新型冠状病毒肺炎疫情防控期间子宫颈癌三级防控综合管理中国专家共识

        世界卫生组织将新型冠状病毒命名为SARS-CoV-2,将新型冠状病毒肺炎命名为COVID-19。COVID-19作为急性传染病已于2020年1月20日纳入《中华人民共和国传染病防治法》［1］乙类传染病,按甲类传染病管理。疫情期间需依照《国家突发公共卫生事件应急预案》［2］实施分级应急防控。国家突发公共卫生事件分为四级,即：特别重大（Ⅰ级）、重大（Ⅱ级）、较大（Ⅲ级）和一般（Ⅳ级）。疫情发生地按照以上分级原则有效控制突发公共卫生事件以减少危害和影响。面对全世界新型冠状病毒疫情的防控形势,新型冠状病毒感染仍然是威胁人民生命健康的重大传染性疾病,疫情的防控也将进入常态化。 浏览更多请关注本刊微信公众号及当期杂志。     

妊娠合并新型冠状病毒感染:美国妇产科医师学会实践建议

美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)对于新型冠状病毒感染(COVID-19)这一疫情的暴发保持着密切关注。2020年3月13日,ACOG对其三月初基于中国2项研究首次发表的妊娠合并COVID-19实践建议进行了更新。ACOG实践建议不同于诊治指南,是对紧急临床问题做出的快速反应并进行实时更新。ACOG指出,现有证据并未发现孕妇感染新型冠状病毒病情更重的风险,但是既往研究表明,孕妇感染流感和严重急性呼吸综合征冠状病毒(severe acute respiratory syndrome coronavirus,SARS-CoV)等其他呼吸道病毒后,发生重症和死亡的风险明显增加。     

妊娠期接种COVID-19疫苗对妊娠结局影响的研究进展

新型冠状病毒肺炎（corona virus disease 2019,COVID-19）是一种以呼吸道症状为主的急性传染病,迄今尚无特效的治疗方法。除一般的预防措施外,接种疫苗是一种安全、有效的措施。然而,由于孕产妇及哺乳期妇女的群体特殊性,对COVID-19疫苗的安全性和有效性存在疑虑,导致COVID-19疫苗的接种率低,相关数据相对缺乏。但随着妊娠期发生的一系列生理变化,孕妇更容易感染新型冠状病毒,不良妊娠结局发生风险也随之增加。因此,总结COVID-19疫苗在孕产妇中的安全性及有效性证据十分必要,为后续开展相关研究以及COVID-19疫苗的安全性评价提供参考。     

新型冠状病毒流行期间孕产妇胸部影像学检查策略建议

自2019年12月新型冠状病毒肺炎（COVID-19）在我国武汉市暴发以来,随着对疾病认识的不断深入,国家卫生健康委员会持续修正了COVID-19的诊疗方案。根据国家卫生健康委员会发布的《新型冠状病毒肺炎诊疗方案（试行第六版）》［1］,具有COVID-19影像学特征为COVID-19三项临床表现中的一项且影像学特征的动态变化可评价COVID-19的严重程度。因此,影像学检查在COVID-19的诊断和病情评估中起到了重要的作用。 浏览更多请关注本刊微信公众号及当期杂志。     

新型冠状病毒流行期间孕产妇胸部影像学检查策略建议

        自2019年12月新型冠状病毒肺炎（COVID-19）在我国武汉市暴发以来，随着对疾病认识的不断深入，国家卫生健康委员会持续修正了COVID-19的诊疗方案。根据国家卫生健康委员会发布的《新型冠状病毒肺炎诊疗方案（试行第六版）》［1］，具有COVID-19影像学特征为COVID-19三项临床表现中的一项且影像学特征的动态变化可评价COVID-19的严重程度。因此，影像学检查在COVID-19的诊断和病情评估中起到了重要的作用。 浏览更多请关注本刊微信公众号及当期杂志。     

