BMJ: What about the health and perinatal outcomes of pregnant women during the new crown pneumonia epidemic?

During the new crown epidemic, pregnant women are considered to be at high risk of new coronavirus infection, and the potential adverse effects of the virus on maternal and perinatal outcomes are of concern.
quantifying the incidence, risk factors, clinical manifestations and results of covid-19 is key to developing clinical maternal care and management programmes in the face of unclear future trends in pandemics.
from the outbreak of neo-crown pneumonia to the present, there has been a sharp increase in publications on covid-19 during pregnancy, including individual case reports, case series, observational studies and systematic reviews.
as of June 26, 2020, more than 86 comments had been made in this area and 94 were registered with PROSPERO.
early reviews include mainly case reports and case series reports, which are often inappropriately analysed, leading to biased conclusions.
as new evidence emerged, the comments quickly became obsolete.
, no review has provided a comprehensive assessment of comparative data on pregnant and newly pregnant women with covid-19, as well as non-pregnant women.
, the sampling framework in the primary study varied, from SARSCoV-2 tests on all hospitalized pregnant women to symptom-based tests.
testing strategies vary from country to country and from country to country, and many early studies diagnose infections based on epidemiological risk assessments and clinical characteristics, but are not diagnosed, and therefore need to be considered in the analysis.
limitations of the external and internal effectiveness of the study make it difficult for guidelines makers and policymakers to make evidence-based recommendations for pregnant women with covid-19 and newly pregnant women.
A dynamic systematic retrospective study by Professor John Allotey of the Who's Global Partnership for Women's Health, at the University of Birmingham's School of Applied Health Research, published on 1 September, identified the clinical manifestations of covid-19 in pregnant/newly pregnant women, as well as risk factors for related complications, quantified maternal and perinatal outcomes and provided some clinical reference for maternal management.
data sources for this study are Medline, Embase, Cochrane Database, WHO COVID-19 Database, China National Knowledge Infrastructure (China Knowledge Network) and Wanfang Database from December 1, 2019 to June 26, 2020, as well as preprinted servers, social media, and reference lists.
after deleting 49,684 duplicate documents, the researchers identified 20,625 unique documents and included 77 queue studies (55 comparative studies and 22 non-comparative studies) in a systematic review (Figure 1).
1. Study the selection process.
of the study showed that the rate of covid-19 diagnosis was 10 per cent for pregnant or admitted women for any reason.
rates vary according to sampling strategies: 7 per cent of women in the general screening sample were diagnosed with covid-19 (4 to 10 per cent; 18 studies, 6,247 women), while 18 per cent of women in the sample based on symptoms were diagnosed with covid-19 (10 to 28 per cent; 8 studies, 4928 women).
the prevalence of neo-crown pneumonia among pregnant and new pregnant women as determined by various sampling strategies.
Pregnant women with suspected or confirmed covid-19 and new pregnant women reported the most common symptoms were fever (40%) and cough (39%);
women and new mothers were less likely to develop symptoms of fever and myalgia than women of childbearing age who were not pregnant.
women with a history of diabetes are more common than pregnant women with no history of diabetes.
a total of 73 pregnant women diagnosed with covid-19 died from various causes.
13% of patients were diagnosed with covid-19 severity, 4% of covid-19 pregnant women were taken to intensive care units, 3% needed invasive breathing, and 0.4% needed in vitro oxygenation.
the clinical manifestations of pregnant women with neo-coronavirus disease (covid-19) and women with women of childbearing age who are not pregnant in recent years compare with the end of perinatal outcomes of pregnant women with coronavirus disease (covid-19) in 2019? Among pregnant women with covid-19 and new pregnancies, the overall rate of premature birth was 17% and 6%, respectively.
18 still births and 6 neonatal deaths occurred in pregnant women with covid-19 and new pregnancies.
, 25 per cent of covid-19 mothers had their newborns admitted to neonatal units, and 25 per cent of mothers with other diseases had a higher risk of their newborns being admitted to hospital.
no difference in other perinatal outcomes.
overall, pregnant women and new pregnant women are less likely to develop covid-19-related fever and myalgia symptoms than non-pregnant women of childbearing age and may be more in need of intensive care.
pre-existing co-morbidity, maternal age and high body mass index appear to be risk factors for severe covid-19.
women with covid-19 had a higher rate of pre-birth than those without the disease.
to minimize the risk of bias, we limit metaanalytical analysis to queue studies and report on the quality of the studies," the researchers said.
to minimize the risk of losing relevant research data by contacting the authors and obtaining reports that are not published on PubMed.
