Medyannikova IV, Kuklis YuCh, Saveljeva IV, Beznoshchenko GB, Galyanskaya EG, Tsygankova OYu, Krivchik GV, Bukharova EA, Nosova NV, Davidov PV. Optimization of the management of pregnant women with new COVID-19 coronavirus infection: An open prospective cross-sectional study. Gynecology. 2024;26(4):350–357. DOI: 10.26442/20795696.2024.4.203009
Оптимизация тактики ведения беременных с новой коронавирусной инфекцией COVID-19
Medyannikova IV, Kuklis YuCh, Saveljeva IV, Beznoshchenko GB, Galyanskaya EG, Tsygankova OYu, Krivchik GV, Bukharova EA, Nosova NV, Davidov PV. Optimization of the management of pregnant women with new COVID-19 coronavirus infection: An open prospective cross-sectional study. Gynecology. 2024;26(4):350–357. DOI: 10.26442/20795696.2024.4.203009
Обоснование. Многочисленные исследования свидетельствуют о том, что беременные являются группой риска тяжелой заболеваемости, неблагоприятных гестационных исходов и смертности после перенесенной инфекции, вызванной вирусом SARS-CoV-2 (COVID-19). У этих пациенток выше частота прерывания беременности на различных сроках, преждевременных родов, преэклампсии, кесарева сечения, рождения детей с низкой массой тела (МТ). Цель. Улучшить исходы беременности и родов у женщин с COVID-19 путем оптимизации диагностических и лечебно-профилактических мероприятий. Материалы и методы. Проведено открытое проспективное сплошное поперечное исследование, в котором обследованы 114 пациенток после перенесенной инфекции, вызванной SARS-CoV-2. У 32 беременных основной группы с высоким риском акушерских осложнений лечебная тактика помимо стандартной терапии основного заболевания включала назначение эндотелиотропного препарата сулодексид и ацетилсалициловой кислоты. Результаты. Тяжелое течение COVID-19 у беременных определяет высокую вероятность плацентарных нарушений (отношение шансов – ОШ 6,1; 95% доверительный интервал – ДИ 2,6–14,9), задержки роста плода (ОШ 5,6; 95% ДИ 1,2–30,2), преэклампсии (ОШ 8,5; 95% ДИ 3,4–22,4), преждевременных родов (ОШ 14,1; 95% ДИ 5,8–38,4), оперативного родоразрешения (ОШ 8,5; 95% ДИ 4,1–18,1), низкой МТ детей при рождении (ОШ 18,0; 95% ДИ 6,4–62,2), госпитализации в отделение реанимации и интенсивной терапии новорожденных (ОШ 25,4; 95% ДИ 6,4–67,0). Заключение. Усовершенствование тактики ведения беременных при COVID-19 с выделением среди них группы высокого риска по гестационным осложнениям, основанной на ранней их диагностике, своевременном родоразрешении и, помимо стандартной терапии основного заболевания, профилактике венозных тромбоэмболических осложнений, включающей назначение ацетилсалициловой кислоты и эндотелиотропных препаратов, позволяет снизить частоту плацентарных нарушений в 2,3 раза, тяжелой преэклампсии – в 2,9 раза, преждевременных родов на сроке 28–37 нед – в 2 раза, оперативного родоразрешения путем операции кесарева сечения – в 1,6 раза, рождения детей с низкой МТ – в 2,3 раза, госпитализации в отделение реанимации и интенсивной терапии новорожденных – в 2,5 раза.
Background. Many studies indicate that pregnant women are at risk for severe morbidity, adverse gestational outcomes, and mortality following SARS-CoV-2 (COVID-19) infection. Such patients have higher rates of abortion at various times, preterm delivery, preeclampsia, caesarean section, and delivery of low birth weight (LBW) newborns. Aim. To improve pregnancy and childbirth outcomes in women with COVID-19 by optimizing diagnostic and treatment interventions. Materials and methods. An open-label prospective continuous cross-sectional study enrolled 114 patients following SARS-CoV-2 infection. In 32 pregnant women of the main group with a high risk of obstetric complications, the treatment approach included endotheliotropic agent sulodexide and acetylsalicylic acid in addition to the standard of care for the underlying disease. Results. The severe course of COVID-19 in pregnant women is associated with the high rate of placental disorders (odds ratio – OR 6.1; 95% confidence interval – CI 2.6–14.9), fetal growth retardation (OR 5.6; 95% CI 1.2–30.2), preeclampsia (OR 8.5; 95% CI 3.4–22.4), premature birth (OR 14.1; 95% CI 5.8–38.4), surgical delivery (OR 8.5; 95% CI 4.1-18.1), low birth weight of newborns (OR 18.0; 95% CI 6.4–62.2), hospitalization in the neonatal intensive care unit (OR 25.4; 95% CI 6.4–67.0). Conclusion. Improving the management of pregnant women with COVID-19 by identifying a high-risk group for gestational complications, based on their early diagnosis, timely delivery, and use of acetylsalicylic acid and endotheliotropic agents to prevent venous thromboembolic complications, in addition to the standard of care, reduces the frequency of placental disorders by 2.3 times, severe preeclampsia – by 2.9 times, premature birth at 28–37 weeks – by 2 times, surgical delivery by cesarean section – by 1.6 times, delivery of low birth weight newborns – by 2.3 times, hospitalization in the intensive care unit of newborns – by 2.5 times.
