3.Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore.
Citra Nz MATTAR ; Shirin KALIMUDDIN ; Sapna P SADARANGANI ; Shephali TAGORE ; Serene THAIN ; Koh Cheng THOON ; Eliane Y HONG ; Abhiram KANNEGANTI ; Chee Wai KU ; Grace Mf CHAN ; Kelvin Zx LEE ; Jeannie Jy YAP ; Shaun S TAN ; Benedict YAN ; Barnaby E YOUNG ; David C LYE ; Danielle E ANDERSON ; Liying YANG ; Lin Lin SU ; Jyoti SOMANI ; Lay Kok TAN ; Mahesh A CHOOLANI ; Jerry Ky CHAN
Annals of the Academy of Medicine, Singapore 2020;49(11):857-869
INTRODUCTION:
Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.
METHODS:
Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.
RESULTS:
Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).
CONCLUSION
The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.
Abortion, Spontaneous/epidemiology*
;
Adult
;
COVID-19/transmission*
;
COVID-19 Nucleic Acid Testing
;
COVID-19 Serological Testing
;
Cohort Studies
;
Disease Transmission, Infectious/statistics & numerical data*
;
Female
;
Fetal Blood/immunology*
;
Humans
;
Infectious Disease Transmission, Vertical/statistics & numerical data*
;
Live Birth/epidemiology*
;
Maternal Age
;
Milk, Human/virology*
;
Obesity, Maternal/epidemiology*
;
Placenta/pathology*
;
Pregnancy
;
Pregnancy Complications, Infectious/physiopathology*
;
Pregnancy Outcome/epidemiology*
;
Pregnancy Trimester, First
;
Pregnancy Trimester, Second
;
Prospective Studies
;
RNA, Viral/analysis*
;
Risk Factors
;
SARS-CoV-2
;
Severity of Illness Index
;
Singapore/epidemiology*
;
Umbilical Cord/pathology*
;
Young Adult
4.Radiographic features of COVID-19 based on an initial cohort of 96 patients in Singapore.
Hau Wei Wei KHOO ; Terrence Chi Hong HUI ; Salahudeen Mohamed Haja MOHIDEEN ; Yeong Shyan LEE ; Charlene Jin Yee LIEW ; Shawn Shi Xian KOK ; Barnaby Edward YOUNG ; Sean Wei Xiang ONG ; Shirin KALIMUDDIN ; Seow Yen TAN ; Jiashen LOH ; Lai Peng CHAN ; Angeline Choo Choo POH ; Steven Bak Siew WONG ; Yee-Sin LEO ; David Chien LYE ; Gregory Jon Leng KAW ; Cher Heng TAN
Singapore medical journal 2021;62(9):458-465
INTRODUCTION:
Chest radiographs (CXRs) are widely used for the screening and management of COVID-19. This article describes the radiographic features of COVID-19 based on an initial national cohort of patients.
METHODS:
This is a retrospective review of swab-positive patients with COVID-19 who were admitted to four different hospitals in Singapore between 22 January and 9 March 2020. Initial and follow-up CXRs were reviewed by three experienced radiologists to identify the predominant pattern and distribution of lung parenchymal abnormalities.
RESULTS:
In total, 347 CXRs of 96 patients were reviewed. Initial CXRs were abnormal in 41 (42.7%) out of 96 patients. The mean time from onset of symptoms to CXR abnormality was 5.3 ± 4.7 days. The predominant pattern of lung abnormality was ground-glass opacity on initial CXRs (51.2%) and consolidation on follow-up CXRs (51.0%). Multifocal bilateral abnormalities in mixed central and peripheral distribution were observed in 63.4% and 59.2% of abnormal initial and follow-up CXRs, respectively. The lower zones were involved in 90.2% of initial CXRs and 93.9% of follow-up CXRs.
CONCLUSION
In a cohort of swab-positive patients, including those identified from contact tracing, we found a lower incidence of CXR abnormalities than was previously reported. The most common pattern was ground-glass opacity or consolidation, but mixed central and peripheral involvement was more common than peripheral involvement alone.
COVID-19
;
Humans
;
Lung/diagnostic imaging*
;
Radiography, Thoracic
;
Retrospective Studies
;
SARS-CoV-2
;
Singapore