The sample size of our systematic review is large and growing, and through a variety of comparative analyses, the relationship between pregnancy and covid-19-related outcomes, covid-19 and pregnancy outcomes, risk factors for SARS-CoV-2 infection and complications can be fully assessed.
, our Life System Review will provide a strong evidence base for covid-19 and pregnancy life guides.
so what should be taken into care for pregnant covid-19 patients at the moment? Comprehensive WHO recommendations and China's health care guidelines, epidemic transmission period, in order to reduce exposure and infection opportunities, can be moderate adjustment of the time of birth testing, and high-risk pregnant women's provisions of the birth test time and time-limited important routine prenatal screening, do their own protection, must go to the hospital for examination.
the following time period must be a birth test: 6 to 8 weeks to complete the first examination, to determine the pregnancy inside and outside the hospital, for determining the age of pregnancy has guiding significance.
important time for the ultrasound detection of the post-neck transparent band (nuchal translucency, NT) value of 11 to 13 weeks of pregnancy, the first line of defense for fetal malformation prejudgment.
14 to 18 weeks of pregnancy for Down's screening or non-invasive prenatal testing, the delivery period of pregnant women over 335 years of age (no contraindication certificate), in accordance with the provisions of the state appointment for prenatal diagnosis (after 19 weeks amniocentesis).
B-type ultrasound at 20 to 14 weeks of pregnancy excludes general structural fetal malformations, and subtle abnormalities are not all detected.
24 to 28 weeks of pregnancy sugar tolerance test.
should not be 28 weeks pregnant at the latest, guide pregnant women blood sugar control, avoid fetal risk.
28 weeks after pregnancy no special discomfort, pregnant women have no high-risk complications, monitoring fetal movement normal, moderate adjustment to the full 36 weeks of pregnancy to do B-type ultrasound, fetal heart monitoring, B streptococcus screening, related bio-chemical indicators testing.
There are roughly two situations that require personal protection, immediately go to the hospital, obstetric factors recommend obstetric first consultation, the epidemic epidemic general hospital should open a special emergency obstetric area, in order to separate from other patients.
recommended for non-obstetric factors to the fever clinic of a designated hospital with obstetrics, an obstetrician should be consulted before the fever clinic needs to be referred.
1. Combined obstetric factors fetal membrane early break, vaginal bleeding, uterine contraction, etc.; high blood pressure, headache, blurred vision, abdominal pain, abnormal fetal movement, etc.; abnormally elevated blood sugar, can not lie flat at night; severe edema of the lower extremities, inconsistent weight of the legs (fear of lower limb venous embolism).
2. Non-obstetric factors such as a history of exposure within 14 d, sub-tongue body temperature (not recommended underarm body temperature) exceeds 37. 3 degrees C, accompanied by cough, fatigue and other clinical manifestations, should be timely medical treatment, such as 14d within the epidemic area or patient contact history, normal body temperature, but there is shortness of breath, chest tightness or menstrual oxygen saturation decreased, should be timely medical treatment;
In short, during the epidemic, maternal as a special susceptible group should pay more attention to do a good job of protection, protect themselves, less out, especially not to go to crowded places, such as must go out must wear masks, should not stay outside or in the hospital for a long time.
Home waiting for child is a topic of concern to medical workers and pregnant women, not only the outbreak period, Ping Su should also pay attention to, because it is related to the safety of mothers and children, especially pay attention to the focus on monitoring high-risk pregnant women, with good "five colors" early warning, keep a good safety bottom line.
Pixabay References: Allotey, J., Stallings, E., Bonet, M., Yap, M., Chatterjee, S., ... Kew, T. (2020). Clinical outcomes, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living system review and meta-analysis. BMJ, m3320. doi:10.1136/bmj.m3320.MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Original" are owned by Mets Medical and are not authorized to reproduce, and any media, website or individual may not reproduce them with the words "Source: Met Medical".
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