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

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
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 : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : QC14 - QC17 Full Version

Foetomaternal Outcomes in COVID-19 Positive Obstetric Patients: An Observational Study


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/50962.15899
Sahana Gowda, KB Suma

1. Senior Resident, Department of Obstetrics and Gynaecology, JSS Medical College, Mysuru, Karnataka, India. 2. Head, Department of Obstetrics and Gynaecology, JSS Medical College, Mysuru, Karnataka, India.

Correspondence Address :
Dr. Sahana Gowda,
Senior Resident, Department of Obstetrics and Gynaecology, JSS Medical College,
Mysuru, Karnataka, India.
E-mail: sahanakgowda22@gmail.com

Abstract

Introduction: In Coronavirus Disease-2019 (COVID-19) pandemic, a serious concern has been raised regarding the health of the newborn and the pregnant mother. Limited data is available on the foetomaternal outcomes in this pandemic.

Aim: To assess the foetomaternal outcomes in COVID-19 positive pregnant patients.

Materials and Methods: A prospective cohort study was conducted from October 2020 to December 2020, at JSS Medical College, Mysuru, Karnataka, India, on 27 COVID-19 positive obstetric patients admitted to the ward who had confirmed COVID-19 on the basis of Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) or lung opacities. The study period belonged to first wave of COVID-19. The foetomaternal outcomes such as mode of delivery, abortions, foetal admission in Intensive Care Unit (ICU) and mortality among the mother and the baby were recorded. The data was collected and tabulated in Microsoft Excel sheet and frequency (n) and percentages (%) were calculated.

Results: Total of 27 COVID-19 positive obstetric patients (age 19-37 years; mean gestational age 34.84±7.75 weeks) formed the sample of the study. The mean age of the study patients were 27.11±4.5 years. The primary symptoms included cough (18.52%) and breathlessness (11.11%). After diagnosis, seven cases (25.92%) continued pregnancy and were lost to follow-up while among those who delivered (n=20), the mode of delivery was Lower Segment Caesarean Section (LSCS) in 12 (44.44%), normal vaginal 6 (22.22%), emergency laparotomy in 1 (3.7%) and incomplete abortion in 1 (3.7%) women. Among the 20 who delivered, 1 was Intrauterine Death (IUD) and the rest of the 19 foetuses were negative for COVID-19. Of the total 20 foetuses delivered, 10 required Neonatal Intensive Care Unit (NICU) admission where one died. Repeat testing was done in 13 female subjects, all of them were negative, while rest of the seven patients did not turn in for repeat testing and were lost. Among the pregnant women, one patient died secondary to COVID-19 bronchopneumonia in the postpartum period.

Conclusion: If managed properly without any complications, the outcomes are good for the mother and the baby without a significant risk of transmission. However, the long-term follow-up is needed to assess the mortality of the patients.

Keywords

Coronavirus disease-2019, Newborn, Pandemic, Pregnancy

The outbreak of Coronavirus Disease (COVID-19) was caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) in Wuhan, China and then it was declared as a public health emergency by the World Health Organisation (WHO) and an international concern was raised (1). The high mortality rate necessitates recognition as well as protection of the susceptible individuals. The information acquired from outbreaks caused by human coronavirus such as SARS-CoV and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) indicates susceptibility of pregnant women to poor outcomes. Intensive care unit admission is common and 35% of case fatality rate is reported (2),(3). As pregnant women and newborns are at an increased risk of COVID-19, evaluation is required (4).

In spite of widespread studies related to the clinical manifestations and treatment of patients with COVID-19, there is scarcity of studies among pregnant women with COVID-19 in India (5),(6),(7). The difference in the clinical characteristics of pregnant women with COVID-19 pneumonia from non pregnant women with COVID-19 is still not clear. Also, it is unclear whether COVID-19 pneumonia symptoms are aggravated by pregnancy and childbirth, and also if antiviral therapy is essential for pregnant women with COVID-19 (8). Ongoing research has been vast which reports the data on foetomaternal outcomes. Since COVID-19 is a new disease, medical literature demands continuing research in this regard. Children have been spared from this disease but the newborn susceptibility to COVID-19 in cases of infection to their mothers needs further research.

