnostic procedures and the year each of the procedures performed are compared, a statistically significant difference was found between the study and control groups (p: .041 and p < .001, respectively). When evaluating the rates of performed prenatal diagnostic procedures during the first patient visit in comparison to years, a statistically significant difference was observed in the A/S group and in the total number of cases (p ¼ .023, p < .001, respectively). Similarly, the rate of performed prenatal diagnostic procedure during the first patient visit and the patient's city of residence was similarly statistically significant from year to year (p < .05). Conclusions: The decrease in number of prenatal diagnosis and screening tests during the COVID-19 pandemic draws attention. Prenatal care services are a serious issue that cannot be overcome by any deficiencies in both maternal and fetal care.

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“…Procedures of unproven benefit should not be offered [65]. Fetal care team must weigh the risks and benefits to the fetus and the mother when the situation gets more complex with a continuous change of evidence and logistic challenges in individual healthcare system [66].…”

Section: Point-of-care Obstetric Ultrasound During Covid-19 Pandemicmentioning

confidence: 99%

Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic

Wataganara

Ruangvutilert

Sunsaneevithayakul

et al. 2020

Journal of Perinatal Medicine

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)–associated infection (COVID-19) is affecting populations worldwide. This statement may serve as guidance for infection prevention and safe ultrasound practices during the COVID-19 pandemic. Ultrasound examination is a fundamental part of obstetric care, yet it is a potential vector for transmission of SARS-CoV-2. Decontamination methods should always be implemented for ultrasound equipment, especially in the presence of suspected or confirmed COVID-19 cases. There must be workflow policies to protect pregnant women and healthcare providers from nosocomial cross transmission of SARS-CoV-2. Cleaning and disinfecting of equipment must be in accordance with their potential of pathogen transmission. Consider using telemedicine and genetic technologies as an adjunctive of obstetric ultrasound to reduce patient crowding. Patient triage and education of healthcare providers of infection prevention are crucial to minimize cross contamination of SARS-CoV-2 during obstetric ultrasound.

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SARS‐CoV2 (COVID‐19) infection: is fetal surgery in times of national disasters reasonable?

Cited by 18 publications

References 22 publications

SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review

Effect of COVID-19 pandemic process on prenatal diagnostic procedures

Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic

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