Figure 1
Objective: To review studies published with pregnant women infected with SARS-CoV-2 and analyze the evolution of them and also of the newborn in order to learn about this pathology in pregnant women. Search strategy: Systematic review in the PUBMED and GOOGLE Scholar databases until March 30, 2020. This research was extended to the references of such articles. Selection criteria: Observational studies that examined maternal and perinatal outcomes of pregnant women with SARS-CoV-2 are published. Data collection and analysis: Data about study characteristics, maternal y perinatal outcomes variable extracted. Main results: We found 14 publications regarding a total of 83 pregnant women with SARS-CoV-2 and results of 84 newborns. The average gestational age was 37 weeks. The most common symptom was fever, and 30% of the pregnant women had lymphopenia on admission to hospital. Cesarean section was performed in 89% of the patients; 70% of them were indicated by SARS-CoV-2. The most common obstetric complication was premature rupture of membranes in 9.6% of them. The need for ventilation support was low. The use of antivirals, corticosteroids, and drugs for the pathology management was scarce, except for antibiotics. Preterm birth was 25%, perinatal mortality was low, and there was no maternal death. There was no evidence of vertical transmission. Conclusion: Maternal and perinatal morbidity-mortality is lower than in other known respiratory diseases. Currently, it appears to be no benefit from antivirals and other drugs, beyond the general support of the disease, and vertical transmission of the virus has not been demonstrated.
Flow diagram (figure1)
Background: The optimal duration of magnesium administration postpartum for prevention of eclampsia has not yet been established. Objective: To investigate the effect of early discontinuation of postpartum magnesium on the rates of postpartum eclampsia when compared to continuation for 24-hour postpartum. Search Strategy: Searches were performed using keywords related to “preeclampsia” and “magnesium sulfate” from inception of database until March 2019. Selection Criteria: Randomized controlled trials of women with preeclampsia receiving magnesium prior to delivery randomized to early discontinuation of magnesium postpartum. The control group was 24-hours of magnesium postpartum. Data Collection and Analysis: The primary outcome was the rate of postpartum eclampsia. Main Results: Eight RCTs with 2,183 women were included with five different magnesium administration time-frames. Eclampsia rates were not different between the two groups (5/1,088 (0.5%) after early discontinuation, versus 2/1,095 (0.2%) in the 24-hour group; RR 2.25, 95% CI 0.5-9.9, I2=0%, 8 studies, 2,183 participants). A number needed to treat was calculated; 370 women would need to receive 24-hours of magnesium postpartum to prevent one episode of postpartum eclampsia. The early discontinuation group had a significant decrease in time to ambulation and breastfeeding. Conclusions: Compared to continuation of magnesium for 24 hours postpartum, early magnesium discontinuation postpartum does not significantly increase the rate of postpartum eclampsia. The largest proportion of women did not receive magnesium postpartum after receiving at least 8 grams intrapartum, thus it is reasonable to consider discontinuation of magnesium postpartum if a woman has received similar adequate dose prior to delivery.