This study aimed at describing the clinical manifestations, treatment, and maternal and foetal outcomes in COVID-19 positive pregnant patients.

Material and Methods

This was a prospective cohort study conducted from October 2020 to December 2020 at JSS Medical College, Mysuru, Karnataka, India, where a total of 27 COVID-19 positive pregnant patients in third trimester were enrolled. Of the 27 cases, seven continued pregnancy and were lost to follow-up of whom the foetomaternal outcomes could not be determined. The study period belonged to first wave of COVID-19. Institutional Ethical Committee approval was obtained (JSSMC/IEC/310821/04NCT/2021-22).

Inclusion criteria: COVID-19 positive pregnant women, of age greater than 18 years , with confirmed RT-PCR or High Resolution Computed Tomography (HRCT) report (for COVID positivity) and in their third trimester were included in the study.

Exclusion criteria: Those pregnant women in their first and second trimester and those patients not willing to participate in the study were excluded from the study.

Sample size estimation: The study of Liu D et al., observed that 1 out of 15 patients got delivered vaginally (4). Taking this value as reference, the minimum required sample size with 10% margin of error and 5% level of significance was 24 patients. To reduce margin of error, total sample size taken was 27.

Procedure

The diagnosis was made on the basis of RT-PCR or lung opacities on High Resolution CT scan (HRCT). HRCT was done in cases of clinical worsening. All women were tested for Complete Blood Count (CBC), liver profile, and D-dimer assays. The demography details (age, gestational age), treatment and foetomaternal outcomes such as mode of delivery, abortions, foetal admission in ICU and mortality among the mother and the baby were recorded.

Delivery protocols: The indications for caesarean section included eclampsia, imminent eclampsia, failed progression for more than 12 hours, failed induction, history of previous caesarean section and request by the mother. The indication for emergency laparotomy included ectopic pregnancy.

Treatment protocol: The patients were treated with antibiotics. Those who underwent normal delivery were given oral antibiotics (amoxiclav tablet 625 mg was given once daily for 5 days) and those who underwent caesarean were given injectables, that is, Augmentin 12 mg single daily dose for 3 days and Injection taxim 1 mg for five days or three consecutive doses. Multivitamin tablets (zinc and vitamin C) were given to all COVID-19 patients. For controlling fever, dolo 650 mg 4 times a day were given.

Indication of repeat RTPCR testing: The indications for repeat testing included the persistence of symptoms like fever, cough, cold and loose stools. The repeat samples were taken after two weeks of clinical improvement of the patient as per the discharge criteria. We followed this protocol only during the first wave of COVID-19. In the present study centre , as its a teaching institute, the authors followed the repeat testing protocol for psychological benefit for the pregnant women and lactating mother.

Statistical Analysis

The presentation of the categorical variables was done in the form of number (n) and percentage (%). On the other hand, the presentation of the continuous variables was done as mean±SD and median values. The data entry was done in the Microsoft Excel spreadsheet and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0.

Results

The mean age of the study patients were 27.11±4.5 years with 13 primi and 14 multigravida. The gestational age of presentation was ≥37 weeks in majority of the women (59.26%) (Table/Fig 1). Mean values of C-Reactive Protein (CRP), lymphocytes, neutrophils, Aspartate Aminotransferase (AST), Ferritin, and D-dimer were 70.24±64.21 mg/L, 17.6±6.41 µL, 77.43±7.92 µL, 51.89±92.49 U/L, 61.04±45.89 ng/mL, and 1.61±1.27 mg FEU/µL, respectively (Table/Fig 2).

The signs and symptoms included cough in 5 (18.52%), breathlessness in 3 (11.11%), fever, loose stools, and pulmonary oedema in only 1 out of 27 patients each. In majority of patients,18 (77.78%) showed no symptoms. All patients were positive for RT-PCR except one who showed ground glass opacities on HRCT.