妊娠合并新型冠状病毒肺炎九例临床分析

目的评估妊娠合并新型冠状病毒肺炎(COVID-19)患者的临床特征及母婴妊娠结局。方法回顾性分析武汉大学人民医院2020年1月22日至2月1日收治入院的9例COVID-19孕妇的病例资料,包括流行病学史、临床症状、实验室检查、胸部CT影像学表现、治疗方案、分娩方式和新生儿结局的相关资料。并对其中6例孕妇的阴道分泌物标本和4例分娩孕妇的羊水、脐带血、新生儿鼻咽拭子、母乳标本进行新型冠状病毒核酸检测。对数据资料进行描述性统计分析。结果(1)9例孕妇中,5例为妊娠晚期,4例为妊娠中期。潜伏期中位数为8(1~14)d。9例孕妇均出现发热症状,7例出现咳嗽,5例出现腹泻症状。其他症状包括气短或气促、肌肉疼痛、乏力(各4例),鼻塞、咽痛、胸痛、头痛或头晕(各3例),皮疹(2例),以及寒战和咳痰(各1例)。7例孕妇合并淋巴细胞减少,6例C-反应蛋白升高。7例孕妇行胸部CT检查,均见肺部多发斑片状毛玻璃影。1例孕37周+5孕妇在确诊7 d后,超声提示羊水过少。(2)所有患者均给予经验性抗生素治疗、抗病毒治疗和中成药物辅助治疗。8例患者接受吸氧及激素治疗,6例接受免疫治疗。(3)9例孕妇中,4例分娩,1例于孕26周引产。分娩的4例中3例行剖宫产术终止妊娠;1例胎膜早破自发性早产并经阴道分娩,产后2 d出现急性呼吸窘迫综合征,转入重症监护病房治疗。4例新生儿中2例为足月儿;2例为早产儿,其中1例为低出生体重儿。所有新生儿出生时均无窒息。其余4例继续妊娠孕妇病情均稳定。羊水、脐带血、新生儿鼻咽拭子、母乳及母亲阴道分泌物行新型冠状病毒核酸检测均为阴性。结论妊娠合并COVID-19患者的临床特征与非妊娠期成人患者相比无特异性,尚无证据表明妊娠合并COVID-19可导致更严重不良母儿结局或垂直传播。     

妊娠合并新型冠状病毒肺炎治愈17例临床分析

目的:探讨妊娠合并新型冠状病毒肺炎(COVID-19)的临床特点及治疗方法。方法:对武汉大学人民医院东院2020年1月31日至3月26日收治的妊娠合并COVID-19并痊愈出院的患者17例临床资料进行回顾性分析。结果:17例患者中轻型6例,普通型11例,无一例转为重症或危重症。发热10例,咳嗽6例,同时出现咳嗽、腹泻、气促及乏力等症状1例,无呼吸道症状4例。4例孕妇合并白细胞计数升高,10例出现淋巴细胞计数降低,11例出现淋巴细胞百分比降低,13例孕妇D-二聚体值升高。17例痊愈患者行抗病毒、抗感染及中成药物等对症支持治疗,10例使用小剂量糖皮质激素治疗,3例使用免疫调节剂,11例行低流量吸氧治疗。17例中6例患者(包含瘢痕子宫)因临产或先兆临产等原因经剖宫产术分娩,1例顺产,1例早孕自然流产,7例新生儿出生后查新型冠状病毒核酸均阴性。9例患者出院后继续妊娠。17例患者经治疗后各项指标均好转,符合出院标准。结论:早发现、早治疗、适时终止妊娠对改善妊娠合并COVID-19的预后有一定效果,轻型或普通型COVID-19孕妇无终止妊娠的其他医学指征,可在严密监测下继续妊娠,COVID-19病毒及治疗药物对胎儿的影响尚待进一步研究。     

