key: cord-0683852-tcs36kp9 authors: Berghella, Vincenzo title: Attack on coronavirus disease 2019 from American Journal of Obstetrics & Gynecology MFM date: 2020-04-21 journal: Am J Obstet Gynecol MFM DOI: 10.1016/j.ajogmf.2020.100119 sha: e3710bcef1d41e966de8332ddc10d1cc825c2e2b doc_id: 683852 cord_uid: tcs36kp9 nan cology MFM (AJOG MFM), the "pink" Journal, has 8 of the first scientific manuscripts 1e8 in the world describing coronavirus disease 2019 (COVID-19) during pregnancy. My mother, sister and her family members, brother (also an obstetrician-gynecologist) and his wife, as well as some of my best friends live in Italy. I understood from them and Italian news, loud and clear, how bad COVID-19 was for humans, and for pregnant women, early on. Hence, AJOG MFM went early into attack. Like New York Governor Cuomo said, what most people have done is being reactive or defensive to the COVID-19 pandemic. COVID-19 should instead be attacked aggressively first and foremost by prevention and, if prevention fails, by proper care, including in pregnant women. AJOG MFM wants to thank the authors of these 8 manuscripts and those of the manuscripts in progress. These early manuscripts provided the first data and guidance for obstetrical providers during the COVID-19 pandemic. I want to thank the AJOG MFM Editorial Board, who provided most of the peer reviews that improved the manuscripts. I also want to thank Elsevier, in particular Andrea Bocelli, Donna Stroud, and Brian Arnold, without whom these manuscripts would not have been promptly processed, and the information would have been too old to help us all early in this quest to save lives. These early manuscripts highlight the importance of proper personal protective equipment (PPE) for everyone, both healthcare workers (HCWs) and patients, both in outpatient and inpatient settings, and of testing asymptomatic pregnant women presenting for care. 1e3 They offer guidance on how to decrease patient-HCW interactions and still provide essential obstetrical and maternal-fetal medicine care both in outpatient 4 and inpatient settings, including labor and delivery (L&D). 5 They report the first meta-analysis of coronavirus pregnancy cases including COVID-19 cases from China. 6 We thank our New York-area colleagues for sharing some of their early experience that warned us about the possibility of critical COVID-19 infection developing quickly in asymptomatic women presenting to L&D. 2 In the largest-still small-series (n¼43) published so far of pregnant women in the United States who received a diagnosis of COVID-19, 37 (86%) had mild, 4 (9.3%) severe, and 2 (4.7%) critical disease 3 ; these percentages are similar to those described for nonpregnant adults with COVID-19 (about 80% mild, 15% severe, and 5% critical disease), based on the COVID-19 disease severity characteristics described by Wu and McGoogan. 9 Although this is reassuring, obstetrical providers should be cognizant of possible quick progression from asymptomatic admission to transfer to the intensive care unit for respiratory failure and mechanical ventilation, 2 as well as cardiomyopathy, in pregnant women with COVID-19. 7 The possibility of needing extracorporeal membranous oxygenation (ECMO) has been discussed in the care of pregnant women with COVID-19: we thank the authors of the meta-analysis of ECMO use in pregnancy, a timely subject. 8 UpToDate has published their free guidance on COVID-19 in pregnancy. Dr Manuck, AJOG MFM associate editor, helped develop a dedicated website, , with invaluable information for both providers and pregnant women. A US registry has started (), which will soon provide information about the management and outcomes on hundreds of pregnant women in the United States with COVID-19. There is no need to panic. I feel this is what we'll talk about with our grandchildren, like my grandfather and father (I miss him!) talked to me about the World War-II and the Americans coming to save Italy. Help is co Q3 ming this time too, guidance will continue to evolve, and AJOG MFM is glad to be in a position to offer some of this precious assistance. There's a large group of obgyn moms (in a Facebook group of 1500ish) talking about you and how much they appreciate your guidance. They wanted you to know this ... tell him we know he's trying to save lives. We hear him. We are scared. All leadership he can offer is welcome. 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 Now! Protection for obstetrical providers and patients Labor and delivery guidance for COVID-19 Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis Two cases of COVID-19 related cardiomyopathy in pregnancy Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention