key: cord-0913858-4yyg1roy authors: Sanchez, J.; Espinosa, J.; Caballero, L. C.; Campana, S.; Quintero, A.; Luo, C.; Ng, J.; de Gracia, R.; Vigil-De Gracia, P. title: NEW CORONAVIRUS IN PREGNANT WOMEN. Maternal and perinatal outcomes. date: 2021-06-06 journal: nan DOI: 10.1101/2021.06.03.21258328 sha: f17b5a3730a68a91ba9640b3778e59e5b531e56e doc_id: 913858 cord_uid: 4yyg1roy Objectives: To report the maternal and neonatal results of patients infected with COVID-19 in Panama. Methods: The study is based on the analysis of pregnant women with COVID-19, in 5 hospitals in the Republic of Panama. The inclusion criteria were: Patients with or without symptoms, positive RT-PCR for SARS-CoV-2 in the period from March 23 to 6 months after, whose births were attended in one of those 5 hospitals and who signed the consent. Data was obtained at the time of diagnosis of the infection and at the time of termination of pregnancy for the mother and newborn. Results: 253 patients met the inclusion criteria. Most were diagnosed in the third trimester (89.3%). 10.3% of the patients presented in a severe form of COVID-19. The most frequent complication was pre-eclampsia and if we add gestational hypertension they represent 21.2%; most of the patients terminated the pregnancy by caesarean section (58%). 26.9% (95% CI 21.3-32.9%) of the births were premature, and perinatal mortality was 5.4% (95% CI 3.0-9.0%). There was a need for mechanical ventilation in 5.9% (95% CI 3.6-9.6%) of the cohort and there were four maternal deaths (1.6% - 95% CI 0.6-4.0%). Conclusions: This study of pregnant women infected with COVID-19 and diagnosed with RT-PCR shows serious maternal complications such as high admission to the ICU, need for mechanical ventilation and one death in every 64 infected. Frequent obstetric complications such as hypertension, premature rupture of membranes, high rate of prematurity and perinatal lethality were also seen. Since the end of 2019 it has been detected in Wuhan-China, a viral infection whose causative agent was a new coronavirus, later identified as SARS-CoV-2; this viral disease led the World Health Organization to declare the COVID-19 pandemic for March 11 1-3. One year after the appearance of this disease, much progress has been made in the knowledge of its epidemiological behavior, virology, genetics, clinical findings, lethality and affectation by age groups and baseline conditions of the population 4 . We have learned during this first year about the associated complications, risk of hospitalization, greater possibility of admission to an intensive care unit, greater possibility of mechanical ventilation and greater possibility of death 5 , in pregnant women with COVID-19. Furthermore, we know that its evolution is less severe than other respiratory diseases caused by coronavirus such as SARS and MERS 6 . High frequencies of cesarean sections, premature births, ruptures of membranes and other complications have been associated with COVID-19 7 . From the neonatal side, prematurity, low weight and pneumonia are the most frequent findings 5-7 , vertical transmission has not been proved with certainty 8 and perinatal transmission is slightly more frequent but its impact on neonatal health is mild 9 . As time passes, more reports are made about the new coronavirus and pregnancy, but few reports are from third world countries and Latin America .It is necessary to know about the evolution and results that the SARS-CoV-2 infection produces around the world and thus have a more accurate knowledge of its global impact. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 6, 2021. ; Our objective is to report the findings and evolution of pregnant women with SARS-CoV-2 in 5 main hospitals in the Republic of Panama during the first 6 months of the epidemic. We conducted a prospective and observational cohort study from the beginning of The sampling, processing, and laboratory techniques in patients with clinical suspicion, contacts, or specific indication were done following the national guidelines given by the ministry of health of Panama, which are those required by the World Health Organization. Maternal data such as age, parity, symptoms, body mass index, comorbidities, gestational age at the onset of symptoms and at the end of pregnancy, severity of the disease, admission to the intensive care unit, need for mechanical ventilation and evolution were recorded. In addition, obstetric complications, cause of pregnancy termination, birth route, birth weight, APGAR at the first and fifth minute, time between the onset of symptoms and the termination of pregnancy were recorded. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 6, 2021. ; The protocol was approved by the national bioethics committee of Panama, protocol reference: EC-CNBI-2020-04-45. The maternal baseline characteristics and the neonatal results are presented in absolute numbers, percentages with 95% CI, means and standard deviation. In view of incomplete data in some cases, absolute numbers were paired with total number of cases in which the information about the characteristic being studied was available. Statistical analysis was performed with Epi Info software version 7 (Centers for Disease Control and Prevention, Atlanta, GA). Table 2 . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 6, 2021. In relation to births, a prematurity of 26.9% (59/221) was found, 12.2% (27/221) presented growth restriction or small for gestational age and perinatal mortality of 5.3% (12/227, includes twins), predominantly intra-uterine death. Antiviral treatment was only offered to 4% of the cohort and of them 75% was postbirth, see Table 2 . There was a need for mechanical ventilation in 5.9% (95% CI 3.6-9.6%) of the group and four of them died (1.6%), table 2. America on SARS-CoV-2 infection. The diagnosis of the infection is made predominantly in the third trimester, one in every 4 pregnant women has obesity as a risk factor, one third are asymptomatic, pre-eclampsia is the most frequent obstetric complication, one in ten presented the severe form of the disease and one in every 64 infected dies. There is a high frequency of prematurity, perinatal mortality is also high, and neonatal infection is rare. Obesity is a known risk factor 10 for becoming infected with SARS-CoV-2 and this finding has also been reported in other studies of pregnant women 11-12 ; we found that obesity is present as a risk factor in 24.9% of pregnant women and the average body mass index in the entire population is in overweight values (28.4 kg / m2). Another very interesting finding in our cohort is the gestational age at the time of making the diagnosis, 89% were more than 27 weeks of gestation; This finding is also reported in previous studies [11] [12] [13] [14] ; a greater possibility of maternal infection in the third trimester is evident. This is a finding that deserves a follow-up study to assess prognosis and complications according to the trimester of infection. So far it . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 6, 2021. ; has not been analyzed in large cohorts, despite the fact that there appears to be a greater susceptibility to infection in the third trimester. Surprisingly, we found that pre-eclampsia with or without severe form and gestational hypertension were diagnosed in one of every 5 patients with COVID-19. This finding represents twice that diagnosed in a population before COVID-19 15,16 , in addition, this finding has not been reported in previous studies with COVID-19 [11] [12] [13] [14] . Definitely, more research is needed on the possible relationship, association or imitation between pre-eclampsia and maternal infection by SARS-CoV-2 17 , theoretically, it is possible to explain the greater presence of pre-eclampsia and gestational hypertension in pregnant women with COVID-19 18 . The severity, need to admit to the intensive care unit, need for mechanical ventilation and lethality is definitely higher in pregnant women with COVID-19 5, 19 . We found that the need to admit to intensive care units was 6.7%, being lower than that reported in the USA 5 , but with a 5.9% possibility of endotracheal intubation which is double that reported in the USA, the lethality is similar to that reported in other latitudes 5, 12, 14 , and possibly lower than in brazil 19 . Births before 37 weeks (prematurity) was found in 26.9% of the studied cohort, largely induced by the severity of the infection, and complications such as hypertension and premature rupture of membranes. Similar findings have been previously reported 12,13,20 , however, it is more than twice the risk of that reported in the UK 11 . The perinatal mortality found in this study (5.3%) is very high compared to the UK, Wuhan and Sweden 11, 21 , and similar to that reported in a multinational study 14 . The factor that contributes the most to mortality in our cohort is prematurity, since 67% . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 6, 2021. ; https://doi.org/10.1101/2021.06.03.21258328 doi: medRxiv preprint (8/12) were less than 28 weeks old at the time of birth. The limitations of this survey is the type of study (simple survey); the study does not involve the entire population; short duration, it was only for a period of 6 months, . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 6, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 6, 2021. ; Obstetrics and clinical outcomes of neonates born from women infected by SARS-CoV-2 *. 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