After diagnosis, 7 (25.92%) women continued pregnancy and were lost to follow-up. Among 20 women who delivered,the mode of delivery was Lower Segment Caesarean Section (LSCS) in 12 (44.44%), normal vaginal 6 (22.22%), emergency laparotomy in 1 (3.7%) and incomplete abortion in 1 (3.7%) women (Table/Fig 3).

Among the 20 who delivered, one was Intrauterine Death (IUD) and the rest of the 19 foetuses were negative for COVID-19. This case of IUD was born to a primigravida mother with 34 weeks of breech presentation who was diagnosed with preeclampsia and had symptoms of cough and cold. The reasons for IUD maybe lack of antenatal care probably due to the pandemic, preeclampsia and abruption because we found retroplacental clot in the postdelivery period. Though we did not find any patient in Disseminated Intravascular Coagulation (DIC), inflammatory markers such as CRP was increased in 10 cases, D-dimer in 8 cases with simultaneous lymphopenia in 3 cases.

Among 19 alive foetuses, 10 required NICU admission with ventilatory support where one died. The baby died due to prematurity and respiratory distress syndrome (Table/Fig 4). Twelve foetuses were isolated from mother and none of them had vertical transmission from mother. Breast feeding was given in six foetuses (33.33%).

Augmentin, vitamin C, and zinc were given in 44.44% patients; amoxiclav, vitamin C, zinc in 40.74% patients; vitamin C, zinc in 2 (7.41%) patients; amoxiclav, vitamin C, dolo in one patient; and antihypertensives, dolo, vitamin C, zinc in one patient (Table/Fig 5).

In present study, in 100% of patients, advice for home quarantine was given. Total of 51.85% patients underwent repeat testing in follow-up and report was negative. Among the pregnant women, one patient died secondary to COVID-19 bronchopneumonia. She presented to the hospital with oxygen desaturation of 59%, fever, cough, generalised weakness and loss of taste for six days. After admission to the COVID-19 ICU, the investigations showed imminent eclampsia with blood pressure 170 by 110 mm of Hg. She delivered a preterm male baby weighing 1.4 kg who was on ventilatory support after caesarean section. Serial arterial blood gas analysis was done and patient was maintained on non invasive ventilation. The condition of the patient deteriorated on day three where she had postpartum haemorrhage. She was managed medically with oxytocin and carboprost. She was also given antipyretics dolo 650 mg and injectable antibiotics. She had hypertension for which vasopressors were started. Despite efforts, the patient had cardiorespiratory arrest and she died. We suspect refractory hypoxia as an immediate cause of septic shock secondary to COVID-19 bronchopneumonia as a proceeding cause and pregnancy as the antecedent cause.

Discussion

On December 2019, the first cases of COVID-19 pneumonia were reported from Wuhan, Hubei Province in China after which a rapid spread occurred worldwide (6). Cases of COVID-19 in pregnancy were identified by Obstetricians. This study showed the findings from 27 pregnancies confirmed to have COVID-19 during the period of October to December 2020. Studies reported that COVID-19 during pregnancy may be associated with severe maternal morbidity and the possibility of maternal-foetal transmission could not be ruled out entirely (8),(9),(10),(11),(12). The mean age of the patients in the present study was 27.11±4.5 years. Higher mean age of the patients (32±5 years) was reported in the study by Liu D et al., (4). Mean age of the patients as reported in the studies by Zaigham M and Andersson O; Liu H et al., Chen H et al., and Zhang L et al., were 31, 30, 30, and 30 years, respectively (8),(10),(12),(13).

In the present study, out of 27 patients, 13 were primigravida and 14 were multigravidas and most of the women presented at the gestational age of ≥37 weeks. Mean gestational age at the time of presentation in the studies by Liu D et al., Chen H et al., and Zhang L et al., were 224±8, 260±14, and 271±10, respectively (4),(12),(13). The common symptoms were flu like such as fever, cough and breathlessness. Fever at the time of admission was the main symptom in pregnant women with COVID-19 in the study by Liu D et al., (4). Other symptoms were cough, myalgia, fatigue, fever postpartum, sore throat, dyspnoea, and diarrhea (4). Similarly, fever and coughing were present in most of the patients in previous studies conducted on pregnant women with COVID-19 (8),(9),(11).

