Severe COVID-19 in a Postpartum Woman: A Three-Month Challenge with Convalescent Plasma and Corticosteroid

Introduction: Management of seriously ill patients infected with new corona virus (SARS-CoV-2) is challenging especially in pregnancy and postpartum state. Case presentation: A 39- year-old primigravid critically ill woman with acute respiratory distress (ARDS) due to confirmed SARS-CoV-2 infection underwent urgent cesarean delivery (a healthy neonate) at 33 weeks and 5/7 of pregnancy. She received treatments including hydroxychloroquine, antivirals and broad-spectrum antibiotics while she was intubated for mechanical ventilation. In spite of all treatments, she developed a critical course after the mild primary clinical improvement. Convalescent plasma transfusion as a rescue treatment was performed and led to an improvement in her general condition and delayed gradual recovery in respiratory function after two months. Conclusion: The promising role of early treatment with convalescent plasma transfusion in seriously ill pregnant women infected with SARS-CoV-2, needs to be elucidated by further randomized studies.&nbsp

A case–control study to predict the risk of gestational diabetes mellitus by initial fasting blood sugar or past gestational history

Background: Gestational diabetes mellitus (GDM) deserves proper prevention, diagnosis, and management due to healthcare implications from both maternal and fetal concerns. Objective: To evaluate the rate and investigate the risk factors for developing GDM. Materials and Methods: In this case-control, universal screening for GDM between 24 and 28 wk of gestation was performed in 613 pregnant women attending a prenatal clinic in Tehran who were followed-up until delivery between March 2017 to March 2018. Of the 613 women, 143 had GDM and 470 had normal glucose tolerance test as the primary diagnosis. Some GDM risk factors were compared in two groups. Results: Impaired glucose tolerance test was detected in 143 (23.3%) patients. Prevalence of GDM was higher in the first-trimester fasting blood sugar (FBS) > 90 qmg/dl group (p < 0.001). Comparison of the GDM and the normal glucose tolerance test groups demonstrated significant differences in maternal age, first-trimester FBS, third-trimester vitamin D level, maternal platelet count, maternal body mass index (BMI) (before 12 wk of gestation), weight gain during pregnancy, and the history of gestational complications in previous pregnancy (p < 0.01). In logistic regression, GDM was independently associated with older maternal age, higher first-trimester FBS, the history of gestational complications in previous pregnancy, lower third-trimester vitamin D level, and higher maternal platelet count (p < 0.01). Conclusion: Both patients with higher initial FBS and the history of gestational complications in previous pregnancy should be considered high risk for GDM and screened earlier. Key words: Diabetes Mellitus, Gestational, Blood glucose, Risk factor

Assessing the risk factors and management outcomes of ectopic pregnancy: A retrospective case-control study

Background: Ectopic pregnancy (EP) is the implantation of a fertilized egg outside the uterine cavity or in an unusual location. According to the clinical case reports, hormonal contraceptive failures may be related to emergency contraceptives and EP. EP may be treated medically, surgically, or expectantly. Currently, there is no consensus regarding whether a multiple- or double-dose regimen with methotrexate (MTX) or an additional dose could be more effective than a single-dose regimen. Objective: This study aimed to assess risk factors and treatment outcomes for EP. Materials and Methods: This case-control study was conducted in Tehran, Iran from March 2020 to March 2021. The case group was comprised of all EP-diagnosed cases (n = 191). Based on the levels of β-human chorionic gonadotropin, MTX was administered to stable individuals with no surgical indications. Risk factors were assessed through 2 control groups: intrauterine pregnancy (n = 190) and nonpregnant groups (n = 180). Results: The medical treatment significantly improved with an extra dose of MTX, especially in individuals with higher β-human chorionic gonadotropin concentrations and gestational age > 7.5 wk (p = 0.002). Considering risk factors, it is assumed that hormonal contraceptive failures, including both oral and emergency contraceptives, may increase the EP likelihood (p < 0.001). Conclusion: Based on our findings, we recommended an additional dose of MTX for subjects who are further along in their pregnancy. It is also concluded that failure of contraceptive pills increases the chances of EP. Key words: Contraception, Ectopic pregnancy, Intrauterine device, Levonorgestrel

When Is Non-Invasive Prenatal Testing Reliable in Pregnancies with a Vanishing Twin? - A Systematic Review of Case Reports

