Experience in managing severe and extremely severe COVID-19 in pregnant women
- 作者: Gareyeva A.I.1, Mozgovaya E.V.2,3, Belopolskaya M.A.1,4, Kovalchuk A.S.1, Kucheryavenko A.N.1
-
隶属关系:
- S.P. Botkin Clinical Infectious Diseases Hospital
- The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott
- Saint Petersburg State University
- Institute of Experimental Medicine
- 期: 卷 71, 编号 1 (2022)
- 页面: 11-22
- 栏目: Original study articles
- URL: https://ogarev-online.ru/jowd/article/view/72169
- DOI: https://doi.org/10.17816/JOWD72169
- ID: 72169
如何引用文章
详细
论证。在由SARS-CoV-2病毒引起的COVID-19大流行的背景下,病毒性肺炎是冠状病毒感染的主要临床形式,也是孕产妇死亡的一个重要原因。
本研究的目的是评估COVID-19严重与极端严重形式的病程性质、其对怀孕和胎儿的影响以及孕产妇死亡率。
材料与方法。对39例重度与极重度COVID-19患者的病历进行了回顾性评估。患者被分为两组。第一组包括22名冠状病毒感染过程严重且结果良好的孕妇;第二组包括17名孕妇,其中SARS-CoV-2引起的并发症导致了致命的结果。
结果。严重病程患者80%以上为孕妇贫血。最重要的临床和内科不良结果因素是妊娠期糖尿病(p=0.02)、先兆子痫(р=0.05)和缺水(р=0.01)。在死亡的患者中,被诊断为肥胖的人数比其他患者高两倍。两组患者临床表现均以发热、气短、乏力、干咳为主。在实验室检测中,在疾病最严重时死亡的患者白细胞增多,尿素和乳酸脱氢酶水平高于恢复的患者(p=0.05)。两组患者丙氨酸转氨酶和天门冬氨酸转氨酶活性均升高。死亡患者的平均转氨酶值比康复后孕妇高两倍。随着呼吸衰竭增加,两组患者均需要氧支持。绝大多数重症与极端重症患者在妊娠晚期暴露于冠状病毒感染。
结论。在晚期妊娠,COVID-19的严重与极端严重的病程更容易引起不良后果。妊娠期糖尿病、子痫前期和缺水是COVID-19孕妇易发生严重病程和预后不良的主要伴随疾病。冠状病毒感染的严重过程伴随着呼吸急促和发烧,并有明显的肺组织损伤。肝酶活性的显著增加和胎盘功能不全的增加可作为多器官功能衰竭的一种表现,提示预后不良。
作者简介
Aygul I. Gareyeva
S.P. Botkin Clinical Infectious Diseases Hospital
Email: aygul.gareeva.90@mail.ru
ORCID iD: 0000-0001-7403-4594
MD
俄罗斯联邦, Saint PetersburgElena V. Mozgovaya
The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; Saint Petersburg State University
Email: elmozg@mail.ru
ORCID iD: 0000-0002-6460-6816
SPIN 代码: 5622-5674
MD, Dr. Sci. (Med.)
俄罗斯联邦, 3, Mendeleevskaya Line, Saint Petersburg, 199034; Saint PetersburgMaria A. Belopolskaya
S.P. Botkin Clinical Infectious Diseases Hospital; Institute of Experimental Medicine
Email: belopolskaya.maria@yahoo.com
ORCID iD: 0000-0002-5107-8831
MD, Cand. Sci. (Med.)
俄罗斯联邦, Saint Petersburg; Saint PetersburgAlexey S. Kovalchuk
S.P. Botkin Clinical Infectious Diseases Hospital
Email: babai_jo@bk.ru
ORCID iD: 0000-0001-8206-6561
MD
俄罗斯联邦, Saint PetersburgAlexandr N. Kucheryavenko
S.P. Botkin Clinical Infectious Diseases Hospital
编辑信件的主要联系方式.
