COVID-19 Pozitif Gebelerin Hastaneye İlk Başvurularındaki Demografik, Klinik ve Laboratuvar Verilerinin Değerlendirilmesi

Yıl 2023, Cilt: 20 Sayı: 2, 1759 - 1763, 03.07.2023

Özlem Gündüz Banu Seven A. Seval Özgü-erdinç Batuhan Turgay Özlem Moraloğlu Tekin Hüseyin Levent Keskin

https://doi.org/10.38136/jgon.1178509

Öz

Amaç: Acil Servise başvuran gebelerin demografik, klinik ve laboratuvar verilerini değerlendirerek, gebeliğin farklı trimesterlerinde COVİD-19 hastalığının klinik seyrini araştırmak.
Gereç ve Yöntemler: Olgular semptomlara ve Sat O2 değerine göre asemptomatik, hafif semptomatik ve şiddetli hastalık olarak 3 grupta incelendi. Lenfopeni, kan testlerinde yüksek CRP, ferritin ve D-dimer seviyeleri kötü prognostik faktörler olarak kabul edildi.
Bulgular: COVİD-19'lu 678 gebenin 118'i (%17.4) birinci trimesterde, 261'i (%38.5) ikinci trimesterde ve 299'u (%44.1) üçüncü trimesterdeydi. 120'si sadece covid 19 enfeksiyonuna bağlı olmak üzere toplam 257 (%37,9) COVİD-19 (+) gebe hastaneye yatırıldı. Olguların 57'sinde (%8.4) ağır hastalık saptandı, bunların 29'u (%50.9) 2. trimesterde, 26'sı (%45.6) 3. trimesterdeydi. Ağır hastalık insidansı gebeliğin sonraki haftalarında ilk trimestere göre anlamlı derecede yüksekti (p=0.004). Kötü prognostik laboratuvar kriterlerinin trimesterlere göre dağılımı incelendiğinde, COVİD-19'lu gebelerin %22,9'u ilk trimesterde en az bir kötü prognostik laboratuvar kriterine sahipken, bu oran ikinci ve üçüncü trimesterlerde sırasıyla %41,7 ve %63 idi (p<0.001).
Sonuç: Bu çalışmada, COVİD-19 pozitif gebelerde hastalığın seyrinin gebeliğin ileri  haftalarında ilk trimestere göre daha şiddetli olduğunu gözlemledik.

Anahtar Kelimeler

COVİD-19, gebelik, trimester

Evaluation of Demographic, Clinic and Laboratory data of COVID-19 (+) Pregnants in their First Admission to Hospital

Öz

Aim: To investigate the clinical course of COVID-19 in different trimesters of pregnancy by evaluating the demographic, clinical and laboratory data of pregnant women who applied to the Emergency Service.
Materials and method: Cases were examined in 3 groups as asymptomatic, mild symptomatic and severe disease according to symptoms and oxygen saturation. High levels of CRP, ferritin, D-dimer and lymphopenia in blood tests were considered as poor prognostic factors.
Results: Of 678 pregnant women with COVİD-19 , 118 (17.4%) were in the first trimester, 261 (38.5%) were in the second trimester and 299 (44.1%) were in the third trimester. A total of 257 (37.9%) COVID-19 (+) pregnant women were hospitalized and 120 of them were due to COVID-19 infection without any obstetric indication. Severe disease was detected in 57 (8.4%) of the cases; 29 of them (50.9%) were in the 2nd trimester and 26 (45.6%) were in the 3rd trimester. The incidence of severe disease was statistically significantly higher in the later weeks of pregnancy compared to the first trimester (p=0.004). When the distribution of the poor prognostic laboratory criteria according to trimesters was examined, 22.9% of pregnant women with COVID-19 had at least one poor prognostic laboratory criterion in the first trimester, while this rate was 41.7% and 63.9% in the second and third trimesters, respectively (p<0.001).
Conclusion: In this study, we observed that the course of the disease in COVID-19 positive pregnant women is more severe in the later weeks of pregnancy than in the first trimester.

