The Rare Case of a COVID-19 Pregnant Patient with Quadruplets and Postpartum Severe Pneumonia. Case Report and Review of the Literature

Background and Objectives: The multiple pregnancies associated with COVID-19 is a new and difficult condition to manage. The prognosis for rapid deterioration after the cesarean delivery is difficult to assess and needs close interdisciplinary follow-up due to pregnancy and postpartum-related changes. Materials and Methods: We report the case of a 37-year-old primigesta primipara patient who was admitted to “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology at 33 weeks and 3 days of gestation with high-grade multiple pregnancies (triplets) for threatened premature birth associated with COVID-19. The patient had a history of surgically corrected atrial septal defect during childhood and currently is known to have paroxysmal supraventricular tachycardia. Tocolysis was ineffective and the decision to perform a cesarean operation was made. The diagnosis was established: primigesta, primipara, at 34 weeks of gestation, high-grade multiple pregnancy with triplets, intact membranes, threatened premature birth, surgically corrected atrial septal defect, paroxysmal supraventricular tachycardia, infection with COVID-19. The patient underwent a cesarean intervention and treatment for COVID-19 pneumonia. The intervention took place at 33 weeks and 4 days of gestation resulting in four newborns with weights between 1400 g and 1820 g and Apgar scores between 6–8. All newborns were transferred to a third-degree Neonatology ICU service due to their prematurity. The fourth newborn was not identified in any of the ultrasounds performed during pregnancy. During the postpartum period, the patient had a fulminant evolution of COVID-19 pneumonia, with rapid deterioration, needing respiratory support and antiviral treatment. Discussions: Managing high-risk obstetrical pregnancies associated with COVID-19 requires a multidisciplinary team consisting of obstetricians, anesthesiologists, neonatologists, and infectious disease doctors. Conclusion: Our case is the first to our knowledge in Romania to present an association of high-grade multiple pregancy with COVID19 moderate form, rapidly evolving postpartum, needing rapid intensive care admission, and specific treatment with Remdesivir, with good post-treatment evolution.

THE RELATIONSHIP BETWEEN CHANGES IN IMMUNE STATUS AND DISORDERS OF PSYCHO-EMOTIONAL STATE IN PREGNANT WOMEN WITH IN VITRO FERTILIZATION AND THREATENED PREMATURE BIRTH

Women who experience failures at the stage of fertilization or during pregnancy can develop psycho-emotional stress as a result of prolonged negative emotions with a high level of anxiety, neurotic conflict, often accompanied by a complicated pregnancy. The international academic literature discusses a possible link between high levels of anxiety and depression, on the one hand, and changes in the state of the immune system, on the other. The aim of the research was to identify the relationship between psycho-emotional changes in pregnant women with in vitro fertilization and threatened premature birth and changes in their immune status. The psycho-emotional state was studied in 60 women in the second trimester of pregnancy with a history of infertility, whose pregnancy resulted from IVF, and with threatened premature birth. As a control group, 20 healthy women with a physiological course of pregnancy were examined. The levels of trait (TA) and state anxiety (SA), as well as the degree of depressive disorders in these women, were assessed. In parallel, the levels of pro- and anti-inflammatory cytokines and the state of cellular-humoral immunity were determined, looking for correlations between these indicators, the levels of anxiety, and manifestations of depression in the examined patients. Pregnant women with in vitro fertilization and threatened premature birth revealed high levels of state (53.3% of women) and trait (56.8% of women) anxiety; 70% of pregnant women are dominated by euphoric, anxious, and depressive types of the psychological component of gestational dominant; 33.3% of the examined women demonstrated a state of mild and masked depression. Correlations were found between an increase in SA and TA scores and an elevated concentration of TNF-α and INF-γ, as well as between an increase in the level of TNF-α and the score of depression. A connection was found between a decrease in the number of T-helpers and an increase in the TA score in the examined patients.

Evaluation of the comparative influence of magnesium sulfate single and combination with ritodrine hydrochloride in the prevention of preterm delivery

This project was designed to explore the effects of ritodrine hydrochloride combined with magnesium sulfate in the prevention of preterm delivery of patients with threatened premature birth. 128 cases of threatened premature birth were randomly divided into two groups according to the number table method. The control group was treated with magnesium sulfate, while the study group was treated with ritodrine hydrochloride combined with magnesium sulfate. The d(p>0.05). ata was analyzed using SPSS 18.0 and was subjected to Chi-square and t test. The onset time and prolonged gestation time of the study group were shorter than those of the control group (p<0.05). There was no difference in the incidence of myocardial ischemia between the study group and the control group (p>0.05). The heart rate per minute of the study group was higher than that of the control group (p<0.05). There was no difference in blood pressure between the study group and the control group Nevertheless, the neurological function, pregnancy outcome and neonatal status of the group were better than those of the control group (p<0.05).

Influence of Arterial Hypertension on the Pregnancy in Women with RH-Negative Blood

The purpose of the study was to assess the role of arterial hypertension (AH) in the development of immunization in women with Rh-negative blood to optimize perinatal outcomes. Subject and methods. A prospective comparatively study was conducted in 3 groups of pregnant women with Rh-negative blood. The 1-st group (n=148) was with hypertensive disease (HD), the 2-nd group (n=144) - with gestational arterial hypertension (GAH); the 3-rd group (n=110) - without somatic pathology. The immune-hematological studies included a definition of the partial D antigen using gel method. Results. It was definited that the pregnancy of these patients accompanied by the high frequency of early gestational toxicosis, threatened premature birth, preeclampsia, placental insufficiency as well as expressed changes immu-nological properties of blood, which are pathogenetic basis of fetal and neonatal rhesus hemolytic disease. Antibodies (AB) in the blood serum of patients with hypertension were detected in the first half of pregnancy (up to 20 weeks) in 1.2-1.4 times more often than in healthy women, high titer of AB rate in patients with HD was significantly higher compared to other groups. Disadvantageous combination of immunoglobulins subclasses Gl and G3 was found in the group of pregnant women with HD (11.4%) and GAH (10,8%), significantly less frequently (6,45%) in the control group. Conclusion. To improve maternal, fetal and neonatal gestation outcomes the authors justified the necessity of prenatal work-up and delivery of these women.