Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children

13 avril 2020

Source : Acta Obstet Gynecol Scand

Auteur : Zaigham M et Andersson O


ANALYSE

Commentateur : Dr Philippe DERUELLE

Objectif :

  • Résumer les manifestations cliniques et les résultats maternels et périnataux de COVID ‐ 19 pendant la grossesse rapportées dans la littérature

Principaux résultats :

  • La plupart des études rapportent des femmes se présentant au troisième trimestre avec de la fièvre (68%) et de la toux (34%). Une lymphocytopénie (59%) avec une protéine C réactive élevée (70%) a été observée et 91% ont été accouchées par césarienne. Trois admissions en unité de soins intensifs maternels ont été notées mais aucun décès maternel. Un décès néonatal et un décès intra-utérin ont également été signalés.

Points forts:

  • Synthèse des données actuellement publiées

Points faibles:

  • La majorité des cas sont issus des données chinoises

Conclusion :

  • les femmes enceintes présentent des caractéristiques de la maladie similaires à la population. Des cas de morbidité maternelle sévère ayant nécessité un transfert en USI ont été rapportés ainsi que des complications à type de mort in utéro et de décès néonatal. Les données actuelles ne permettent pas de conclure quant au risque de transmission verticale.

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ABSTRACT

Introduction:

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to an unprecedented global health crisis. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The objective of this study was to summarize the clinical manifestations and maternal and perinatal outcomes of COVID-19 during pregnancy.

Material and methods:

We searched databases for all case reports and series from February 12 to April 4, 2020. Multiple terms and combinations were used including COVID-19, pregnancy, maternal mortality, maternal morbidity, complications, clinical manifestations, neonatal morbidity, intrauterine fetal death, neonatal mortality and SARS-CoV-2. Eligibility criteria included peer-reviewed publications written in English or Chinese and quantitative realtime polymerase chain reaction (PCR) or dual fluorescence PCR confirmed SARS-CoV-2 infection. Unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, cases with suspected COVID-19 that were not confirmed by a laboratory test, and unreported maternal or perinatal outcomes were excluded. Data on clinical manifestations, maternal and perinatal outcomes including vertical transmission were extracted and analyzed.

Results:

Eighteen articles reporting data from 108 pregnancies between December 8, 2019 and April 1, 2020 were included in the current study. Most reports described women presenting in the third trimester with fever (68%) and coughing (34%). Lymphocytopenia (59%) with elevated Creactive protein (70%) was observed and 91% were delivered by cesarean section. Three maternal intensive care unit admissions were noted but no maternal deaths. One neonatal death and one intrauterine death were also reported.

Conclusions:

Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 and perinatal deaths were reported. Vertical transmission of the COVID-19 could not be ruled out. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.


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