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Coronavirus disease 2019 (COVID-19) pandemic and pregnancy.
Am J Obstet Gynecol. 2020 06; 222(6):521-531.AJ

Abstract

The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 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 more than 7000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious 2 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 toward 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 transcription 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, is addressed. In addition, 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 that 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.

Authors+Show Affiliations

Department of Obstetrics & Gynaecology, National University Hospital, Singapore. Electronic address: pradip_dashraath_vijayakumar@nuhs.edu.sg.Department of Obstetrics & Gynaecology, National University Hospital, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Obstetrics & Gynaecology, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32217113

Citation

Dashraath, Pradip, et al. "Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy." American Journal of Obstetrics and Gynecology, vol. 222, no. 6, 2020, pp. 521-531.
Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020;222(6):521-531.
Dashraath, P., Wong, J. L. J., Lim, M. X. K., Lim, L. M., Li, S., Biswas, A., Choolani, M., Mattar, C., & Su, L. L. (2020). Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. American Journal of Obstetrics and Gynecology, 222(6), 521-531. https://doi.org/10.1016/j.ajog.2020.03.021
Dashraath P, et al. Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy. Am J Obstet Gynecol. 2020;222(6):521-531. PubMed PMID: 32217113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. AU - Dashraath,Pradip, AU - Wong,Jing Lin Jeslyn, AU - Lim,Mei Xian Karen, AU - Lim,Li Min, AU - Li,Sarah, AU - Biswas,Arijit, AU - Choolani,Mahesh, AU - Mattar,Citra, AU - Su,Lin Lin, Y1 - 2020/03/23/ PY - 2020/02/25/received PY - 2020/03/17/revised PY - 2020/03/17/accepted PY - 2020/3/29/pubmed PY - 2020/6/5/medline PY - 2020/3/29/entrez KW - COVID-19 KW - MERS-CoV,morbidity KW - SARS-CoV KW - SARS-CoV-2 KW - antiviral KW - baricitinib KW - chloroquine KW - coronavirus KW - fever KW - mask KW - mortality KW - obstetric management KW - pandemic KW - pregnancy KW - remdesivir KW - respiratory distress syndrome KW - respiratory failure KW - sepsis KW - susceptibility KW - virus SP - 521 EP - 531 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 222 IS - 6 N2 - The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 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 more than 7000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious 2 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 toward 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 transcription 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, is addressed. In addition, 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 that 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. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/32217113/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(20)30343-4 DB - PRIME DP - Unbound Medicine ER -