Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : QC01 - QC04 Full Version

Outcome of Pregnancy in COVID-19 Positive Pregnant Women: A Retrospective Observational Study


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49539.15229
Shreetoma Datta, Sonali Jitendra Ingole, Jitendra R Ingole

1. Intern, Department of Obstetrics and Gynaecology, SKN Medical College, Sinhgad Road, Pune, Maharashtra, India. 2. Associate Professor, Department of Obstetrics and Gynaecology, SKN Medical College, Sinhgad Road, Pune, Maharashtra, India. 3. Professor, Department of Medicine, SKN Medical College, Sinhgad Road, Pune, Maharashtra, India.

Correspondence Address :
Dr. Sonali Jitendra Ingole,
Associate Professor, Department of Obstetrics and Gynaecology, SKN Medical College, Sinhgad Road, Narhe, Pune-411041, Maharashtra, India.
E-mail: drsonali.ingole@gmail.com

Abstract

Introduction: Pregnant women have also been affected globally due to the Coronavirus Disease 2019 (COVID-19) pandemic. As foeto-maternal unit is involved, hence it is important to know possible manifestations and outcome of COVID-19 affected pregnant women. The findings of the study can be a guide for betterment of COVID-19 affected antenatal patients care.

Aim: To find the outcome of pregnancies affected by the COVID-19 infection of the Antenatal care (ANC) patients who presented to the tertiary care hospital in terms of laboratory parameters, treatment of the infection, mode of delivery, adverse outcome if and presence of documented infection in newborn.

Materials and Methods: This was a retrospective observational study done from May 2020 to December 2020 conducted on the admitted pregnant women to the tertiary care hospital who tested positive for the COVID-19 virus were included in the study. Data collection (symptoms, reports and treatment) from these pregnant COVID-19 positive patients was done. Patients who were discharged before delivery were contacted telephonically and were asked the relevant information.

Results: During the study period, total 1150 COVID-19 positive patients were admitted to the hospital. Amongst these, there were 441 female patients including pregnant and non pregnant women. Amongst the 441 COVID-19 infected female patients, 20 were pregnant. Majority of the patients were in the age group of 21-30 years. An 85% of women were in their third trimester at the time of admission. Pre-eclampsia and Hypothyroidism were the major co-morbidities observed. Six maternal Intensive Care Unit (ICU) admissions were noted. Breathlessness was the main symptom seen followed by sore throat, fever and cough. Previous Lower Segment Caesarean Section (LSCS) and foetal distress were cited as the main reasons for undergoing LSCS. No vertical transmission of virus was seen in the study. There were two neonatal ICU admission. Low Molecular Weight Heparin (LMWH) was administered to 33% patients. Fifty percent of the patients were prescribed steroids.

Conclusion: Advanced gestational age, pre-eclampsia, hypothyroidism, elevated levels of d-dimer, Neutrophil/Lymphocyte (NL) ratio and C-reactive protein were seen as the main findings. Mother to child transmission was not observed in this study.

Keywords

Coronavirus disease-2019, C-reactive protein, D-Dimer, Ferritin, Inflammatory markers, Vertical transmission

The COVID-19 pandemic has affected the healthcare system on a global level and has become a public health challenge. The virus which was first detected in December 2019, in Wuhan province of China eventually has spread across the world (1). This viral outbreak has mostly affected the elderly population (2). Physiological changes in the respiratory system, makes pregnant women more vulnerable to respiratory viral infection during pregnancy. Also pregnancy is a state of altered immunity which helps the developing foetus maternal environment (3),(4). Anatomical changes in pregnancy lead to a decrease in the Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) (5). These maternal adaptations result in increased susceptibility of the pregnant mother to airway tract infections (6). Respiratory Tract Infections with Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS-CoV2) have previously shown to affect pregnant women and have led to obstetric complications resulting in poor maternal and foetal outcomes (4).

