Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy.
Identifieur interne : 000128 ( PubMed/Curation ); précédent : 000127; suivant : 000129Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy.
Auteurs : Pradip Dashraath [Singapour] ; Wong Jing Lin Jeslyn [Singapour] ; Lim Mei Xian Karen [Singapour] ; Lim Li Min [Singapour] ; Li Sarah [Singapour] ; Arijit Biswas [Singapour] ; Mahesh Arjandas Choolani [Singapour] ; Citra Mattar [Singapour] ; Su Lin Lin [Singapour]Source :
- American journal of obstetrics and gynecology [ 1097-6868 ] ; 2020.
Abstract
The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome 2 (SARS-CoV-2) virus, is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2 - 2.5, indicating that 2 - 3 persons will be infected from an index patient. A serious public health emergency, it is particularly deadly in vulnerable populations and communities in which healthcare providers are insufficiently prepared to manage the infection. As of March 16, 2020, there are more than 180,000 confirmed cases of COVID-19 worldwide, with over 7,000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious two weeks after cessation of symptoms. The substantial morbidity and socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns and border closures. Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks. To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure in the gravida. Furthermore, the pregnancy bias towards T-helper 2 (Th2) system dominance which protects the fetus, leaves the mother vulnerable to viral infections, which are more effectively contained by the Th1 system. These unique challenges mandate an integrated approach to pregnancies affected by SARS-CoV-2. Here we present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcriptase polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission and maternal-fetal complications. We discuss the latest options in antiviral therapy and vaccine development, including the novel use of chloroquine in the management of COVID-19. Fetal surveillance, in view of the predisposition to growth restriction and special considerations during labor and delivery are addressed. Additionally, we focus on keeping frontline obstetric care providers safe while continuing to provide essential services. Our clinical service model is built around the principles of workplace segregation, responsible social distancing, containment of cross-infection to healthcare providers, judicious use of personal protective equipment and telemedicine. Our aim is to share a framework which can be adopted by tertiary maternity units managing pregnant women in the flux of a pandemic while maintaining the safety of the patient and healthcare provider at its core.
DOI: 10.1016/j.ajog.2020.03.021
PubMed: 32217113
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Electronic address: pradip_dashraath_vijayakumar@nuhs.edu.sg.</nlm:affiliation><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Obstetrics & Gynaecology, National University Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Jing Lin Jeslyn, Wong" sort="Jing Lin Jeslyn, Wong" uniqKey="Jing Lin Jeslyn W" first="Wong" last="Jing Lin Jeslyn">Wong Jing Lin Jeslyn</name><affiliation wicri:level="1"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</nlm:affiliation><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Obstetrics & Gynaecology, National University Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Mei Xian Karen, Lim" sort="Mei Xian Karen, Lim" uniqKey="Mei Xian Karen L" first="Lim" last="Mei Xian Karen">Lim Mei Xian Karen</name><affiliation wicri:level="1"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</nlm:affiliation><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Obstetrics & Gynaecology, National University Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Li Min, Lim" sort="Li Min, Lim" uniqKey="Li Min L" first="Lim" last="Li Min">Lim Li Min</name><affiliation wicri:level="1"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</nlm:affiliation><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Obstetrics & Gynaecology, National University Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Sarah, Li" sort="Sarah, Li" uniqKey="Sarah L" first="Li" last="Sarah">Li Sarah</name><affiliation wicri:level="1"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</nlm:affiliation><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Obstetrics & Gynaecology, National University Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Biswas, Arijit" sort="Biswas, Arijit" uniqKey="Biswas A" first="Arijit" last="Biswas">Arijit Biswas</name><affiliation wicri:level="4"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</nlm:affiliation><country>Singapour</country><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Arjandas Choolani, Mahesh" sort="Arjandas Choolani, Mahesh" uniqKey="Arjandas Choolani M" first="Mahesh" last="Arjandas Choolani">Mahesh Arjandas Choolani</name><affiliation wicri:level="4"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</nlm:affiliation><country>Singapour</country><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Mattar, Citra" sort="Mattar, Citra" uniqKey="Mattar C" first="Citra" last="Mattar">Citra Mattar</name><affiliation wicri:level="4"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</nlm:affiliation><country>Singapour</country><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Lin, Su Lin" sort="Lin, Su Lin" uniqKey="Lin S" first="Su Lin" last="Lin">Su Lin Lin</name><affiliation wicri:level="4"><nlm:affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</nlm:affiliation><country>Singapour</country><orgName type="university">Université nationale de Singapour</orgName></affiliation></author></analytic><series><title level="j">American journal of obstetrics and gynecology</title><idno type="eISSN">1097-6868</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome 2 (SARS-CoV-2) virus, is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2 - 2.5, indicating that 2 - 3 persons will be infected from an index patient. A serious public health emergency, it is particularly deadly in vulnerable populations and communities in which healthcare providers are insufficiently prepared to manage the infection. As of March 16, 2020, there are more than 180,000 confirmed cases of COVID-19 worldwide, with over 7,000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious two weeks after cessation of symptoms. The substantial morbidity and socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns and border closures. Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks. To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure in the gravida. Furthermore, the pregnancy bias towards T-helper 2 (Th2) system dominance which protects the fetus, leaves the mother vulnerable to viral infections, which are more effectively contained by the Th1 system. These unique challenges mandate an integrated approach to pregnancies affected by SARS-CoV-2. Here we present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcriptase polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission and maternal-fetal complications. We discuss the latest options in antiviral therapy and vaccine development, including the novel use of chloroquine in the management of COVID-19. Fetal surveillance, in view of the predisposition to growth restriction and special considerations during labor and delivery are addressed. Additionally, we focus on keeping frontline obstetric care providers safe while continuing to provide essential services. Our clinical service model is built around the principles of workplace segregation, responsible social distancing, containment of cross-infection to healthcare providers, judicious use of personal protective equipment and telemedicine. Our aim is to share a framework which can be adopted by tertiary maternity units managing pregnant women in the flux of a pandemic while maintaining the safety of the patient and healthcare provider at its core.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32217113</PMID><DateRevised><Year>2020</Year><Month>03</Month><Day>28</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1097-6868</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Mar</Month><Day>23</Day></PubDate></JournalIssue><Title>American journal of obstetrics and gynecology</Title><ISOAbbreviation>Am. J. Obstet. Gynecol.</ISOAbbreviation></Journal><ArticleTitle>Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">S0002-9378(20)30343-4</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ajog.2020.03.021</ELocationID><Abstract><AbstractText>The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome 2 (SARS-CoV-2) virus, is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2 - 2.5, indicating that 2 - 3 persons will be infected from an index patient. A serious public health emergency, it is particularly deadly in vulnerable populations and communities in which healthcare providers are insufficiently prepared to manage the infection. As of March 16, 2020, there are more than 180,000 confirmed cases of COVID-19 worldwide, with over 7,000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious two weeks after cessation of symptoms. The substantial morbidity and socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns and border closures. Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks. To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure in the gravida. Furthermore, the pregnancy bias towards T-helper 2 (Th2) system dominance which protects the fetus, leaves the mother vulnerable to viral infections, which are more effectively contained by the Th1 system. These unique challenges mandate an integrated approach to pregnancies affected by SARS-CoV-2. Here we present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcriptase polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission and maternal-fetal complications. We discuss the latest options in antiviral therapy and vaccine development, including the novel use of chloroquine in the management of COVID-19. Fetal surveillance, in view of the predisposition to growth restriction and special considerations during labor and delivery are addressed. Additionally, we focus on keeping frontline obstetric care providers safe while continuing to provide essential services. Our clinical service model is built around the principles of workplace segregation, responsible social distancing, containment of cross-infection to healthcare providers, judicious use of personal protective equipment and telemedicine. Our aim is to share a framework which can be adopted by tertiary maternity units managing pregnant women in the flux of a pandemic while maintaining the safety of the patient and healthcare provider at its core.</AbstractText><CopyrightInformation>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Dashraath</LastName><ForeName>Pradip</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore. Electronic address: pradip_dashraath_vijayakumar@nuhs.edu.sg.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jing Lin Jeslyn</LastName><ForeName>Wong</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mei Xian Karen</LastName><ForeName>Lim</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Li Min</LastName><ForeName>Lim</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sarah</LastName><ForeName>Li</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Biswas</LastName><ForeName>Arijit</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Arjandas Choolani</LastName><ForeName>Mahesh</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mattar</LastName><ForeName>Citra</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lin</LastName><ForeName>Su Lin</ForeName><Initials>SL</Initials><AffiliationInfo><Affiliation>Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>03</Month><Day>23</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Obstet Gynecol</MedlineTA><NlmUniqueID>0370476</NlmUniqueID><ISSNLinking>0002-9378</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">MERS-CoV</Keyword><Keyword MajorTopicYN="N">SARS-CoV</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword><Keyword MajorTopicYN="N">antiviral</Keyword><Keyword MajorTopicYN="N">baricitinib</Keyword><Keyword MajorTopicYN="N">chloroquine</Keyword><Keyword MajorTopicYN="N">coronavirus</Keyword><Keyword MajorTopicYN="N">fever</Keyword><Keyword MajorTopicYN="N">mask</Keyword><Keyword MajorTopicYN="N">morbidity</Keyword><Keyword MajorTopicYN="N">mortality</Keyword><Keyword MajorTopicYN="N">obstetric management</Keyword><Keyword MajorTopicYN="N">pandemic</Keyword><Keyword MajorTopicYN="N">pregnancy</Keyword><Keyword MajorTopicYN="N">remdesivir</Keyword><Keyword MajorTopicYN="N">respiratory distress syndrome</Keyword><Keyword MajorTopicYN="N">respiratory failure</Keyword><Keyword MajorTopicYN="N">sepsis</Keyword><Keyword MajorTopicYN="N">susceptibility</Keyword><Keyword MajorTopicYN="N">virus</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>02</Month><Day>25</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>03</Month><Day>17</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>03</Month><Day>17</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>3</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>3</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>3</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32217113</ArticleId><ArticleId IdType="pii">S0002-9378(20)30343-4</ArticleId><ArticleId IdType="doi">10.1016/j.ajog.2020.03.021</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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