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OBJECTIVES: Sickle cell disease (SCD) occurs in 2.8 % of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. METHODS: A retrospective comparative analysis of HbSS, HbSC and HbSßThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. RESULTS: Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the 'non-HbSS' group, i.e. HbSßThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95 % 3.5-32.3; p<0.001), hospitalizations (OR 7.6, 95 % CI 3.4-16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSßThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03-0.9, p=0.03)). CONCLUSIONS: HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.

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INTRODUCCIÓN Y OBJETIVOS: COVID-19 es una patología producida por el virus RNA SARS-CoV-2, declarada pandemia por la OMS en marzo de 2020. La literatura mundial describe mayor incidencia de parto prematuro y cesáreas en pacientes infectadas por COVID-19 principalmente de origen iatrogénico, sin embargo, existen escasos datos del pronóstico del embarazo al decidir diferir el parto hasta después del período infeccioso del virus. Este trabajo reporta un grupo de embarazadas diagnosticadas con COVID-19 en tercer trimestre donde se decidió no interrumpir el embarazo y diferir su parto hasta recuperación de la patología. MÉTODOS: Estudio observacional retrospectivo que analiza resultados materno-perinatales en 9 casos de mujeres infectadas por COVID, diagnosticadas posterior a las 33 semanas y cuyo parto se verificó después de recuperadas del COVID. RESULTADOS: Se observó un 77% de pacientes sintomáticas, 77% requirieron hospitalización, 33% por COVID, todas ingresaron a unidad de paciente crítico, sólo una requirió ventilación mecánica no invasiva. Dos cursaron con cetoacidosis normo-glicémica y dos con neumonía por COVID-19. Un 88% resultó en parto de término, sólo una paciente tuvo parto prematuro de causa obstétrica. La vía de parto fue un 67% vaginal y 33% por cesárea, todas por indicación obstétrica. La latencia al parto promedio fue de 17.3 días. Los puntajes de Apgar fueron todos mayor a 7 al minuto y 5 minutos. CONCLUSIÓN: Los resultados de esta serie sugieren que, en casos seleccionados, los partos posteriores al período infeccioso del COVID se asocian a buenos resultados materno-perinatales, sin embargo, resulta importante aumentar la casuística.

INTRODUCTION AND OBJECTIVES: COVID-19 is a pathology produced by the RNA virus SARS-CoV-2, declared a pandemic by the WHO in March of 2020. The world literature describes more preterm birth and caesarean section in pregnant women infected by COVID-19, principally by medical indication, but it has not been described in depth what happens when we differ delivery after the infectious period. This report reviews a subgroup of patients who were diagnosed with COVID-19 in the third trimester and decided to differ birth until they recovered from the disease. METHODS: Retrospective observational study that analyzes maternal and perinatal outcome of 9 women who were diagnosed with COVID-19 after the 33 weeks of pregnancy, decided to differ delivery and had their birth recovered from the disease. RESULTS: We observed 77% of patients symptomatic, 77% required hospitalization, 33% because of COVID, all admited to critical patient care, only one required non invasive mechanical ventilation. 2 patients suffered normoglycemic ketoacidosis, 2 had COVID-19 pneumonia. An 88% resulted in term birth, only 1 was prematurely interrupted by obstetric cause. 66% patients had vaginal delivery and 33.3% caesarean section, all by obstetric cause. The average latency to birth was 17.3 days. Apgar scores were all more than 7 at minute 1 and 5. CONCLUSION: The results of this series suggest that in selected cases where the clinical characteristics allow it, to differ interruption of pregnancy until after the infectious period can associate to good outcomes of maternal and neonatal morbimortality, however, it's fundamental to continue research.

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Objetivo: Evaluar el comportamiento de marcadores bioquímicos: proteína plasmática asociada al embarazo (PAPP-A) y fracción β de la hormona gonadotrofina coriónica (β hCG) con resultado materno y perinatal adverso en el Hospital “Dr. Adolfo Prince Lara”. Métodos: Estudio prospectivo, comparativo en 35 gestantes con embarazos simples entre las 11 y 13 semanas + 6 días y resultado del embarazo conocido. Se realizó tamizaje combinado: traslucencia nucal, hueso nasal, ductus venoso, longitud craneocaudal y marcadores bioquímicos (PAPP-A y β -hCG). Se determinó la concentración de PAPP-A y β -hCG y sus resultados se expresaron en MoM. Variables cuantitativas fueron expresadas en media y desviación estándar (DE), cualitativas en porcentajes y se compararon estas variables entre el grupo de gestantes con resultado materno perinatal normal (RMPN) y adverso (RMPA) con la prueba U de Mann-Whitney. Resultados: 71 % tuvieron un RMPN y 29 % RMPA. No se encontraron diferencias entre los grupos respecto a edad materna, peso materno, IMC, paridad, presión arterial. La PAPP-A expresado en MoM presentan un valor más alto en las embarazadas que tuvieron un RMPA (1,07 vs 1,43) siendo estadísticamente significativo, los valores de β-HCG tuvieron valores más altos (0,60 vs 0,76) entre el grupo con RMPA en relación al grupo con RMPN sin llegar a la significancia estadística. Conclusión: Valores de la MoM PAPP-A difieren en las embarazadas con RMPA de aquellas con resultado normal, pero con valores mayores en las primeras, contrario a lo encontrado en la mayoría de las publicaciones estudiadas, iguales hallazgos con la β-hCG. Se debe profundizar en estos estudios para verificar los resultados encontrados.

Objective: To evaluate the behavior of biochemical markers PAPP-A and β hCG with adverse pregnancy and perinatal outcomes. Methods: Prospective, comparative study in 35 pregnant women with singleton pregnancies between 11 and 13 weeks + 6 days and outcome of pregnancy known. Nuchal translucency, nasal bone, ductus venosus, rump length and biochemical markers (PAPP-A and β-hCG) combined screening was performed. The concentration of PAPP-A and β-hCG was determined and the results were expressed in MoM. Quantitative variables were expressed as mean and standard deviation (SD), and these percentages qualitative variables between the group of pregnant women with a normal perinatal maternal outcome (NPMO) and adverse (AMPO) with the U Mann-Whitney test were compared. Setting: Hospital “Dr. Adolfo Prince Lara”. Results: 71 % had a NPMO and 29 % had an AMPO. No differences between the groups in respect of maternal age, maternal weight, BMI, parity, blood pressure were found. PAPP-A MoM have expressed a higher value in pregnant having an AMPO (1.07 vs 1.43) were statistically significant, the values of β-HCG had higher values (0.60 vs 0.76) between the group with AMPO relative to NMPO group without reaching statistical significance. Conclusion: MoM values of PAPP-A differ in pregnant with AMPO than in those with normal results, but with higher values in the first opposite to that found in most of the studied publications, the same findings with β-hCG. Thus, it should look into these studies to verify the results found.

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