Previous pandemic with H1N1 influenza virus affected pregnant women more seriously requiring intensive treatment (7). Pregnant women being amongst the vulnerable population are also affected with SARS-CoV2 virus (1),(8). During pregnancy, changes in “T” cells occur such as decrease in numbers of helper T cells, reduced lymphocyte cytotoxic activity, and synthesis of substances that can block maternal recognition of foetal major histocompatibility antigens (9),(10). There is paucity of Indian studies, regarding the effect of COVID-19 infection on pregnancy. The study aims to find out the effect of COVID-19 infection in pregnancy, laboratory characteristics maternal and foetal outcome.

Material and Methods

This was retrospective observational study, involving pregnant women who were admitted to COVID ward with documented COVID-19 infection by the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) swab test (11). The study was commenced after approval from the Institutional Ethics Committee (Ref. SKNMC/Ethics/App/2020/677). All hospitalised COVID-19 positive pregnant women between the periods from May 2020 to December 2020 were in the study, analysis of the retrospective data was done and completed by February 2021 and informed consent was duly obtained from the included patients.

Inclusion criteria: All pregnant women who were admitted to the hospital and who tested positive for the COVID-19 virus by RT-PCR test test were included in the study.

Exclusion criteria: Non pregnant female patients were excluded from the study.

Study Procedure

During the study period, total 1150 COVID positive patients were admitted to the hospital. Amongst these, there were total 441 female patients, of which 20 were pregnant. Pregnant women who showed symptoms suggestive of COVID-19 infection and were awaiting their results were shifted to the COVID-19 suspect ward/ICU. Out of these women who were later tested positive for COVID-19 infection were shifted to COVID wards and only such confirmed COVID-19 positive pregnant patients were included in the study.

Patient information was collected from the COVID wards, COVID ICU registers, medical records, telephonic contact with the patients. The data was collected for the gestational age, maternal age, parity, obstetric risk factors, clinical characteristics, laboratory parameters and co-morbid conditions relevant to COVID-19. Mode of delivery, neonatal birth weight, neonatal nasopharyngeal swab report tested for COVID-19 virus by RT-PCR was also collected. Anaemia was classified into three categories viz., mild (10-10.9 gm/dL), moderate (7-9.9 gm/dL) and severe anaemia (<7 gm/dL) as per World Health Organisation (WHO) classification (12).

Statistical Analysis

The data collected was compiled and analysed using Excel (Windows 10 Version 16051.13426.20332.0).

Results

Out of 20 COVID-19 positive pregnant patients admitted to the hospital, majority {n=14 (70%)} were in the age group of 20-30 years. A total of twelve women had obstetric risk factors, five women had hypertensive disorders of pregnancy, one patient had pre-existing diabetes mellitus while other one patient had gestational diabetes mellitus. One patient had rheumatic heart disease with mitral regurgitation. Three women had hypothyroidism. Under the COVID-19 relevant co-morbidities, one patient had asthma, two were diabetic and five patients had hypertensive disorders of pregnancy (Table/Fig 1).

The overlapping of patients in two categories was due to the fact that conditions like diabetes, hypertensive disorders and asthma are obstetric risk factors as well as co-morbid conditions relevant to COVID-19. Patient demographic characteristics and risk factors along with number of patients are mentioned in (Table/Fig 1).

(Table/Fig 2) shows the clinical and laboratory characteristics of each patient. Eight patients (40%) were asymptomatic, at the time of admission. These eight patients were tested and were found to be positive for SARS-COV-2 as they were close contacts of confirmed COVID-19 positive patients. Fever, cough and breathlessness were most common presenting symptoms in remaining 12 patients with varying combination. Two patients had fever and breathlessness, two patients had fever and dry cough, while two patients had all three symptoms. Patient 5 and 11 had breathlessness as the only symptom while Patient 7 had only cough as presenting symptom.

Amongst the patients complaining of breathlessness (n=6), three patients had oxygen saturation of less than 95% on room air. All these three patients required oxygen support (Table/Fig 3).