妊娠期新型冠状病毒感染的垂直传播风险及其与胎儿异常超声表现的相关性探讨

目的 探讨妊娠期新型冠状病毒感染的垂直传播风险及其与胎儿异常超声表现的相关性。方法 通过回顾性分析,对2022年12月至2023年1月湖南省妇幼保健院收治的新型冠状病毒感染孕妇及其新生儿的一般资料、产前超声结果及其相关检查进行重点分析。结果 2022年12月至2023年1月在湖南省妇幼保健院收治的妊娠合并新型冠状病毒感染的孕妇共547例,有68例新型冠状病毒感染孕妇纳入研究,其中有2例可能存在母婴垂直传播,1例存在母婴垂直传播,并伴有胎儿出现继发性改变的超声表现。结论 妊娠期新型冠状病毒感染可能存在罕见的母婴垂直传播风险,并且这可能与胎儿的异常超声表现存在相关性,需引起临床医生与超声医生的充分重视。     

妊娠晚期合并新冠肺炎的围生期结局

目的:探讨妊娠晚期合并新型冠状病毒肺炎患者的临床特点、治疗及母儿结局。方法:回顾分析2020年1月1日至2020年2月12日华中科技大学同济医学院附属同济医院收治的23例妊娠晚期合并新冠肺炎患者的临床资料,分析其流行病学特点、临床特点、治疗和母儿结局。结局随访至2月18日。结果:23例患者均无华南海鲜市场接触史,均为武汉疫区居住史。患者平均年龄(32.34±6.21)岁(23～42岁),均为足月妊娠,平均孕周为39周(37～41~(+2)周)。临床表现中有发热13例(56.52%)、咳嗽6例(26.09%)、呼吸急促1例(4.35%)和腹泻2例(8.70%)。18例患者行剖宫产和5例患者经阴分娩终止妊娠,平均39~(+2)周,孕妇和新生儿的预后良好。对其中9例新生儿进行新型冠状病毒(SARS-CoV-2)咽试纸核酸检测,36h后发现1例新生儿感染SARS-CoV-2。结论:产妇为新型冠状病毒肺炎的易感人群,对于足月或肺部病变进展迅速患者,建议及时终止妊娠。本例研究发现,妊娠晚期合并新冠肺炎及时终止妊娠者母婴结局良好,远期结局及是否存在母婴垂直传播有待进一步研究。     

新型冠状病毒感染疫情下的妊娠管理策略

2019年12月,湖北省武汉市陆续发现多例感染新型冠状病毒肺炎患者[1],随后该新型冠状病毒感染逐渐蔓延至全国以及其他国家,世界卫生组织(WHO)将其命名为2019冠状病毒病(corona virus disease 2019,COVID-19)。该病传染性强,已纳入《中华人民共和国传染病防治法》规定的乙类传染病,并按甲类传染病管理。人群对COVID-19普遍易感,孕妇也不例外.且由于妊娠引起心肺负荷增加,孕妇感染后病情可能会更加危重而导致严重的不良妊娠结局,甚至引起孕产妇及围产儿死亡。在此疫情下,产科医生不仅要加强自我防护,也要加强对COVID-19相关知识的学习,并将此运用到产科临床实践中,熟悉疑似和确诊的COVID-19孕妇管理流程,严格按照多学科管理共同治疗COVID-19孕妇。     

The influence of COVID-19 pandemic on intrauterine fetal demise and possible vertical transmission of SARS-CoV-2

ObjectiveThe impact of COVID-19 on intrauterine fetal demise (IUFD) and vertical transmission of the SARS-CoV-2 from the mother to the fetus are crucial issues of the COVID-19 pandemic. In the current study, we aimed to detect the pandemic's influence on the IUFD and evaluate the vertical transmission of the SARS-CoV-2 through analysis of placental tissues collected from PCR positive women with IUFD above 20 weeks of gestation.Materials and methodsThe pregnant women above 20 weeks of gestation and had a fetus intrauterine demised during pandemic were included in the study. The pregnant women screened for COVID-19. Vertical transmission searched from placental tissues of COVID-19 positive women by RT-PCR tests for the presence of SARS-CoV-2 RNA. The number of IUFD before the pandemic and during the pandemic compared to assess the influence of the COVID-19 pandemic on the IUFD ratio.ResultsAmong 138 pregnant women with IUFD, 100 of them could screen for COVID-19 status. RT-PCR test results of 6 of the screened pregnant women were positive for SARS-CoV-2. Placental tissues of these six women were analyzed, and one test result was positive for SARS-CoV-2 RNA. The IUFD ratio was significantly increased during the pandemic.ConclusionIt is clear that COVID-19 increases the IUFD ratio. Previous data for vertical transmission of SARS-CoV-2 during the second trimester is limited. We present the third case of literature that has positive placental results for SARS-CoV-2 RNA in the second trimester of pregnancy.     

