Investigation and Care of a Small‐for‐Gestational‐Age Fetus and a Growth Restricted Fetus (Green‐top Guideline No. 31) DOI
R. Katie Morris, Edward Johnstone,

C. Lees

et al.

BJOG An International Journal of Obstetrics & Gynaecology, Journal Year: 2024, Volume and Issue: 131(9)

Published: May 13, 2024

Key recommendations All women should be assessed at booking (by 14 weeks) for risk factors fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings the midtrimester anomaly scan incorporated into assessment and updated throughout pregnancy. GPP] Reduce smoking in pregnancy by identifying smoke with assistance of carbon monoxide (CO) testing ensuring in‐house treatment from a trained tobacco dependence advisor is offered all pregnant smoke, opt‐out referral process. Women pre‐eclampsia and/or placental dysfunction take aspirin 150 mg once daily night 12 +0 –36 weeks reduce their chance small‐for‐gestational‐age (SGA) FGR. A] Uterine artery Dopplers carried out between 18 23 +6 high disorders B]. In woman normal uterine Doppler biometry scan, serial ultrasound scans can commence 32 weeks. abnormal (mean pulsatility index > 95th centile) 24 –28 based on individual history. B] are low FGR have measurement symphysis fundal height (SFH) each antenatal appointment after (no more frequently than every 2 weeks). The first 28 C] moderate category late onset so commencing For majority women, interval four until birth appropriate. Maternity providers ensure that they clearly reference charts plot SFH, estimated weight (EFW) measurements calculate centiles. method used same as development chart EFW Hadlock three parameter model used. guidance promotes use standard planes acquisition calliper placement when performing scanning assessment. Quality control images undertaken. Ultrasound fetuses identified SGA C]. Umbilical primary tool point diagnosis during follow‐up minimum 3rd 10th centile, other features must present recommended prior 39 weeks, either maternal (maternal medical conditions or concerns regarding movements) compromise (a assessment, velocity concern cardiotocography [CTG]) abdominal circumference less centile where has been excluded, initiation induction labour considered discussion her partner/family/support network. Birth occur Pregnancies early (prior monitored managed input tertiary level units highest neonatal care. Care multidisciplinary neonatology obstetricians medicine expertise, particularly extremely preterm (before Fetal repeated Assessment wellbeing include multiple modalities but computerised CTG ductus venous. pregnancies FGR, initiated 37 completed A]. Decisions assessments indication.

Language: Английский

An update on COVID-19 and pregnancy DOI Open Access
Denise J. Jamieson, Sonja A. Rasmussen

American Journal of Obstetrics and Gynecology, Journal Year: 2021, Volume and Issue: 226(2), P. 177 - 186

Published: Sept. 14, 2021

Language: Английский

Citations

421
Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study DOI Creative Commons
Aris T. Papageorghiou, Philippe Deruelle, Robert B. Gunier

et al.

American Journal of Obstetrics and Gynecology, Journal Year: 2021, Volume and Issue: 225(3), P. 289.e1 - 289.e17

Published: June 26, 2021

Language: Английский

Citations

275
Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study DOI Creative Commons
Ipek Gurol‐Urganci, Jennifer Jardine, Fran Carroll

et al.

American Journal of Obstetrics and Gynecology, Journal Year: 2021, Volume and Issue: 225(5), P. 522.e1 - 522.e11

Published: May 20, 2021

Language: Английский

Citations

264
SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland DOI Creative Commons
Sarah J. Stock, Jade Carruthers, Clara Calvert

et al.