Additionally, myalgia and diarrhoea were found in one patient each. (Patient 13 and 14, respectively). Majority of the patients had deranged inflammatory markers (18 out of 20), which included serum ferritin, D dimer, C-Reactive Protein and NL ratio. Patients 1, 5 and 14 had elevations in all three inflammatory markers. Ten patients had raised NL ratio. The highest NL ratio was seen in patient 20 with a value of 12.71.The maximum value of elevated serum ferritin of 5639.2 ng/mL was seen in patient 14.This patient had asthma as associated co-morbid condition.

Patient 3 had all three key symptoms of COVID-19 infection- fever, cough and breathlessness. The CRP level of 686 mg/L, in this patient was the highest value observed amongst all patients. Patient 20 shows leukocytosis. She also had a high NLR (highest in the cohort) at 12.71, and CRP value of >90 mg/L and raised D-dimer value. Yet, she showed no symptoms of COVID-19 infection clinically. Nine out of 20 patients were anaemic three had mild anaemia while six had moderate anaemia. Oxygen support was required by three patients, one of whom was admitted to the ICU (Table/Fig 3). The others were managed at the COVID-19 positive ward.

(Table/Fig 2) also shows the maternal and neonatal outcomes in 20 mothers. Fourteen (70%) of the patients underwent LSCS while six (30%) had a vaginal delivery. Amongst these six women, one had forceps assisted vaginal delivery due to foetal distress with meconium stained liquor. Elective caesarean section was done in seven patients and other seven patients had emergency caesarean section. Out of the patients who underwent elective LSCS, three patients were previous caesarean section and were not willing for vaginal delivery. The other indications for elective LSCS were severe oligohydramnios (one patient), cephalo-pelvic disproportion (one patient), primigravida with breech presentation (one patient) and history of secondary infertility with oligohydramnios (one patient). Seven patients underwent emergency LSCS. Out of the seven patients who underwent emergency LSCS, four had foetal distress during labour. One patient had placenta accrete with vaginal bleeding and required emergency caeserean section along with obstetric hysterectomy. There was prolonged rupture of membranes with failed induction in one patient, while one patient had prolonged labour. None of the patients in the study required mechanical ventilation.

There were 17 term births and three preterm births, out of which twopreterm births and three term births had a low birth weight neonate (total low birth weight neonates=5). Overall, 13 out of the 20 neonates were in the normal birth weight range i.e., 2500-3499 g and two were above normal birth weight (≥3500 g). APGAR scores of 12 neonates were available, out of which majority had a score of 8 at one minute and 9 at five minutes (7 and 6 neonates respectively).

Two neonates required NICU admission after birth for hypoglycaemia and low birth weight respectively in each baby. Meconium Stained Amniotic Fluid was found in three cases. Twelve neonates were tested for COVID-19 infection by RT-PCR of nasal and oropharyngeal swabs. Nasal swabs of all 12 neonates were negative for COVID-19 infection. Eight neonates were not tested for the infection at birth.

(Table/Fig 3) shows the various treatment modalities, number of maternal ICU admissions and mothers requiring oxygen support. Twelve patients received antibiotics, followed by steroids (8 patients) and Low Molecular Weight Heparin (7 patients). Six women were prescribed antiparasitic drug (Ivermectin) and five patients were taking antivirals.

Antibiotics included were amoxicillin and clavulinic acid or doxycycline or cefixime while steroids included any one of methylprednisolone or prednisolone or betamethasone. Enoxaparin was the low molecular weight heparin used. Antiparasitic drugs prescribed included both hydroxycholoroquine and ivermectin, oseltamivir and remdesivir were the antivirals used.

Three patients required oxygen support due to a low oxygen saturation. Two patients received oxygen at a rate of 2 L/min while the third required a rate of 4 L/min. There were six maternal ICU admissions during their pregnancy due to various obstetric and COVID-19 high risk factors. These included pre-eclampsia, diabetes mellitus, cardiomegaly, hypotension, decreased oxygen saturation and postcaesarean section with obstetric hysterectomy for postoperative monitoring.

