Data are mixed regarding preterm birth (PTB) rates during the COVID19 pandemic, with many reports suggesting a decrease in PTB. We sought to determine the rates of short cervix and PTB in our cohort during the pandemic. This was a retrospective cohort study of women with singleton gestations presenting for anatomical survey between 16 and 24 weeks and delivering at a single-institution in NYC, where universal transvaginal cervical length (TVCL) screening is performed at anatomical survey and universal testing for COVID19 is performed at delivery. Included women had TVCL measurements between March and May, 2020 and delivered before 8/17/2020. Women with incomplete outcome data were excluded. Our primary outcome, cervical shortening, defined as TVCL <2.5cm was compared between exposure groups: women who ever tested positive for SARS-CoV-2 by RT-PCR or IgG positive by serology at any time during the pregnancy and those testing negative. Secondary outcomes included spontaneous PTB (sPTB), preterm prelabor rupture of membranes (PPROM) and other adverse perinatal outcomes. Data were abstracted from electronic medical records and compared between groups. The rate of sPTB was then compared to a historical cohort in the same delivery time period. 316 women were included. Hispanics were disproportionally affected by COVID19 (Table 1). Of 60 COVID+ women, 33 (55%) women had positive RT-PCR, most with mild symptoms, and 53 (88%) women had positive IgG near delivery. There were no cases of short cervix in the positive group. The data suggest a higher rate of PPROM in the positive group but after controlling for confounders, our numbers were too small to confirm this difference (aOR 2.34, 95% CI 0.84-6.46) (Table 2). Similarly, there was no difference in sPTB rates between the groups (aOR 1.35, 95% CI 0.48-3.75). Further, there was no difference in sPTB relative to the same time period in 2019 (2.9% vs 3.1%, p=0.68). In our cohort, COVID19 RT-PCR or IgG positive patients had a similar to slightly increased odds of cervical shortening, sPTB, and PPROM compared to negative patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
The objective of this study was to understand the available financial assistance for infertility treatments provided by private foundations in the United States and Canada. Cross-sectional study. Institutional Review Board (IRB) approval was obtained. A web-based search was performed to identify private foundations that provide financial support for infertility treatments. Foundations were invited to participate in a 14-question survey via email and non-responders were contacted by email and phone to increase participation. Descriptive statistics were analyzed. Thirty-eight foundations that provide grant support for infertility treatments were identified. Twenty-six of the 38 foundations (68%) completed the survey, 1 foundation declined participation, and 11 did not respond. Among the 26 foundations, 9996 grants had been awarded for infertility treatments, with 1800 grants awarded in 2016 alone. Grants were either in the form of financial assistance (range $500-$25,000) or donated services (discounted treatment, reduced cost or fully covered IVF cycles). Eighty-eight percent (23/26) of foundations provided assistance to infertile couples, 12% (3/26) provided assistance solely for fertility preservation in cancer patients and 19% (5/26) provided financial support for elective oocyte cryopreservation. Seventy-three percent (19/26) and 65% (17/26) of the foundations included lesbian women and gay men respectively among grant awardees and 50% (13/26) assisted transgender patients. The included foundations have existed for between 2 and 25 years, with half of the foundations in existence for less than 10 years (median 7.5 years). Ninety-six percent (25/26) of foundations have a governing board. Fifty-eight percent (15/26) of foundations serve the entire United States, 15% (4/26) serve a given region, and 23% (6/26) serve a given state/province within the United States or Canada. Forty-two percent (11/26) charge an application fee (average $42, maximum $60). Private foundations vary greatly in the populations they serve, the geographic regions they cover and the amount of funds and services they provide. While private foundations have made an impact on the lives of many individuals, a more permanent solution of increased insurance coverage for infertility services is greatly needed.
Respiratory distress in late-preterm and early term infants generally may warrant admission to a special care nursery or an intensive care unit. In particular, respiratory distress syndrome and transient tachypnea of the newborn are the two most common respiratory morbidities. Antenatal corticosteroids (ACS) facilitate surfactant production and lung fluid resorption. The use of ACS has been proven to be beneficial for preterm infants delivered at less than 34 weeks’ gestation. Literature suggests that the benefits of giving antenatal corticosteroids may extend to late-preterm and early term infants as well. This review discusses the short-term benefits of ACS administration in reducing respiratory morbidities, in addition to potential long term adverse effects. An update on the current practices of ACS use in pregnancies greater than 34 weeks’ gestation and considerations of possibly extending versus restricting this practice to certain settings will also be provided.
BACKGROUND: Varicella vaccination of non-immune post-partum women is recommended to reduce the risk of chickenpox in mothers and their infants. Though rare, transmission of the varicella vaccine strain vOka can occur from recent vaccinees to non-immune contacts who usually develop mild chickenpox. METHODS/RESULTS: Here we describe an infant hospitalized in the neonatal ICU with vaccine-strain varicella due to transmission from their mother who received the varicella vaccine post-partum. We describe the infection prevention and control strategies implemented to prevent further transmission. CONCLUSION: Vaccine-strain varicella transmission from mother to infant is a rare event and its occurrence in the neonatal ICU setting can be challenging. Anticipatory guidance for mothers vaccinated in the postpartum period and support of parents of an infected infant are recommended.
Abstract The coordinated biomechanical performance, such as uterine stretch and cervical barrier function, within maternal reproductive tissues facilitates healthy human pregnancy and birth. Quantifying normal biomechanical function and detecting potentially detrimental biomechanical dysfunction (e.g., cervical insufficiency, uterine overdistention, premature rupture of membranes) is difficult, largely due to minimal data on the shape and size of maternal anatomy and material properties of tissue across gestation. This study quantitates key structural features of human pregnancy to fill this knowledge gap and facilitate three-dimensional modeling for biomechanical pregnancy simulations to deeply explore pregnancy and childbirth. These measurements include the longitudinal assessment of uterine and cervical dimensions, fetal weight, and cervical stiffness in 47 low-risk pregnancies at four time points during gestation (late first, middle second, late second, and middle third trimesters). The uterine and cervical size were measured via 2-dimensional ultrasound, and cervical stiffness was measured via cervical aspiration. Trends in uterine and cervical measurements were assessed as time-course slopes across pregnancy and between gestational time points, accounting for specific participants. Patient-specific computational solid models of the uterus and cervix, generated from the ultrasonic measurements, were used to estimate deformed uterocervical volume. Results show that for this low-risk cohort, the uterus grows fastest in the inferior-superior direction from the late first to middle second trimester and fastest in the anterior-posterior and left-right direction between the middle and late second trimester. Contemporaneously, the cervix softens and shortens. It softens fastest from the late first to the middle second trimester and shortens fastest between the late second and middle third trimester. Alongside the fetal weight estimated from ultrasonic measurements, this work presents holistic maternal and fetal patient-specific biomechanical measurements across gestation.