COVID-19 Treatment: Drug Safety Prior to Conception and During Pregnancy and Breastfeeding

In December 2019, a new viral respiratory infection known as coronavirus disease 2019 (COVID-19) was first diagnosed in the city of Wuhan, China. COVID-19 quickly spread across the world, leading the World Health Organization to declare it a pandemic on March 11, 2020. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a similar virus to those involved in other epidemics such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Epidemiological studies have shown that COVID-19 frequently affects young adults of reproductive age and that the elderly and patients with chronic disease have high mortality rates. Little is known about the impact of COVID-19 on pregnancy and breastfeeding. Most COVID-19 cases present with mild flu-like symptoms and only require treatment with symptomatic relief medications, whereas other cases with COVID-19 require treatment in an intensive care unit. There is currently no specific effective treatment for COVID-19. A large number of drugs are being used to fight infection by SARS-CoV-2. Experience with this therapeutic arsenal has been gained over the years in the treatment of other viral, autoimmune, parasitic, and bacterial diseases. Importantly, the search for an effective treatment for COVID-19 cannot expose pregnant women infected with SARS-CoV-2 to the potential teratogenic risks of these drugs. Therefore, it is necessary to determine and understand the safety of anti-COVID-19 therapies prior to conception and during pregnancy and breastfeeding.Key words: COVID-19, SARS-CoV-2, antiviral, pregnancy, breastfeeding     

Prevalence of SARS-CoV-2 in Pregnant Women Assessed by RT-PCR in Franconia,Germany: First Results of the SCENARIO Study (SARS-CoV-2 prEvalence in pregNAncy and at biRth In FrancOnia)

Purpose Detection of SARS-CoV-2-infected pregnant women admitted to maternity units during a pandemic is crucial. In addition to the fact that pregnancy is a risk factor for severe COVID-19 and that medical surveillance has to be adjusted in infected women and their offspring, knowledge about infection status can provide the opportunity to protect other patients and healthcare workers against virus transmission. The aim of this prospective observational study was to determine the prevalence of SARS-CoV-2 infection among pregnant women in the hospital setting. Material and Methods All eligible pregnant women admitted to the nine participating hospitals in Franconia, Germany, from 2 June 2020 to 24 January 2021 were included. COVID-19-related symptoms, secondary diseases and pregnancy abnormalities were documented. SARS-CoV-2 RNA was detected by RT-PCR from nasopharyngeal swabs. The prevalence of acute SARS-CoV-2 infection was estimated by correcting the positive rate using the Rogan–Gladen method. The risk of infection for healthcare workers during delivery was estimated using a risk calculator. Results Of 2414 recruited pregnant women, six were newly diagnosed RT-PCR positive for SARS-CoV-2, which yielded a prevalence of SARS-CoV-2 infection of 0.26% (95% CI, 0.10 – 0.57%). Combining active room ventilation and wearing FFP2 masks showed an estimated reduction of risk of infection for healthcare workers in the delivery room to < 1%. Conclusions The prevalence of newly diagnosed SARS-CoV-2 infection during pregnancy in this study is low. Nevertheless, a systematic screening in maternity units during pandemic situations is important to adjust hygienic and medical management. An adequate hygienic setting can minimise the calculated infection risk for medical healthcare workers during patientsʼ labour. Key words: SARS-CoV-2, COVID-19, pregnancy, prevalence, infection     

