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      ISIDOG Recommendations Concerning COVID-19 and Pregnancy

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          Abstract

          Providing guidelines to health care workers during a period of rapidly evolving viral pandemic infections is not an easy task, but it is extremely necessary in order to coordinate appropriate action so that all patients will get the best possible care given the circumstances they are in. With these International Society of Infectious Disease in Obstetrics and Gynecology (ISIDOG) guidelines we aim to provide detailed information on how to diagnose and manage pregnant women living in a pandemic of COVID-19. Pregnant women need to be considered as a high-risk population for COVID-19 infection, and if suspected or proven to be infected with the virus, they require special care in order to improve their survival rate and the well-being of their babies. Both protection of healthcare workers in such specific care situations and maximal protection of mother and child are envisioned.

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

            Fei Zhou, Ting Yu, Ronghui Du … (2020)
            Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
              In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
              Article 0 comments Cited 10817 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diagnostics (Basel)
                Journal ID (iso-abbrev): Diagnostics (Basel)
                Journal ID (publisher-id): diagnostics
                Title: Diagnostics
                Publisher: MDPI
                ISSN (Electronic): 2075-4418
                Publication date (Electronic): 22 April 2020
                Publication date Collection: April 2020
                Volume: 10
                Issue: 4
                Electronic Location Identifier: 243
                Affiliations
                [1 ]Femicare VZW Clinical Research for Women, 3300 Tienen, Belgium; francesca.donders@ 123456gmail.com
                [2 ]Department Gynecology, Hospital St Olav, 7010 Trondheim, Norway; Risa.Lonnee-Hoffmann@ 123456stolav.no
                [3 ]Department Ob/Gyn, LETO Obstetrician Gynecological & Surgical Center, 11525 Athens, Greece; atsiakalos@ 123456gmail.com
                [4 ]German Center for Infections in Gynecology and Obstetrics, 42283 Wuppertal, Germany; w.mendling@ 123456t-online.de
                [5 ]Department OB/Gyn, University Interior Beira, 6200 Covilha, Portugal; jmo@ 123456fcsaude.ui.pt
                [6 ]Department OB/Gyn, CHU De Nancy—Université de Lorraine, 54000 Nancy, France; pjudlin@ 123456gmail.com
                [7 ]Department OB/Gyn, Tianjin Medical University General Hospital, Tianjin 30000, China; dongmengting@ 123456gmail.com
                [8 ]Department Ob/Gyn, University Hospital Antwerp, 2650 Ekeren, Belgium
                Author notes
                [†]

                President International Society Infectious Diseases (ISIDOG).

                [‡]

                A complete list of the ISIDOG COVID-19 Guideline Workgroup is provided in Appendix A.

                Author information
                https://orcid.org/0000-0003-0376-0067
                https://orcid.org/0000-0002-7851-5376
                Article
                Publisher ID: diagnostics-10-00243
                DOI: 10.3390/diagnostics10040243
                PMC ID: 7235990
                PubMed ID: 32338645
                SO-VID: a0e2297b-8674-494e-838d-2b1fcc55bdce
                Copyright © © 2020 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 02 April 2020
                Date accepted : 18 April 2020
                Categories
                Subject: Guidelines

                Keywords: coronavirus,covid-19,maternal complications,pandemic,obstetric complications,pregnancy outcome,review
                Data availability:
                Keywords: coronavirus, covid-19, maternal complications, pandemic, obstetric complications, pregnancy outcome, review

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