Special Issues

Special Issue Title: CoVID-19 in OB/GYN

· Deadline for manuscript submissions: 31 May 2021

Special Issue Editor

Guest Editor

Prof. Romolo Di Iorio

Department of Medico-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy

Website | E-Mail1 | E-Mail2

Interests: CoVID-19; SARS-CoV-2; pregnancy; gynaecologic oncology; human reproduction; fertility and sterility

Prof. Paola Bianchi

Department of Medico-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy

Website | E-Mail

Interests: CoVID-19; SARS-CoV-2; pregnancy; gynaecologic oncology; human reproduction; fertility and sterility

Special Issue Information

Dear Colleagues,

Between the end of 2019 and the beginning of 2020, a novel coronavirus, named SARS-CoV-2 (Severe Acute Respiratory Syndrome - Coronavirus 2) was identified and correlated to the new emerging viral pneumonia, consequently named CoVID-19 (Coronavirus Disease 2019).

A worldwide public health response has ensued to address the impact of the CoVID-19 pandemic. Unfortunately, the almost exclusive emphasis on high-risk populations, including older people and people with serious underlying medical conditions, resulted in a relative neglect of the specific risks and needs of other populations such as women, when in fact the CoVID-19 pandemic is affecting various areas of health care, including reproductive health.

The pandemic is associated with decreased desire for pregnancy, decreased use of contraception, and increased menstrual disorders. Fertility treatments have been postponed in order to support the healthcare system by avoiding placing it under increased pressure. In addition, an indirect effect of the virus on gametes and embryos during their manipulation cannot be ruled out.

In the field of gynaecologic oncology, from CoVID-19 pandemic outbreak, the highest priority is to achieve the maximum benefit from less demanding procedures. Extensive procedures should be avoided, in order to reduce the in-hospital spread of the virus. Nevertheless, surgery for some gynaecologic pathologies cannot be postponed.

CoVID-19 is associated with a systemic inflammatory response with activation of coagulation in symptomatic patients. The possibility of coagulopathies in peri- and post-menopausal women taking oestrogens makes it necessary to consider antithrombotic strategies.

Due to the physiological changes in the immune and cardiopulmonary systems, pregnant women are more likely to develop severe illness after infection with respiratory viruses. At the beginning of the epidemic, the possibility that CoVID-19 may adversely influence pregnancy was raised and guidelines were issued. More recently, a few systematic reviews have shown that, in most cases, in pregnancies complicated by CoVID-19 infection, foetal and neonatal outcomes appear good, although information gathered so far only include pregnant women infected in their third trimester. Furthermore, pregnancy-related complications appear to vary depending on settings and screening strategies for SARS-CoV-2 identification (universal, based on epidemiological risk, or on symptoms).

The goal of this special issue is to provide additional data, both original articles and comprehensive reviews, about women’s health in CoVID-19 era to develop effective preventive and clinical strategies.

Prof. Romolo Di Iorio, Prof. Paola Bianchi

Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at https://ceog.imrpress.org by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Clinical and Experimental Obstetrics & Gynecology is an international peer-reviewed open access quarterly journal published by IMR Press.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is $1250. Submitted papers should be well formatted and use good English.

Keywords

CoVID-19; SARS-CoV-2; Pregnancy; Gynaecologic oncology; Human reproduction; Fertility and sterility

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Hysteroscopy in COVID-19 times

Alessandra Gallo, Attilio Di Spiezio Sardo, Antonietta Legnante, Romolo Di Iorio, Carlo De Angelis

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (5): 1017-1021. DOI: 10.31083/j.ceog4805163

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Objective: The coronavirus disease 2019 (COVID-19) pandemic is a global public health concern. Health Care Facilities in every country have to deal with a complete reorganization of labor and delivery unit, and resource management. Aim of this review is to summarize the available literature data about the impact of COVID-19 on hysteroscopic surgery. Mechanism: A search on PubMed and Medline databases was performed until March 2021. Findings in brief: Most of evidence agree on complete cancellation of elective endoscopic gynecologic surgery, and on its deferring until the pandemic has been contained. When hysteroscopy is performed, precautions should be observed to prevent COVID-19 infection. Conclusions: We summarized all best practice to perform safe and effective hysteroscopic surgery in COVID-19 times and in the slow restore of normal activities.