Nature Medicine, Journal Year: 2022, Volume and Issue: 28(3), P. 504 - 512

Published: Jan. 13, 2022

Abstract Population-level data on COVID-19 vaccine uptake in pregnancy and SARS-CoV-2 infection outcomes are lacking. We describe pregnant women Scotland, using whole-population from a national, prospective cohort. Between the start of program 8 December 2020 31 October 2021, 25,917 vaccinations were given to 18,457 women. Vaccine coverage was substantially lower than general female population 18−44 years; 32.3% giving birth 2021 had two doses compared 77.4% all The extended perinatal mortality rate for who gave within 28 d diagnosis 22.6 per 1,000 births (95% CI 12.9−38.5; pandemic background 5.6 births; 452 out 80,456; 95% 5.1−6.2). Overall, (3,833 4,950; 76.2−78.6) infections, 90.9% (748 823; 88.7−92.7) associated with hospital admission 98% (102 104; 92.5−99.7) critical care admission, as well baby deaths, occurred unvaccinated at time diagnosis. Addressing low rates is imperative protect health babies ongoing pandemic.

Language: Английский

Citations

262
Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy DOI Creative Commons
Smriti Prasad, Erkan Kalafat, Helena Blakeway

et al.

Nature Communications, Journal Year: 2022, Volume and Issue: 13(1)

Published: May 10, 2022

Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 I

Language: Английский

Citations

237
Accelerated COVID-19 vaccine development: milestones, lessons, and prospects DOI Creative Commons

Karin Bok,

Sandra Sitar,

Barney S. Graham

et al.

Immunity, Journal Year: 2021, Volume and Issue: 54(8), P. 1636 - 1651

Published: Aug. 1, 2021

The development of effective vaccines to combat infectious diseases is a complex multi-year and multi-stakeholder process. To accelerate the for coronavirus disease 2019 (COVID-19), novel pathogen emerging in late spreading globally by early 2020, United States government (USG) mounted an operation bridging public private sector expertise infrastructure. success endeavor can be seen rapid advanced multiple vaccine candidates, with several demonstrating efficacy now being administered around globe. Here, we review milestones enabling USG-led effort, methods utilized, ensuing outcomes. We discuss current status COVID-19 provide perspective how partnership preparedness better utilized response future public-health pandemic emergencies.

Language: Английский

Citations

234
Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications DOI Open Access
Torri D. Metz,

Rebecca G. Clifton,

Brenna L. Hughes

et al.

JAMA, Journal Year: 2022, Volume and Issue: 327(8), P. 748 - 748

Published: Feb. 7, 2022

It remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity. To evaluate association with maternal morbidity or mortality from common complications. Retrospective cohort study 14 104 pregnant and postpartum patients delivered between March 1, 2020, December 31, 2020 (with final follow-up to February 11, 2021), at 17 US hospitals participating in Eunice Kennedy Shriver National Institute Child Health Human Development's Gestational Research Assessments COVID-19 (GRAVID) Study. All were included compared those without a positive test result who on randomly selected dates over same period. was based nucleic acid antigen result. Secondary analyses further stratified by disease severity. The primary outcome composite death related hypertensive disorders pregnancy, hemorrhage, other than SARS-CoV-2. main secondary cesarean birth. Of (mean age, 29.7 years), 2352 had 11 752 did not have Compared result, significantly associated (13.4% vs 9.2%; difference, 4.2% [95% CI, 2.8%-5.6%]; adjusted relative [aRR], 1.41 1.23-1.61]). 5 deaths group. birth (34.7% 32.4%; aRR, 1.05 0.99-1.11]). moderate higher severity (n = 586) (26.1% 16.9% 13.3%-20.4%]; 2.06 1.73-2.46]) major (45.4% 12.8% 8.7%-16.8%]; 1.17 1.07-1.28]), but mild asymptomatic 1766) (9.2% 0% -1.4% 1.4%]; 1.11 0.94-1.32]) (31.2% -3.6% 0.8%]; 1.00 0.93-1.07]). Among individuals hospitals, an increased for

Language: Английский

Citations

233
Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy DOI Open Access
Regan N. Theiler, Myra J. Wick,

Ramila A. Mehta

et al.

