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Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies.
新型冠状病毒肺炎的母婴结局: 108 例妊娠的系统回顾。
- 影响因子:2.21
- DOI:10.1111/aogs.13867
- 作者列表:"Zaigham M","Andersson O
- 发表时间:2020-07-01
Abstract
INTRODUCTION:The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to an unprecedented global health crisis. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The objective of this study was to summarize the clinical manifestations and maternal and perinatal outcomes of COVID-19 during pregnancy. MATERIAL AND METHODS:We searched databases for all case reports and series from 12 February to 4 April 2020. Multiple terms and combinations were used including COVID-19, pregnancy, maternal mortality, maternal morbidity, complications, clinical manifestations, neonatal morbidity, intrauterine fetal death, neonatal mortality and SARS-CoV-2. Eligibility criteria included peer-reviewed publications written in English or Chinese and quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR-confirmed SARS-CoV-2 infection. Unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, cases with suspected COVID-19 that were not confirmed by a laboratory test, and unreported maternal or perinatal outcomes were excluded. Data on clinical manifestations, maternal and perinatal outcomes including vertical transmission were extracted and analyzed. RESULTS:Eighteen articles reporting data from 108 pregnancies between 8 December 2019 and 1 April 2020 were included in the current study. Most reports described women presenting in the third trimester with fever (68%) and coughing (34%). Lymphocytopenia (59%) with elevated C-reactive protein (70%) was observed and 91% of the women were delivered by cesarean section. Three maternal intensive care unit admissions were noted but no maternal deaths. One neonatal death and one intrauterine death were also reported. CONCLUSIONS:Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 and perinatal deaths were reported. Vertical transmission of the COVID-19 could not be ruled out. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.
摘要
简介: 新型冠状病毒 (SARS-CoV-2) 造成的大流行使脆弱人群面临前所未有的全球健康危机。从以前的人类冠状病毒爆发中获得的知识表明,孕妇及其胎儿特别容易出现不良结局。本研究旨在总结妊娠期新型冠状病毒肺炎的临床表现及母婴结局。 材料和方法: 我们检索了 2020 年 2 月 12 日至 4 月 4 日所有病例报告和系列数据库。使用了多种术语和组合,包括新型冠状病毒肺炎、妊娠、孕产妇死亡率、孕产妇发病率、并发症、临床表现、新生儿发病率、胎儿宫内死亡、新生儿死亡率和SARS-CoV-2。合格标准包括用英文或中文撰写的同行评议出版物和定量实时聚合酶链反应 (PCR) 或双重荧光PCR证实的SARS-CoV-2 感染。未发表的报告、未指明的研究日期和地点或怀疑有重复报告、实验室检测未证实的疑似新型冠状病毒肺炎病例以及未报告的孕产妇或围产期结局被排除在外。提取并分析有关临床表现、孕产妇和围产儿结局 (包括垂直传播) 的数据。 结果: 本研究纳入了 18 篇报告 2019 年 12 月 8 日至 20 20 年 4 月 1 日期间 108 例妊娠数据的文章。大多数报告描述了在妊娠晚期出现发热 (68%) 和咳嗽 (34%) 的妇女。淋巴细胞减少 (59%) 伴C反应蛋白升高 (70%),91% 的妇女通过剖宫产分娩。观察到 3 例产妇重症监护室入院,但无产妇死亡。还报告了 1 例新生儿死亡和 1 例宫内死亡。 结论: 尽管大多数母亲出院时没有出现任何重大并发症,但报告了新型冠状病毒肺炎和围产期死亡导致的严重孕产妇发病率。不能排除新型冠状病毒肺炎的垂直传输。应仔细监测妊娠新型冠状病毒肺炎,并采取措施预防新生儿感染。
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METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.
呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。