Email: botkin.zamakush@zdrav.spb.ru
MD
俄罗斯联邦, Saint Petersburg参考
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497−506. doi: 10.1016/S0140-6736(20)30183-5
- World Health Organization [Internet]. Coronavirus disease (COVID-19) Weekly epidemiological update and weekly operational update. [cited 11 Dec 2021]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
- Moore KM, Suthar MS. Comprehensive analysis of COVID-19 during pregnancy. Biochem Biophys Res Commun. 2021;538:180−186. doi: 10.1016/j.bbrc.2020.12.064
- 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. doi: 10.1016/j.ajog.2020.03.021
- Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with Coronavirus disease (COVID-19) pneumonia: A preliminary analysis. AJR Am J Roentgenol. 2020;215(1):127−132. Corrected and republished from: AJR Am J Roentgenol. 2020;215(1):262. doi: 10.2214/AJR.20.23072
- 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):194. doi: 10.3390/v12020194
- Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809−815. doi: 10.1016/S0140-6736(20)30360-3
- Iqbal SN, Overcash R, Mokhtari N, et al. An uncomplicated delivery in a patient with Covid-19 in the United States. N Engl J Med. 2020;382(16):e34. doi: 10.1056/NEJMc2007605
- Breslin N, Baptiste C, Miller R, et al. Coronavirus disease 2019 in pregnancy: early lessons. Am J Obstet Gynecol MFM. 2020;2(2):100111. doi: 10.1016/j.ajogmf.2020.100111
- LiuW, Wang Q, Zhang Q, et al. Coronavirus disease 2019 (COVID-19) during pregnancy: A case series. Preprints. 2020:2020020373. [cited 5 Dec 2021]. Available from: https://www.preprints.org/manuscript/202002.0373/v1
- Belokrinitskaya TE, Artymuk NV, Filippov OS, Frolova NI. Clinical course, maternal and neonatal outcomes of COVID-19 infection in pregnancy: an epidemiological study in Siberia and the Far East. Gynecology. 2021;23(1):43−47. (In Russ.). doi: 10.26442/20795696.2021.1.200639
- Kanash ZhA, Aubakir AK, Rahmanova UD, et al. Materinskaja smertnost’ sredi pacientov s COVID-19. Rozvitokosvіti, nauki ta bіznesu: rezul’tati 2020: tezi dop. mіzhnarodnoї naukovo-praktichnoїіnternet-konferencії, 3-4 grudnja 2020. Dnіpro. 2020;1:464. (In Russ.). [cited 11 Dec 21]. Available from: http://dspace.puet.edu.ua/bitstream/123456789/10007/1/(Part%201)%20Conference%20Results%202020.pdf#page=464
- Jafari M, Pormohammad A, Sheikh Neshin SA, et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Rev Med Virol. 2021;31(5):1−16. doi: 10.1002/rmv.2208
- Karimi L, Makvandi S, Vahedian-Azimi A, et al. Effect of COVID-19 on mortality of pregnant and postpartum women: A systematic review and meta-analysis. J Pregnancy. 2021;2021:8870129. doi: 10.1155/2021/8870129
- Ilchenko LYu, Nikitin IG, Fedorov IG. COVID-19 and liver damage. The Russian Archives of Internal Medicine. 2020;10(3):188−197. (In Russ.). doi: 10.20514/2226-6704-2020-10-3-188-197
- Belokrinitskaya TE, Frolova NI, Kolmakova KA, Shametova EA. Risk factors and features of COVID-19 course in pregnant women: a comparative analysis of epidemic outbreaks in 2020 and 2021. Gynecology. 2021;23(5):421−427. (In Russ.). doi: 10.26442/20795696.2021.5.201107
- Pierce-Williams RAM, Burd J, Felder L, et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM. 2020;2(3):100134. doi: 10.1016/j.ajogmf.2020.100134
- Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China. N Engl J Med. 2020;382:1708−1720. doi: 10.1056/NEJMoa2002032
- Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417−1418. doi: 10.1016/S0140-6736(20)30937-5
- Voevodin SM, Shemanaeva TV, Serova AV. Modern aspects of diagnosis and pathogenesis of oligohydramnios. Gynecology. 2017;19( 3):77−80.
- Xu L, Liu J, Lu M, et al. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998−1004. doi: 10.1111/liv.14435
- Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5(5):428−430. doi: 10.1016/S2468-1253(20)30057-1
- Xie H, Zhao J, Lian N, et al. Clinical characteristics of non-ICU hospitalized patients with coronavirus disease 2019 and liver injury: A retrospective study. Liver Int. 2020;40(6):1321−1326. doi: 10.1111/liv.14449
- Knight M, Bunch K, Vousden N, 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. doi: 10.1136/bmj.m2107
- Breslin N, Baptiste C, Gyamfi-Bannerman C, 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. doi: 10.1016/j.ajogmf.2020.100118
- Torosyan AO, Loginova EV, Gagaev ChG. Screening for gestational diabetes due to of the COVID-19 pandemic. Problemi Endocrinologii. 2020;66(3):56–61. (In Russ.). doi: 10.14341/probl12482