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1. Manoshkina EM, Banteva MN. Features of the course of the new coronavirus infection and its impact on the dynamics of public health indicators. Sotsial'nye aspekty zdorov'ia naseleniia. 2023;69(5):4 (in Russian). DOI:10.21045/2071-5021-2023-69-5-4
2. Timerbulatov VM, Timerbulatov MV. Healthcare during and after the COVID-19 pandemic. Bulletin of the Academy of Sciences of the Republic of Bashkortostan. 2020;35(2):77-86 (in Russian). DOI:10.24411/1728-5283-2020-10209
3. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2):194. DOI:10.3390/v12020194
4. Westgren M, Pettersson K, Hagberg H, Acharya G. Severe maternal morbidity and mortality associated with COVID-19: The risk should not be downplayed. Acta Obstet Gynecol Scand. 2020;99(7):815-1. DOI:10.1111/aogs.13900
5. Liu H, Wang LL, Zhao SJ, et al. Why are pregnant women susceptible to COVID-19? An immunological viewpoint. J Reprod Immunol. 2020;139:103122. DOI:10.1016/j.jri.2020.103122
6. Khan MMA, Khan MN, Mustagir MG, et al. COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes. medRxiv. The Preprint Server for Health Sciences. 2020. DOI:10.1101/2020.03.31.20049304.
7. Yan J, Guo J, Fan C, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020;223(1):111.e1-1.14. DOI:10.1016/j.ajog.2020.04.014
8. Haffke M, Freitag H, Rudolf G, et al. Endothelial dysfunction and altered endothelial biomarkers in patients with post-COVID-19 syndrome and chronic fatigue syndrome (ME/CFS). J Transl Med. 2022;20(1):138. DOI:10.1186/s12967-022-03346-2
9. Stow LR, Jacobs ME, Wingo CS, Cain BD. Endothelin-1 gene regulation. FASEB J. 2011;25(1):16-28. DOI:10.1096/fj.10-161612
10. Karakus S, Bozoklu Akkar O, Yildiz C, et al. Serum levels of ET-1, M30, and angiopoietins-1 and -2 in HELLP syndrome and preeclampsia compared to controls. Arch Gynecol Obstet. 2016;293(2):351-9. DOI:10.1007/s00404-015-3803-1
11. Belokrinitskaya TE, Artymuk NV, Filippov OS, Frolova NI. Clinical course, maternal and perinatal outcomes of 2019 novel coronavirus infectious disease (COVID-19) in pregnant women in Siberia and Far East. Obstetrics and Gynecology. 2021;2:48-54 (in Russian). DOI:10.18565/aig.202L2.48-54
12. Jafari M, Pormohammad A, Sheikh Neshin SA, et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Rev Med Virol. 2021;31(5):1-6. DOI:10.1002/rmv.2208
13. Diriba K, Awulachew E, Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. Eur J Med Res. 2020;25(1):39. DOI:10.1186/s40001-020-00439-w
14. Bezhenar VF, Zazerskaya IE, Bettikher OA, et al. Controversial issues in obstetric management of women with novel coronavirus disease COVID-19 during pregnancy and childbirth. Obstetrics and Gynecology. 2020;5:13-21 (in Russian). DOI:10.18565/aig.2020.5.13-21
15. Chen L, Li Q, Zheng D, et al. Clinical Characteristics of Pregnant Women with COVID-19 in Wuhan, China. N Engl J Med. 2020;382(25):e100. DOI:10.1056/NEJMc2009226
16. Novoa RH, Quintana W, Llancari P, et al. Maternal clinical characteristics and perinatal outcomes among pregnant women with coronavirus disease 2019. A systematic review. Travel Med Infect Dis. 2021;39:101919. DOI:10.1016/j.tmaid.2020.101919
17. Zdravookhranenie v Rossii. 2019. Statisticheskii sbornik. 2019 (in Russian).
18. Di Mascio D, Khalil A, Saccone G, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107. DOI:10.1016/j.ajogmf.2020.100107
19. Vallejo V, Ilagan JG. A Postpartum Death Due to Coronavirus Disease 2019 (COVID-19) in the United States. Obstet Gynecol. 2020;136(1):52-5. DOI:10.1097/AOG.0000000000003950
20. Liu D, Li L, Wu X, et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. AJR Am J Roentgenol. 2020;215(1):127-32. DOI:10.2214/AJR.20.23072
21. [Lapina IA, Dobrokhotova IuE, Taranov VV, et al. Printsip targetnoi terapii v komplekse prekontseptsionnoi podgotovki u patsientok s postkovidnym sindromom. Zhenskaia klinika. 2021;4:16-24 (in Russian).
1ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия; 2ГБУЗ «Инфекционная клиническая больница №2» Департамента здравоохранения г. Москвы, Москва, Россия; 3БУЗОО «Городской клинический перинатальный центр», Омск, Россия
*mediren@gmail.com
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Irina V. Medyannikova*1, Yuliya Ch. Kuklis2, Irina V. Saveljeva1, Galina B. Beznoshchenko1, Elena G. Galyanskaya1, Olga Yu. Tsygankova1, Galina V. Krivchik1,3, Elena A. Bukharova1, Natalya V. Nosova1, Pavel V. Davidov1
1Omsk State Medical University, Omsk, Russia; 2Infectious Clinical Hospital №2, Moscow, Russia; 3City Clinical Perinatal Center, Omsk, Russia
*mediren@gmail.com