Discussion

Pregnant women have always been amongst the vulnerable population, the others being the elderly population, people with co-morbidities and children. Pregnancy is an immunosuppressive condition (13). Also, during pregnancy there are physiological and anatomical changes in the respiratory system. There is reduction in functional residual capacity, due to elevation of diaphragm by the gravid uterus. Oedema of the respiratory tract in pregnant women leads to decrease in the caliber of the airway (6). A physiological state of respiratory alkalosis due to increase in the tidal volume ensures transfer of oxygen from mother to foetus. All these changes place pregnant women at an increased risk of acquiring respiratory infections. Mortality rate due to COVID-19 in pregnant women was found to be around 1.6% (14).

Previous respiratory viral infections among pregnant women with H1N1, SARS-COV-1 and MERS-COV were associated with poor clinical course and outcome. Respiratory viruses like Influenza virus (H1N1) and the Coronavirus like SARS-COV and MERS-COV have previously caused severe respiratory illness leading to increased maternal morbidity and mortality (4),(15). Various studies have been published since the outbreak of the COVID-19 pandemic, studying the effect of nCOV-2 (SARS-COV-2) on pregnant women and the outcome of pregnancy as well as their clinical and laboratory characteristics. Systemic reviews from different studies conducted in multiple countries have reported that majority of the pregnant women present with mild symptoms, with fever and cough being the most common symptoms (16). The mortality rate due to COVID-19 in pregnant women was found to be 1.6% (13).

In present study, fortunately, there was no maternal mortality amongst the 20 COVID-19 positive pregnant patients. Fever, cough and breathlessness were the most common reported symptoms in present study, similar to a study conducted by Chen N et al., which included 99 cases with COVID-19, suggested that the most common symptoms at presentation were fever, cough and breathlessness (17).

In another study, (18) evaluating the impact of coronavirus infection in pregnancy, amongst 141 COVID-19 positive pregnant women, 27 (19.14%) women had associated co-morbidities like pregnancy induced hypertension, eclampsia, anaemia. In present study, there were 8 patients (40%) with associated co-morbidities relevant to COVID-19. Half of the patients in present study had increased NL Ratio (50% had lymphopenia). Authors in other study (1), which included 118 COVID positive women, observed lymphopenia in 44% patients.

Seven out of 20 women (35%) underwent an elective LSCS, whereas seven had an emergency LSCS (Table/Fig 1). Although, most of the elective LSCS done in these studies were due to the foetal concern of COVID-19 infection in pregnancy.

Six patients had vaginal delivery in present study. None of the new born in present study who were tested by RT-PCR was positive, suggesting less likelihood of the possibility of vertical transmission. In another study (1) on nine patients, samples from amniotic fluid, cord blood, neonatal throat swab and breast milk were taken and all of them tested negative for COVID-19 virus. All patients were delivered by LSCS. However, another study demonstrated that none of the newborns of five patients who underwent vaginal delivery tested positive for the virus (19).

In present study, there were six maternal ICU admissions (Table/Fig 3) due to obstetric and COVID-19 high risk factors including pre-eclampsia, diabetes mellitus, cardiomegaly, hypotension and decreased oxygen saturation. One patient was admitted for postoperative monitoring since she underwent an obstetric hysterectomy after delivery.

Limitation(s)

All neonates were not tested for the viral infection, as some patients were delivered at other hospital. High Resolution Computed Tomography (HRCT Thorax scan was not done on the pregnant patients, as per the institutional protocol.

Conclusion

Most common clinical presentation in SARS-COV-2 affected pregnant women was fever, cough and breathlessness. Presence of these symptoms should prompt clinician to promptly test the ANC in patient to rule out possible COVID-19 infection.

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DOI and Others

10.7860/JCDR/2021/49539.15229

Date of Submission: Mar 22, 2021
Date of Peer Review: Jun 04, 2021
Date of Acceptance: Jun 26, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 22, 2021
• Manual Googling: Jun 19, 2021
• iThenticate Software: Jul 22, 2021 (7%)

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