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Abbreviations SARS-CoV: Severe acute respiratory syndrome corona virus; COVID-19: Coronavirus disease 2019; PRESS EBC: Peer Review of Electronic Search Strategies Evidence-Based Checklist; NOS: Newcastle-Ottawa Quality Assessment Scale; RT-PCR: Real-time polymerase chain reaction; CDC: Centers for Disease Control and Prevention; PROSPERO: The International Prospective Register of Systematic Reviews; PRISMA-P: The Preferred Reporting Item for Systematic Review and Meta-analysis

Abbreviations SARS-CoV: Severe acute respiratory syndrome corona virus; COVID-19: Coronavirus disease 2019; PRESS EBC: Peer Review of Electronic Search Strategies Evidence-Based Checklist; NOS: Newcastle-Ottawa Quality Assessment Scale; RT-PCR: Real-time polymerase chain reaction; CDC: Centers for Disease Control and Prevention; PROSPERO: The International Prospective Register of Systematic Reviews; PRISMA-P: The Preferred Reporting Item for Systematic Review and Meta-analysis

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Background: Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during...

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... A few studies reported negative consequences of COVID-19 on maternal and fetal outcomes [31][32][33]. Considering the coagulation disorder associated with COVID-19, a cautious approach was advised by the panelist [34]. ...
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Background and objective: It aimed to develop an expert consensus regarding the risk assessment, diagnosis, and threatened miscarriage management during the first trimester in Pakistan. Methods: A three-step modified Delphi method was applied to develop the consensus. Eleven specialized obstetricians and gynecologists participated in its development. If 75% or higher agreement level was attained on each assertion, it was declared as a consensus. Results: Age of 35 or above, previous history of two or more previous miscarriages, and direct strong trauma were considered to be threatened miscarriage risk factors. Infection was discussed and specified to include specific infectious diseases, like malaria, and COVID-19 as a risk factor. The experts agreed from the first time on considering endocrinological disorders, thrombophilia, and lifestyle variables as threatened miscarriage risk factors. They proposed adding a statement concerning acquired thrombophilia which was accepted unanimously. Finally, experts agreed on the importance of educating pregnant women about factors whose risk can be modified by modifying their behavior. As for diagnosis statements, it was agreed to be trifold: physical examination, imaging, and laboratory testing. Physical examination included abdominal and pelvic exams but focused more on vaginal examination with speculum to identify bleeding severity and etiology. The statements regarding the imaging approaches to diagnose threatened miscarriage in the first trimester achieved a consensus in most statements. TVS was recommended to check on uterine structural abnormalities, fetus viability focusing on heartbeat and crown-to-rump length, gestation sac size and emptiness, subchorionic hematoma, and ectopic pregnancy. Each was defined on how to identify and diagnose in separate statements. Statements about laboratory tests indicated the need for human chorionic gonadotropin hormone assessment whether serial or once is dependent on the ultrasound. Recommended hematologic investigations include complete blood count for anemia, Rh factor for potential bleeding risk and in special cases, thrombophilia assessment is undertaken. The first and foremost management aspect was follow-up while most management statements were controversial, and some were altogether removed with only some reaching agreement after discussion. Conclusion: These consensus statements aggregated the best available evidence and experts’ opinion-supported statements to improve patient education, risk assessment, diagnosis, and evaluation as well as management of threatened miscarriage during the first trimester in Pakistan.
... There was significant negative correlation between maternal complications and EFW (P-value = 0.014) and BPD (P-value = 0.023). There was significant negative correlation between neonatal complications and AST (P-value = 0.033) and ALT (P-value = 0.039) levels Thomas et al. (2020) aimed to study the impact COVID-19 infection during pregnancy, involving effects on the mother and her baby. According to their findings, about 2.5% had maternal complication with preterm labor occurring in 50% of mothers who suffered from complication. ...