Review of care and management of pregnant women during COVID-19 pandemic

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Covid-19 pandemic began in the end of 2019 and spread all over the world in a short duration of time. Measures have been taken such as social distancing, compulsory lockdown and restriction of activities so as to prevent spread of virus. It has posed problem to both the antenatal women and maternity care workers. The care and management of pregnant women is an essential service to identify high-risk mothers and also to have good pregnancy outcome for both mother and baby. Any delay in this may lead to catastrophe, hence this issue needs to be addressed properly. This review briefs about the literature available on antenatal care during covid-19 pandemic. Pregnancy is not very adversely affected by the virus itself but extra caution should be taken to prevent and complications should they arise. The norms of social distancing by patients and wearing personal protective equipment by hospital staff, testing of pregnant women should be followed as per regional and national guidelines. This will help ensure safety of all people along with care to the expecting mother. The presence of covid-19 infection should not deter women from receiving antenatal care nor should the obstetric treatment be delayed during labor. Decision for timing and mode of delivery should be individualised based on obstetric indications and maternal–fetal status.     

A symptomatic near-term pregnant woman recovered from SARS-CoV-2 infection

ObjectiveCoronavirus-2019 (COVID-19) is a global health crisis. Although pregnant women are a vulnerable population during the infectious pandemics, extremely rare cases of pregnant women infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are described in Taiwan. We share our experience to manage a pregnant women with COVID-19 in the third trimester and subsequent delivery at term.Case reportA 43-year-old woman presented with sore throat, cough and rhinorrhea was diagnosed as laboratory-confirmed SARS-CoV-2 infection at the 35 gestational weeks (GW). During the hospitalization, the disease progressed with a need of oxygen supplement and prednisolone therapy. She was discharged uneventfully at 37 GW. Finally, she delivered a female baby with Apgar score of 8–9 points at 38 GW by cesarean section due to the deformity of pelvic cavity resulted from previous surgery for pelvic bone tumor. Both mother and her offspring (without SARS-CoV-2 infection) were discharged uneventfully.ConclusionOur report adds the growing body of experience toward management of pregnant women with SARS-CoV-2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.     

Cerebrospinal fluid analysis of pregnant women at early stages of COVID-19

ObjectiveTo determine the presence or absence of SARS-CoV-2 in the cerebrospinal fluid of pregnant women at early stages of COVID-19.Materials and methodsWe conducted a prospective observational study with pregnant women undergoing cesarean section and real-time polymerase chain reaction to SARS-CoV-2 was performed in the cerebrospinal fluid in the early stages of COVID-19.ResultsFourteen pregnant women, whose COVID-19 symptoms started between four to 18 days prior to delivery, were included. Eleven of the women reported anosmia, dysgeusia, and headaches and there were two fatal cases. SARS-Cov-2 was not present in the cerebrospinal fluid of these COVID-19 patients with early neurological symptoms, even in severe cases.ConclusionOur study suggests that peripheric cell damage and parainfectious phenomena may predominate over direct central nervous system injury in the pathophysiology of COVID-19 related early neurological symptoms on pregnant women.     

Care of the COVID-19 exposed complex newborn infant

As we confront COVID-19, the global public health emergency of our times, new knowledge is emerging that, combined with information from prior epidemics, can provide insights on how to manage this threat in specific patient populations. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), both caused by coronaviruses, caused serious respiratory illness in pregnant women that resulted in adverse perinatal outcomes. Thus far, COVID-19 appears to follow a mild course in the vast majority of pregnant women. A significant proportion of pregnant women appear to be asymptomatic carriers of SARS-CoV-2. However, there is limited information on how COVID-19 impacts the fetus and whether vertical transmission occurs. While these knowledge gaps are addressed, it is important to recognize the highly efficient transmission characteristics of SARS-C0V-2 and its potential for causing serious disease in vulnerable individuals, including health care workers. This review provides perspectives from a single center in New York City, the epicenter of the pandemic within the United States. It offers an overview of the preparations required for deliveries of newborns of mothers with COVID-19 and the management of neonates with particular emphasis on those born with complex issues.