Background: Fetal demise can complicate aneuploidy screening in a multi fetal pregnancy. The cell-free DNA (CF-DNA) from a non-viable conception may be discordant with the viable fetuses. The Aim of study was to review the waiting period, follow-on single fetal demise in a twin gestation before performing NIPT (Non-Invasive Prenatal Testing).Methods: In this review article we searched through online databases of CINAHL, Cochrane, Database of Abstracts of Reviews of Effects (DARE), PubMed, Medical Library, and Google Scholar for English literature between 2011 to 2020, with the following keywords: “NIPT”, “non-invasive prenatal screening testing”, “cell-free DNA”, “vanishing twin” and “co-twin demise”. We included the studies regarding the duration between the twin vanishing or reduction and NIPT false results.Results: 201 studies across the eight scientific websites were detected; 178 of which were excluded for duplication or being irrelevant. And 29 studies were fully read. 4 case series, finally, met the criteria for systematic review. The findings suggested that the NIPT screening test can be falsely-positive several weeks after vanishing twins although the live fetus is normal. Therefore, the time duration in which the placenta can release CF-DNA of the vanished twin is unknown. In addition, several weeks after reduction, the fetal CF-DNA increases and then decreases, thus CF-DNA analyzing in multifetal pregnancies with reduction can be challenging as well.Conclusion: In pregnancies with vanishing twin or reduction, evaluating NIPT results is more complex than single fetal pregnancy. According to the reviewed studies, after a fetal demise, the cytotrophoblast continues to release to the CF-DNA in the maternal circulation for a variable time, which may cause a false-positive result if the demised twin is aneuploidy

Vitamin D Binding Protein as screening biomarker candidate for late-onset preeclampsia without intrauterine growth restriction during 16 week of gestation.

The aim of this investigation was conducted to proteomic analysis of plasma obtained from pregnant women who destined to develop late-onset preeclampsia without intrauterine growth restriction (IUGR) during 16th week of gestation. Plasma was obtained from primiparous women during 16th week of gestation. 2-DE proteomic analysis was done for plasma from 11 healthy pregnant women and 11 women who developed preeclampsia later. Using bioinformatic analysis with Progenesis SameSpots ver4.0 software and ANOVA test, expression of 2 spots were statistically different between two groups. In preeclamptic state, expression of both were decreased, one of these spots was vitamin D binding protein (p-value: 0.047), the other one will be discussed in another paper. According to results, we concluded that during 16th week of gestation, occurance of late-onset preeclampsia without IUGR is predictable. During this week, pathology of disease is present and may be the process of placental degeneration and impaired placentation are include in disease pathology.

'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5)

Abstract Background Our purpose was to determine whether AFI Methods We performed a prospective cohort study of 95 singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 26 and 34 weeks gestation. Patients were categorized in two groups on the basis of amniotic fluid index2 and Fisher exact tests. Continuous data were evaluated for normal distribution and tested for significance with the student t test. All 2-sided p values Results Both groups were similar with respect to selected demographics, gestational age at rupture of the membranes, gestational age at the delivery, birth weight. Both groups were similar with respect to selected variable, latency until delivery, early onset neonatal sepsis, RDS and neonatal death. Patients with AFI Conclusions An AFI<5 cm after PPROM between 26 and 34 weeks gestation is associated with an increased risk of maternal infections and frequency of C/S.</p

Effect of progesterone as maintenance tocolytic therapy on the prevention of recurrent preterm labor: a randomized clinical trial

Objective: The study evaluated the efficacy and safety of vaginal rogesterone on prevention of recurrent preterm labor. Materials and methods: Total number of 70 patients with preterm labor treated with intravenous magnesium sulfate in perinatology department of valiasr hospital entered to a randomized clinical trial. Treatment group after inhibition of preterm labor with magnesium sulfate received progesterone suppository (400 mg) daily until delivery and control group received no treatment. Latency until delivery, recurrence of preterm labor and neonatal outcomes were studied. Statistical significance was defined as p< 0.05. Results: Mean latency until delivery (p< 0.05), low birth weight (p< 0.05), birth weight (p< 0.01) were significantly different between the two groups. Recurrence of preterm labor was not significantly different between the groups. Conclusions: The use of vaginal progesterone suppository after successful parenteral tocolysis associated with a longer latency preceding delivery but failed to reduce the incidence of recurrent preterm labor