RESUMEN
OBJECTIVE: To describe clinical characteristics of pregnant and postpartum women with severe COVID-19 in Brazil and to examine risk factors for mortality. DESIGN: Cross-sectional study based on secondary surveillance database analysis. SETTING: Nationwide Brazil. POPULATION OR SAMPLE: 978 Brazilian pregnant and postpartum women notified as COVID-19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020. METHODS: Data was abstracted from the Brazilian ARDS Surveillance System (ARDS-SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. MAIN OUTCOME MEASURES: Case fatality rate. RESULTS: We identified 124 maternal deaths, corresponding to a case fatality rate among COVID-19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID-19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect. CONCLUSIONS: Negative outcomes of COVID-19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period. TWEETABLE ABSTRACT: A total of 124 COVID-19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.
Asunto(s)
Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/epidemiología , Obesidad Materna/epidemiología , Neumonía Viral/mortalidad , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/mortalidad , Trastornos Puerperales/mortalidad , Síndrome de Dificultad Respiratoria/mortalidad , Adulto , Betacoronavirus , Brasil , COVID-19 , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Infecciones por Coronavirus/terapia , Cuidados Críticos , Estudios Transversales , Bases de Datos Factuales , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Mortalidad , Análisis Multivariante , Pandemias , Neumonía Viral/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Trastornos Puerperales/terapia , Respiración Artificial , Síndrome de Dificultad Respiratoria/terapia , Factores de Riesgo , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Adulto JovenAsunto(s)
Cesárea/estadística & datos numéricos , Depresión Posparto/epidemiología , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Edad Gestacional , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Femenino , Humanos , EmbarazoRESUMEN
CONTEXT: The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. CASE REPORT: In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes.
Asunto(s)
Calcinosis/diagnóstico , Muerte Fetal/diagnóstico , Embarazo Abdominal/diagnóstico , Adulto , Calcinosis/cirugía , Femenino , Muerte Fetal/cirugía , Humanos , Embarazo , Embarazo Abdominal/cirugíaRESUMEN
We report a case of placenta percreta diagnosed by ultrasound and color doppler image at the fourteenth week of gestation. Initial approach was a trial of IM methotrexate followed by total hysterectomy, during which was observed a rupture of the uterus with the adherence of the placenta to the posterior region of the bladder. We also present a literature review on the incidence of placenta percreta, etiology, diagnosis, treatment, and complications.