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SARS-CoV-2 detection in pregnant and non-pregnant women

Noor Hazim Abdulkareem, Elham Hazeim Abdulkareem

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (5): 1141-1145. DOI: 10.31083/j.ceog4805183

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Background: The coronavirus causing severe acute respiratory syndrome has infected over 2 million people worldwide, killed thousands, and triggered a global pandemic. There is a scarcity of information about pregnant and non-pregnant women who have coronavirus disease (COVID-19). This study's aim was to determine whether the severe acute respiratory syndrome coronavirus 2 was present in the vaginal fluid of infected women. Also, their platelet counts were examined to see whether they were higher in severe versus moderate cases of the COVID-19 disease. Methods: Our Obstetrics Clinic treated 31 women with confirmed COVID-19 (23 pregnant and 8 non-pregnant women) between 1 September 2020 and 30 September 2020). The existence of syndrome coronavirus 2 (SARS-CoV-2) in vaginal fluid samples was used to determine evidence of genital transmission of the virus. A clinical laboratory procedure, including taking blood samples, IgG/IgM Rapid Test Cassette was performed to validate SARS-CoV-2 infection. Vaginal swabs were retrieved from SARS-CoV-2 positive patients between seven and 10 days of onset. Swabs were inserted two or three centimetres into the vagina and rotated three or five times. The swabs were immediately sent to the lab for RT-PCR, and the patients' COVID-19 status was verified. The real-time Polymerase Chain Reaction (BIORON Diagnostics GmbH's - RealLine SARS-CoV-2 (B-Format) BI1020-96 Tests). Results: Patients' vaginal fluids tested negative for SARS-CoV-2. Patients who tested positive for SARS-CoV-2 had normal platelet counts. Discussion: Our findings indicate that SARS-2 virus was not present in the vaginal fluid of the 31 patients, meaning that sexual transmission of SARS-CoV-2 is unlikely.

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Can requirement for blood transfusion be predicted before delivery? Analysis of risk factors for blood transfusion in patients with postpartumhemorrhage

Fikret Salık, Mustafa Bıçak

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (3): 572-577. DOI: 10.31083/j.ceog.2021.03.2401

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Background: The most frequent cause of maternal deaths in developing countries is severe postpartum hemorrhage. We aimed to determine the risk factors affecting blood and/or blood product transfusion in patients with postpartum hemorrhage who were admitted to intensive care unit and to reveal clinical outcomes. Methods: After local ethics committee approval, this retrospective study included patients monitored due to postpartum hemorrhage in the 2nd stage intensive care between 1 January 2019–1 January 2020. Patients were divided into two groups as those requiring transfusion (n = 156) and those not requiring transfusion (n = 162). Patients data such as age, blood group, pregnancy week, gravida, parity, previous cesarean history, maternal comorbidity were recorded. The form of delivery, trial of labor, cesarean type, indications, anesthesia type, multiple pregnancy, placental anomalies and predelivery hemoglobin were noteded. The amount of blood products used were identified. Results: High parity (P = 0.002), normal vaginal delivery rate (P < 0.001), primary cesarian delivery (P < 0.001), pre-delivery maternal comorbidity rate (P < 0.001) and low prepartum blood hemoglobin levels (P < 0.001) were statistically significant factors for transfusion. The rates of those with trial of labor, instrumental delivery, intrauterine fetal death, emergency cesarean and general anesthesia were high in blood transfusion group (P values 0.018, 0.024, 0.015, 0.001 and <0.001 respectively). In multivariate logistic regression analysis, positive correlations were identified between parity (aOR: 0.258), gravida (aOR: 1.452) and general anesthesia (aOR: 3.113) with postpartum blood transfusion. Antenatal hemoglobin level (aOR: 0.506) had negative correlation with blood transfusion. Conclusions: Among patients with postpartum hemorrhage, we were able to identify risk factors which predispose peripartum blood transfusion and developed a prediction model with good discrimination.