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... On 30 January 2020, the World Health Organization (WHO) officially declared the disease outbreak an international public health emergency [4]. Exposure to SARS-CoV-2 causes pneumonia with increased mortality, while the management of the perinatal period has led to the creation of special protocols [5]. In addition to the economic and social upheavals the pandemic has led to, there have been shocks to the global health system. ...
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... 12 In this study, 51.85% of pregnant women were infected with SARS COV-2 in 3 rd trimester, 35.18% were in 2 nd trimester and 12.96% were in 1 st trimester. Similarly, of the 23 pregnant patients, 19 were in their third trimester of pregnancy and were infected with COVID-19 in another study. 13 Concerning severity, 29 patients (53.7%) were the mild case, moderate 05 (9.26%) and 20 patients (37.04%) were severe. ...
... These complications were similar to the findings of another study. 19 Out of 54 patients, 48 patients (88.88%) recovered and 6 patients (11.11%) died in the hospital. Regarding fetal outcome, the number of healthy babies was 40 (74.07%), ...
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The great majority of existing studies suggests that the prognosis and outcomes of SARS-CoV-2 infections are improved with adequate vitamin D levels, with or without supplementation. Simultaneously, whether vitamin D supplementation during pregnancy lessens the chance of developing gestational hypertension is controversial. The objective of the present research was to evaluate whether vitamin D levels during pregnancy differ substantially among pregnant women who develop gestational hypertension following SARS-CoV-2 infection. The current research was designed as a prospective cohort following the pregnant women admitted to our clinic with COVID-19 until 36 weeks of gestation. Total vitamin D (25(OH)D) levels were measured in the three study groups in which pregnant women with COVID-19 during pregnancy and a diagnosis of hypertension after 20 weeks of gestation were considered the group of cases (GH-CoV). The second group (CoV) included those with COVID-19 and no hypertension, while the third group (GH) included those with hypertension and no COVID-19. It was observed that 64.4% of SARS-CoV-2 infections in the group of cases occurred during the first trimester, compared to 29.2% in the first trimester among the controls who did not develop GH. Normal vitamin D levels were measured at admission in a significantly higher proportion of pregnant women without GH (68.8% in the CoV group vs. 47.9% in the GH-CoV group and 45.8% in the GH group). At 36 weeks of gestation, the median values of 25(OH)D in the CoV group was 34.4 (26.9–39.7) ng/mL compared to 27.9 (16.2–32.4) ng/mL in the GH-CoV group and 29.5 ng/mL (18.4–33.2) in the GH group, while the blood pressure measurements remained over 140 mmHg among the groups who developed GH. There was a statistically significant negative association between serum 25(OH)D levels and systolic blood pressure (rho = −0.295; p-value = 0.031); however, the risk of developing GH was not significantly higher among pregnant women with COVID-19 if the vitamin D levels were insufficient (OR = 1.19; p-value = 0.092) or deficient (OR = 1.26; p-value = 0.057). Although insufficient or deficient vitamin D among pregnant women with COVID-19 was not an independent risk factor for the development of GH, it is likely that an association between first-trimester SARS-CoV-2 infection and low vitamin D plays a key role in developing gestational hypertension.
... 4 Pregnancy is one of the most pleasant experiences but at the same time it can be one of the most critical periods in the life of a woman. 2,5 A "Positive childbirth experience," as per WHO, is a significant final state of accomplishment for all laboring women which refers to a safe clinical and psychological environment where a woman's desire of physiological labor and birthing a healthy baby is fulfilled or exceeded. Increasing burden of cases has put the healthcare facilities with limited resources at a tough test. ...
... The unfavorable impact of SARS-CoV-2 infection during pregnancy might be due to the RAAS dysregulation (4). The most common COVID-19 related adverse outcomes in the pregnant women include maternal sepsis, preeclampsia, premature rupture of membrane and post-partum hemorrhage (6). Also, hypertension is known as a strong risk factor for complicated COVID-19 (7). ...