As reported in the recent studies by Huang C et al., Chen H et al., and Li Q et al., pregnant women with COVID-19 pneumonia demonstrated a pattern of clinical characteristics that were comparable to that of non pregnant women with COVID-19 pneumonia (14),(12),(15). With respect to the mode of delivery, many studies reported that most of the deliveries were done by caesarean section and foetal distress was the main indication (10),(12),(13). Similar was the case in the present study as the mode of delivery was LSCS in most of the women (44.44%).

Similar to present study, in study by Liu D et al., out of 15 patients, 10 were delivered by caesarean deliveries and one by vaginal delivery during the duration of the study period; four patients were pregnant: three were in the second trimester and one in the third trimester, at the end of the study period (4).

All the three patients in case report by Douedi S et al., delivered successfully by caesarean section. It was suggested that early caesarean section as well as mechanical ventilation for respiratory support to mention oxygen saturation was very beneficial for pregnant women with COVID-19 and their infants. All the three patients were extubated successfully (16). Normal vaginal delivery in the present study and other studies indicate a potential role for natural delivery in pregnant women with mild COVID-19 pneumonia. In the study by Chen H et al., evidence of vertical transmission of SARS-CoV-2 infection in late pregnancy was not seen (12).

In the present study, all patients were positive for RT-PCR except one who had ground glass opacities on HRCT suggesting that there is a vital role of Chest CT in the diagnosis and treatment of COVID-19 pneumonia. Further, there is a significant role of CRP whose levels are increased beyond 20 ng/ml in COVID-19 patients, making it a potential marker of the disease especially in paediatric population. The frequent complications of COVID-19 include Disseminated Intravascular Coagulation (DIC) which necessitates the investigative role of D-Dimer as was done in the study.

In the study by Liu D et al., on chest CT, the most common early finding was Ground Glass Opacity (GGO), out of 15 patients, lymphopenia was seen in 12 patients and elevated C-reactive protein in 10 patients (4). In another study by Liu H et al., elevated C-reactive protein was present in all 16 patients and lymphocytopenia was present in 9 patients. SARS-CoV-2 was confirmed in all patients (10). In the study by Chen H et al., elevated C-reactive protein was present in all three patients and lymphocytopenia was present in one patient. SARS-CoV-2 was confirmed in all patients (12). For management, author followed the standard protocol comprising of multivitamins, antipyretics, oral and injectable antibiotics as indicated. Liu D et al., reported that antibiotic therapy was given to all 15 patients, oxygen support (nasal cannula) in 14, and antipyretics in 11 patients (4). A recent study on COVID-19 in pregnancy mentioned that management guidelines should be on the basis of data from the present epidemic instead of drawing on the experience from previous SARS-CoV-1 and Middle East respiratory syndrome- Coronavirus (MERS-CoV) outbreaks, because there may be difference in epidemiology, clinical manifestations and response to treatment (17). In order to establish treatment algorithms for this patient group, multidisciplinary management of pregnant women with COVID-19 is of the paramount significance and the further larger studies are required (16).

After treatment, negative report was noted in patients who underwent repeat testing in the follow-up (51.85%). Home quarantine was advised to all patients however, one pregnant woman dies of bronchopneumonia in the ICU due to refractory hypoxia and pregnancy as the antecedent cause. Twenty foetuses delivered, 1 was IUD and 19 foetuses were negative for COVID-19. NICU admission was required in 10 foetuses, from which 1 died. In the study by Liu D et al., there were no cases of neonatal asphyxia, neonatal death, stillbirth, or abortion (4).

Breslin N et al., reported that there were two maternal ICU admissions of the mothers who had high Body Mass Index (BMI) (>35 kg/m2) as well as complicated medical history that resulted in question whether COVID-19 increases the risk of severe morbidity in high-risk pregnancies. There was one neonatal death and one intrauterine foetal death. Further studies should be conducted to address this issue (18).