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Anesthesiologic management of pregnant women with SARS-COV-2 infection undergoing cesarean delivery

Antonio Coviello, Concetta Posillipo, Ludovica Golino, Carlo De Angelis, Elisabetta Gragnano, Gabriele Saccone, Marilena Ianniello, Gaetano Castellano, Annachiara Marra, Alfredo Maresca, Maria Vargas, Giuseppe Servillo

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (3): 628-630. DOI: 10.31083/j.ceog.2021.03.2446

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Background: Pregnant women are usually more susceptible to infection due to typical physiological and mechanical changes, such as increased heart rate, stroke volume and pulmonary residual capacity. The aim of this study was to evaluate an innovative anesthesiologic opioid-free management protocol in symptomatic pregnant women, with COVID-19 and with oxygen therapy, undergoing cesarean delivery with spinal anesthesia. Methods: With the patient in the sitting position, spinal anesthesia was performed at the L1–L2 level. Vertebral level has been identified starting from the sacrum, we counted the laminae in the caudal-to-cephalad direction, which was then marked with a surgical pen. The technique was performed in asepsis, in the subarachnoid space after vision of clear Cephalo-Spinal Fluid (CSF) in the spinal needle 27 Gauge, without letting out the CSF, bupivacaine 0.5% 10 mg, dexmedetomidine 10 μg and dexamethasone 4 mg was injected. Results: During the study period, 40 pregnant women with one or more symptoms and supplemental oxygen (FiO2 35–40%) who underwent cesarean delivery were included in the study. All pregnant women had pain visual analog scale (VAS) ≤3, and no pregnant women required rescue dose. Adverse effects, such as nausea, vomiting, shivering, or pruritus were not recorded in any case. After a mean of 2.5 hours from the spinal anesthesia, all the included women had a complete motility of the lower limbs and were able to mobilize independently within 12 hours after delivery. Mean time to first flatus was about 8 hours after delivery. Conclusions: Pregnant women in COVID-19 can safely receive intrathecal dexamethasone and dexmedetomidine during planned cesarean delivery.

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Consequences of SARS-CoV-2 disease on maternal, perinatal and neonatal outcomes: a retrospective observational cohort study

Sahar H. Abdulghani, Lana A. Shaiba, Mahdya A. Bukhari, Muhab M. Hindi, Shaikh A. Hussain, Adnan A. Hadid

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (2): 353-358. DOI: 10.31083/j.ceog.2021.02.2361

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Novel coronavirus disease 2019 (COVID-19) continues to affect pregnant women with concerns for adverse maternal and fetal outcomes and is rapidly spreading throughout many countries since it was first reported in China on 31 December 2019. The aim of this study is to describe characteristics, maternal and fetal outcomes among mothers with confirmed maternal SARS-CoV-2 infection. This study presents a retrospective observational cohort study of 62 test-positive cases of coronavirus disease 2019 that presented at an affiliated tertiary university medical city from March 2020 to May 2020. A total of 14 patients (22.5%) presented with obvious typical symptoms of coronavirus disease 2019 associated viremia and were identified after they developed symptoms during admission or after the implementation of universal testing for all obstetric admissions. A total of 62 mothers were screened positive for the SARS-CoV-2 infection. Length of stay was higher in the symptomatic group. The median length of stay was 4 days for the asymptomatic cases while it was 6 days for the symptomatic cases. Amniotic fluid was meconium stained in (12.5%) of the asymptomatic group and in 30.8% in the symptomatic group. Post discharge mothers with asymptomatic SARS-CoV-2 infection were more likely to breastfeed their infants. OR (95% CI) was 1.4 (1.02–1.90) and P-value was 0.0327. There was non-statistically significant absence of perinatal morbidities or mortalities among symptomatic and asymptomatic mothers.

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