American Journal of Obstetrics & Gynecology MFM, Journal Year: 2021, Volume and Issue: 3(6), P. 100467 - 100467

Published: Aug. 20, 2021

Language: Английский

Citations

170
Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes DOI Open Access
Elisabeth McClymont, Arianne Albert,

Gillian D. Alton

et al.

JAMA, Journal Year: 2022, Volume and Issue: 327(20), P. 1983 - 1983

Published: May 2, 2022

There are limited high-quality, population-level data about the effect of SARS-CoV-2 infection on pregnancy using contemporaneous comparator cohorts.To describe maternal and perinatal outcomes associated with in to assess variables severe disease pregnant population.CANCOVID-Preg is an observational surveillance program for SARS-CoV-2-affected pregnancies Canada. This analysis presents exploratory, from 6 Canadian provinces period March 1, 2020, October 31, 2021. A total 6012 persons a positive polymerase chain reaction test result at any time (primarily due symptomatic presentation) were included compared 2 groups including age-matched female individuals unaffected pandemic period.SARS-CoV-2 during pregnancy. Incident infections reported CANCOVID-Preg by participating provinces/territories.Maternal as well risk factors (ie, requiring hospitalization, admission intensive care unit/critical unit, and/or oxygen therapy).Among Canada (median age, 31 [IQR, 28-35] years), greatest proportion cases diagnosed 28 37 weeks' gestation (35.7%). Non-White disproportionately represented. Being was significantly increased SARS-CoV-2-related hospitalization among all women aged 20 49 years general population (7.75% vs 2.93%; relative risk, 2.65 [95% CI, 2.41-2.88]) unit (2.01% 0.37%; 5.46 4.50-6.53]). Increasing preexisting hypertension, greater gestational age diagnosis worse outcomes. The preterm birth elevated (11.05% 6.76%; 1.63 1.52-1.76]), even milder not same period.In this exploratory study conducted 2020 2021, adverse birth.

Language: Английский

Citations

144
Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes DOI Open Access
Deshayne B. Fell,

Tavleen Dhinsa,

Gillian D. Alton

et al.

JAMA, Journal Year: 2022, Volume and Issue: 327(15), P. 1478 - 1478

Published: March 24, 2022

There is limited comparative epidemiological evidence on outcomes associated with COVID-19 vaccination during pregnancy; monitoring pregnancy in large populations required.To evaluate peripartum following pregnancy.Population-based retrospective cohort study Ontario, Canada, using a birth registry linked the provincial immunization database. All births between December 14, 2020, and September 30, 2021, were included.COVID-19 pregnancy, after no vaccination.Postpartum hemorrhage, chorioamnionitis, cesarean delivery (overall emergency delivery), admission to neonatal intensive care unit (NICU), low newborn 5-minute Apgar score (<7). Linear robust Poisson regression was used generate adjusted risk differences (aRDs) ratios (aRRs), respectively, comparing cumulative incidence of those who received vaccinated record at any point. Inverse probability treatment weights adjust for confounding.Among 97 590 individuals (mean [SD] age, 31.9 [4.9] years), 22 660 (23%) least 1 dose vaccine (63.6% third trimester; 99.8% an mRNA vaccine). Comparing vs (n = 44 815), there significantly increased risks postpartum hemorrhage (incidence: 3.0% 3.0%; aRD, -0.28 per 100 [95% CI, -0.59 0.03]; aRR, 0.91 0.82-1.02]), chorioamnionitis (0.5% 0.5%; -0.04 -0.17 0.09]; 0.92 0.70-1.21]), (30.8% 32.2%; -2.73 -3.59 -1.88]; 0.89-0.95]), NICU (11.0% 13.3%; -1.89 newborns -2.49 -1.30]; 0.85 0.80-0.90]), or (1.8% 2.0%; -0.31 -0.56 -0.06]; 0.84 0.73-0.97]). Findings qualitatively similar when compared did not receive point 30 115).In this population-based vaccination, adverse outcomes. Study interpretation should consider that vaccinations primarily vaccines administered second trimester.

Language: Английский

Citations

137