Neonates delivered by caesarean section in the study by Douedi S et al., tested negative for COVID-19, which suggested no vertical transmission as was seen in the present study (16). Further, infants were asymptomatic during hospitalisation which suggests that infants may acquire immunity from the mother. However, further research on this aspect is needed. The disease burden of COVID-19 is increasing and thus, the results will be helpful for understanding the nature of the disease and making informed decisions while treating pregnant women with COVID-19 infection.

Limitation(s)

Present study was limited by lack of age-matched non pregnant women as a control group.

Conclusion

Cough, breathlessness, fever, loose stools and pulmonary oedema were the main symptoms in pregnant women presenting with COVID-19. Most of the pregnant patients delivered by caesarean section. All alive foetuses were negative for COVID-19 indicating that none of the foetus had vertical transmission from mother. All the women were COVID-19 negative after treatment however, one died due to bronchopneumonia. Though there was no vertical transmission of the infection to the neonate, careful monitoring and measures for the prevention of neonatal infection are warranted.

References

1.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. [crossref] [PubMed]
2.
Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J MicrobiolImmunol Infect. 2019;52(3):501-03. [crossref] [PubMed]
3.
Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191 (1):292-97. [crossref] [PubMed]
4.
Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, 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. [crossref] [PubMed]
5.
Gupta P, Kumar S, Sharma SS. SARS-CoV-2 prevalence and maternal-perinatal outcomes among pregnant women admitted for delivery: Experience from COVID-19-dedicated maternity hospital in Jammu, Jammu and Kashmir (India). J Med Virol. 2021;93(9):5505-14. doi: 10.1002/jmv.27074. Epub 2021 May 24. PMID: 33974301; PMCID: PMC8242893. [crossref] [PubMed]
6.
Yadav V, Goel N, Afreen N, Chutani N, Agarwal S. COVID 19 in pregnancy; obstetrical and neonatal outcomes: A retrospective comparative study. Indian J ObstetGynecol Res. 2020;7(4):584-89. [crossref]
7.
Arora R, Marwah S, Dhama V, Dabral A, Gupta N, Arora B. COVID-19 in pregnancy: A preliminary 50-day review from India. J Family Med Prim Care. 2021;10(2):883-92. [crossref] [PubMed]
8.
Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. ActaObstetGynecol Scand. 2020;99(7):823-29. [crossref] [PubMed]
9.
Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA, Bustillo C, Gonzales G, Vallecillo-Chinchilla G, et al. A pregnant woman with COVID-19 in Central America. Travel Med Infect Dis. 2020;36:101639. [crossref] [PubMed]
10.
Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect. 2020;80(5):e7-13. [crossref] [PubMed]
11.
Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Paediatr. 2020;9(1):51-60. [crossref] [PubMed]
12.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet. 2020;395(10226):809-15. [crossref]
13.
Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province. Zhonghua Fu Chan KeZaZhi. 2020;55(3):166-71.
14.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. [crossref]
15.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of Novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207. [crossref] [PubMed]
16.
Douedi S, Albayati A, Alfraji N, Mazahir U, Costanzo E. Successful maternal and fetal outcomes in COVID-19 pregnant women: An institutional approach. Am J Case Rep. 2020;21:e925513-1-3. [crossref] [PubMed]
17.
Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? ActaObstetGynecol Scand. 2020;99(4):439-42. [crossref] [PubMed]
18.
Breslin N, Baptiste C, Miller R, Fuchs K, Goffman D, Gyamfi-Bannerman C, et al. Coronavirus disease 2019 in pregnancy: Early lessons. Am J ObstetGynecol MFM. 2020;2(2):100111. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/50962.15899

Date of Submission: Jun 20, 2021
Date of Peer Review: Aug 01, 2021
Date of Acceptance: Nov 19, 2021
Date of Publishing: Jan 01, 2022

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: Jun 21, 2021
• Manual Googling: Nov 17, 2021
• iThenticate Software: Dec 30, 2021 (14%)

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