Farhan Fatin Shallal, Nori Wassan, Al Kadir Israa Talib Abd, Hameed Ban Hadi
Department of Gynaecology And Obstetrics, Mustansiriyah University \ College of Medicine, Baghdad, Iraq.
Senior in Gynaecology And Obstetrics, Al Yarmouk Teaching Hospital, Baghdad, Iraq.
J Obstet Gynaecol India. 2022 Dec;72(6):479-484. doi: 10.1007/s13224-022-01663-6. Epub 2022 May 24.
COVID-19 infection has raised multiple concerns in pregnant mothers; many questioned the risk of vertical transmission and the implication on the feto-maternal outcome. Cardiotocogrm (CTG) is the principal method to observe intrapartum fetal well-being. This paper aims to verify intrapartum CTG changes seen in seropositive COVID-19 mothers versus healthy controls and looks into their relation to subsequent delivery mode and neonatal outcome.
A case-control study recruited 90 pregnant women at the labor word of AL Yarmouk Teaching Hospital. All were term pregnancy admitted for delivery. They were grouped into 2: seropositive COVID-19 confirmed by real-time RT-PCR test (30/90) and healthy controls (60/90). We recorded their demographic criteria, laboratory results, CTG changes, delivery mode, and indication.
COVID-19 cases showed significantly higher pulse rate, temperature, and leukocyte counts. Cesarian deliveries (CS) were higher in cases versus healthy controls (70 % vs. 53.3 %) and P = 0.45. Analysis of the CS indications showed that abnormal fetal heart tracing accounts for 33.3 % versus 15.6 % (P-value = 0.015) for cases versus healthy controls. 60 % of COVID-19 cases exhibited abnormal CTG changes versus 19.4 % in healthy controls. These changes were primarily fetal tachycardia and reduced variabilities.
The higher incidence of abnormal CTG in COVID-19 cases, alongside infection signs and symptoms, underlies the exaggerated inflammatory reactions inside the pregnant mother. These inflammatory reactions are the main causes of CTG changes and higher CS rates. Therefore, obstetricians are advised to optimize the maternal condition to rectify reactive CTG changes rather than proceeding into urgent CS.
The online version contains supplementary material available at 10.1007/s13224-022-01663-6.
新型冠状病毒肺炎（COVID-19）感染引发了孕妇的诸多担忧；许多人质疑垂直传播的风险以及对母婴结局的影响。产时胎心监护（CTG）是观察产时胎儿健康状况的主要方法。本文旨在验证COVID-19血清学阳性母亲与健康对照组在产时CTG的变化，并探究其与随后分娩方式及新生儿结局的关系。
一项病例对照研究在亚尔穆克教学医院产房招募了90名孕妇。所有孕妇均为足月妊娠并入院分娩。她们被分为两组：经实时逆转录聚合酶链反应（RT-PCR）检测确诊的COVID-19血清学阳性组（30/90）和健康对照组（60/90）。我们记录了她们的人口统计学标准、实验室检查结果、CTG变化、分娩方式及指征。
COVID-19病例的脉搏率、体温和白细胞计数显著更高。病例组的剖宫产率高于健康对照组（70%对53.3%），P = 0.45。对剖宫产指征的分析显示，异常胎心监护在病例组中占33.3%，而在健康对照组中占15.6%（P值 = 0.015）。60%的COVID-19病例出现异常CTG变化，而健康对照组中这一比例为19.4%。这些变化主要为胎儿心动过速和变异性降低。
COVID-19病例中异常CTG的发生率较高，同时伴有感染的体征和症状，这是由于孕妇体内过度的炎症反应所致。这些炎症反应是CTG变化及剖宫产率升高的主要原因。因此，建议产科医生优化母体状况以纠正反应性CTG变化，而非直接进行紧急剖宫产。
在线版本包含可在10.1007/s13224-022-01663-6获取的补充材料。
