Updated algorithm for managing patients who have had COVID-19 in different trimesters of pregnancy

Introduction. Due to the accumulation of new data on the specific effects of COVID-19 on pregnancy, maternal, and perinatal outcomes during acute infection and in convalescents, it is advisable to improve the management algorithm for patients who have had COVID-19 in different trimesters of pregnancy.

Study Objective. Justification of an updated algorithm for managing patients who have had COVID-19 in different trimesters of pregnancy.

Materials and Methods. To substantiate the modernized algorithm for managing patients who have had COVID-19 of varying severity in different trimesters of gestation, a retrospective study was conducted on 1,368 pregnant women with acute COVID-19 (U07.1) to assess the clinical and laboratory features, course, and outcomes of gestation, as well as the histological and immunohistochemical features of placentas in the context of acute infection and during the convalescence period, in a comparative aspect. Of the 1,368 pregnant women, 161 were in the 1st trimester, 456 were in the 2nd trimester, and 751 were in the 3rd trimester of gestation. The comparison group consisted of 90 pregnant women without COVID-19.

Results. In 1/3 of cases, regardless of the severity of the infection, spontaneous abortion occurs in the 1st trimester of pregnancy, with a predominance of failed miscarriages. There is a high incidence of diabetes mellitus, which is first detected during pregnancy, both in patients with acute COVID-19 and in convalescents. All prolonged pregnancies end in timely, spontaneous births. The weight of newborns from convalescents is statistically significantly lower than that of pregnant women without COVID-19. In the 2nd trimester, COVID-19 is associated with a high incidence of diabetes mellitus, which is first detected during pregnancy, and placental insufficiency. There have been cases of maternal death due to severe COVID-19. Stillbirth (mainly fetal death) is more common in cases of mild and moderate infection. Convalescents have a high incidence of diabetes mellitus that was first detected during pregnancy, after severe COVID-19, an increased incidence of caesarean section, and a statistically significant decrease in the weight of newborns compared to pregnant women without COVID-19. Manifestation of COVID-19 in the 3rd trimester of gestation is accompanied by an increase in the frequency of diabetes mellitus, which is first detected during pregnancy, statistically significant in the case of extremely severe infection, and placental insufficiency, which is statistically significant in the case of any degree of severity of COVID-19, compared to pregnant women without COVID-19. An increase in the frequency of premature birth due to cesarean section is associated with the severity of COVID-19. There have been cases of maternal death in the case of extremely severe COVID-19. The body weight and length of newborns decrease significantly, and the number of newborns born in asphyxia increases significantly in patients with COVID-19 as the severity of the infection increases. Stillbirth, predominantly fetal death, is observed in patients with mild/moderate COVID-19. In convalescents, the course of gestation does not differ from that of pregnant women without COVID-19, and the frequency of cesarean section increases. The weight of newborns after COVID-19 is statistically significantly lower compared to newborns from pregnant women without COVID-19. A comprehensive morphological study of placentas indicates placental insufficiency of mixed genesis both during acute COVID-19 and in convalescents, regardless of the trimester of manifestation and the severity of the infection. Based on the data obtained, an updated algorithm for managing pregnant women in outpatient and inpatient settings during acute COVID-19 and during convalescence, taking into account the trimester of manifestation and the severity of the infection, has been developed.

Conclusion. The developed modernized algorithm for managing pregnant women during acute COVID-19 and during convalescence, taking into account the trimester of manifestation and severity of the infection, allows for a predictive and personalized approach to the management of obstetric patients, taking into account/based on the prediction of obstetric and perinatal risks.

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