Anahtar Kelimeler

COVID-19, pregnancy, trimester

Kaynakça

• 1. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192-206.
• 2. Elshafeey F, Magdi R, Hindi N, Elshebiny M, Farrag N, Mahdy S, et al. A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet. 2020;150(1):47-52.
• 3. Jamieson DJ, Rasmussen SA. An update on COVID-19 and pregnancy. Am J Obstet Gynecol. 2022;226(2):177-86.
• 4. Boushra MN, Koyfman A, Long B. COVID-19 in pregnancy and the puerperium: A review for emergency physicians. Am J Emerg Med. 2021;40:193-8.
• 5. Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis. 2006;12(11):1638-43.
• 6. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2).
• 7. Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: what about pregnancies? Lancet. 2020;395(10224):e40.
• 8. Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):769-75.
• 9. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1641-7.
• 10. Di Mascio D, Buca D, Berghella V, Khalil A, Rizzo G, Odibo A, et al. Counseling in maternal-fetal medicine: SARS-CoV-2 infection in pregnancy. Ultrasound Obstet Gynecol. 2021;57(5):687-97.
• 11. Syeda S, Baptiste C, Breslin N, Gyamfi-Bannerman C, Miller R. The clinical course of COVID in pregnancy. Semin Perinatol. 2020;44(7):151284.
• 12. Delahoy MJ, Whitaker M, O'Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(38):1347-54.
• 13. Mirbeyk M, Saghazadeh A, Rezaei N. A systematic review of pregnant women with COVID-19 and their neonates. Arch Gynecol Obstet. 2021;304(1):5-38.
• 14. Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2(2):100118.
• 15. Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, et al. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol. 2021;57(4):573-81.
• 16. Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. Bmj. 2020;369:m2107.
• 17. Abedzadeh-Kalahroudi M, Sehat M, Vahedpour Z, Talebian P. Maternal and neonatal outcomes of pregnant patients with COVID-19: A prospective cohort study. Int J Gynaecol Obstet. 2021;153(3):449-56.
• 18. Salem D, Katranji F, Bakdash T. COVID-19 infection in pregnant women: Review of maternal and fetal outcomes. Int J Gynaecol Obstet. 2021;152(3):291-8.
• 19. Mark EG, McAleese S, Golden WC, Gilmore MM, Sick-Samuels A, Curless MS, et al. Coronavirus Disease 2019 in Pregnancy and Outcomes Among Pregnant Women and Neonates: A Literature Review. Pediatr Infect Dis J. 2021;40(5):473-8.
• 20. Aabakke AJM, Krebs L, Petersen TG, Kjeldsen FS, Corn G, Wøjdemann K, et al. SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study. Acta Obstet Gynecol Scand. 2021;100(11):2097-110.
• 21. Wenling Y, Junchao Q, Xiao Z, Ouyang S. Pregnancy and COVID-19: management and challenges. Rev Inst Med Trop Sao Paulo. 2020;62:e62.
• 22. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428-55.
• 23. Hariyanto TI, Japar KV, Kwenandar F, Damay V, Siregar JI, Lugito NPH, et al. Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis. Am J Emerg Med. 2021;41:110-9.
• 24. Chaubey I, Vignesh R, Babu H, Wagoner I, Govindaraj S, Velu V. SARS-CoV-2 in Pregnant Women: Consequences of Vertical Transmission. Front Cell Infect Microbiol.
• 25. Diriba K, Awulachew E, Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. Eur J Med Res. 2020;25(1):39.
• 26. Thompson JL, Nguyen LM, Noble KN, Aronoff DM. COVID-19-related disease severity in pregnancy. Am J Reprod Immunol. 2020;84(5):e13339.
• 27. Phoswa WN, Khaliq OP. Is pregnancy a risk factor of COVID-19? Eur J Obstet Gynecol Reprod Biol. 2020;252:605-9.
• 28. Pelayo J, Pugliese G, Salacup G, Quintero E, Khalifeh A, Jaspan D, et al. Severe COVID-19 in Third Trimester Pregnancy: Multidisciplinary Approach. Case Rep Crit Care. 2020;2020:8889487.
• 29. Vlachodimitropoulou Koumoutsea E, Vivanti AJ, Shehata N, Benachi A, Le Gouez A, Desconclois C, et al. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost. 2020;18(7):1648-52.