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters cells through angiotensin converting enzyme 2 (ACE2), which expression of its gene increases during pregnancy that is resulted in an enhanced level of the ACE2 enzyme. It might enhance the risk of SARS-CoV-2 infection and its complications in the pregnant women. Although, pregnancy hypertensive disorders and severe infection with SARS-CoV-2 are correlated with high comorbidity, these two entities should be discriminated from each other. Also, there is a concern about the risk of preeclampsia and consequently severe coronavirus disease 2019 (COVID-19) development in the pregnant women. So, to answer these questions, in the present review the literature was surveyed. It seems there is higher severity of COVID-19 among pregnant women than non-pregnant women and more adverse pregnancy outcomes among pregnant women infected with SARS-CoV-2. In addition, an association between COVID-19 with preeclampsia and the role of preeclampsia and gestational hypertension as risk factors for SARS-CoV-2 infection and its complications is suggested. However, infection of the placenta and the SARS-CoV-2 vertical transmission is rare. Various mechanisms could explain the role of COVID-19 in the risk of preeclampsia and association between preeclampsia and COVID-19. Suggested mechanisms are included decreased ACE2 activity and imbalance between Ang II and Ang-(1-7) in preeclampsia, association of both of severe forms of COVID-19 and pregnancy hypertensive disorders with comorbidity, and interaction between immune system, inflammatory cytokines and the renin angiotensin aldosterone system and its contribution to the hypertension pathogenesis. It is concluded that preeclampsia and gestational hypertension might be risk factors for SARS-CoV-2 infection and its complications.
... This could be explained by the fear and anxiety that media of communication created when they notified people about the pandemic. However, to date, the current available (21)(22)(23) data suggest that COVID-19 in pregnant women has a similar clinical presentation and illness severity to non-pregnant adults, without adverse maternal or perinatal outcomes. ...
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... The coronavirus is transmitted to humans through droplets or contact of contaminated surfaces with mucous membranes [5]. Clinical findings of the disease are fever, cough, myalgia, headache, diarrhea, neurological findings in some cases, rash, and thrombosis [14][15][16][17]. In general, the disease has a mild course, with 14% of patients requiring hospitalization and oxygen support, and 5% intensive care and mortality is 2% [4,14]. ...
... Clinical findings of the disease are fever, cough, myalgia, headache, diarrhea, neurological findings in some cases, rash, and thrombosis [14][15][16][17]. In general, the disease has a mild course, with 14% of patients requiring hospitalization and oxygen support, and 5% intensive care and mortality is 2% [4,14]. COVID-19 has a mild course in infected infants <1 year of age [18]. ...
... During pregnancy, important physiological changes occur (significant increase in volume of distribution, lower albumin concentrations, hormone-induced susceptibility to liver toxicities, etc.) [6], leading to a state of partial immunosuppression, which results in increased vulnerability to viral infections [4][5][6][7][8][9]. ...
... Thomas et al. [7] 2020 Maternal and perinatal outcomes and pharmacological management of COVID-19 infection in pregnancy: A systematic review protocol. ...
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The recent respiratory virus known as SARS-CoV-2 has caused millions of deaths worldwide, causing great uncertainty due to the lack of a specific treatment, which has been mitigated by the use of various drugs traditionally used against other types of pathologies. Pregnancy presents special physiological conditions that expose the pregnant woman and the foetus to greater risk. Pregnant women are often excluded from trials due to possible risk of toxicity or side effects, resulting in a lack of knowledge about the use of drugs and treatments during pregnancy. The main objective of this review was to compile existing knowledge about currently available drug treatments for COVID-19 in pregnant women. The review report met the criteria of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) review protocol and was registered with the registration number CRD42021251036. The electronic databases searched were Scopus, PubMed, CINAHL and SciELO. Finally, 22 articles were included, resulting in an analysis of drugs with an acceptable safety profile in the treatment of pregnant women with COVID-19.