akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2022.314akusherstvo-1416Research ArticleОRIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИAnalyzing pregnancy course and outcomes in women with varying degrees of severity of novel coronavirus infection COVID-19 in Saint Petersburg: the lessons from pandemicАнализ течения и исходов беременности у женщин с различной степенью тяжести новой коронавирусной инфекции COVID-19 в Санкт-Петербурге: уроки пандемииhttps://orcid.org/0000-0002-7807-4929БеженарьВ. Ф.BezhenarV. F.

Беженарь Виталий Фёдорович – д.м.н., профессор, зав. кафедрами акушерства, гинекологии и неонатологии и акушерства, гинекологии и репродуктологии

Researcher ID: R-7055-2017

Россия, 197022 Санкт-Петербург, ул. Льва Толстого, д. 6–8

Vitaly F. Bezhenar – MD, Dr Sci Med, Professor, Head of the Departments of Obstetrics, Gynecology and Neonatology and Obstetrics, Gynecology and Reproductology

Researcher ID: R-7055-2017.

6–8 Lev Tolstoy Str., Saint Petersburg 197022, Russia

https://orcid.org/0000-0002-4378-6424РомановаМ. Л.RomanovaM. L.

Романова Мария Львовна – к.м.н., доцент кафедры акушерства, гинекологии и репродуктологии

Россия, 197022 Санкт-Петербург, ул. Льва Толстого, д. 6–8

Maria L. Romanova – MD, PhD, Associate Professor, Department of Obstetrics, Gynecology and Reproductology

6–8 Lev Tolstoy Str., Saint Petersburg 197022, Russia

https://orcid.org/0000-0002-7558-7657НестеровИ. М.NesterovI. M.

Нестеров Игорь Михайлович – к.м.н., доцент, зав. учебной работой кафедры акушерства, гинекологии и репродуктологии

Россия, 197022 Санкт-Петербург, ул. Льва Толстого, д. 6–8

Igor M. Nesterov – MD, PhD, Associate Professor, Head of the Educational work, Department of Obstetrics, Gynecology and Reproductology

6–8 Lev Tolstoy Str., Saint Petersburg 197022, Russia

ignester@yandex.ruhttps://orcid.org/0000-0002-9819-213XДобровольскаяИ. А.DobrovolskayaI. A.

Добровольская Ирина Алексеевна – к.м.н., доцент кафедры акушерства, гинекологии и репродуктологии

Россия, 197022 Санкт-Петербург, ул. Льва Толстого, д. 6–8

Irina A. Dobrovolskaya – MD, PhD, Associate Professor, Department of Obstetrics, Gynecology and Reproductology

6–8 Lev Tolstoy Str., Saint Petersburg 197022, Russia

ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov First Saint Petersburg State Medical University, Health Ministry of RussianRussian Federation202213092022164365380Copyright © Bezhenar V.F., Romanova M.L., Nesterov I.M., Dobrovolskaya I.A., 20222022Беженарь В.Ф., Романова М.Л., Нестеров И.М., Добровольская И.А.Bezhenar V.F., Romanova M.L., Nesterov I.M., Dobrovolskaya I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/1416Introduction

Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women.

Aim

Aim: to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy.

Materials and Methods

Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020–2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1 – 57 patients with asymptomatic and mild form of verified COVID-19; Group 2 – 50 patients with COVID-19 of moderate and severe course; Group 3 – 52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19.

Results

Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries – 54 (94.7 %) and 38 (76.0 %) (χ2 = 7.76) respectively, as well as a significantly lower number of premature births – 3 (5.3 %) and 12 (24.0 %) (χ2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births – 33 (57.8 %) and 42 (80.8 %) (χ2 = 6.63) respectively, but a greater rate of caesarean section – 24 (42.0 %) and 10 (19.2 %) (χ2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) – 16 (28.1 %) and 2 (6.3 %) (χ2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia – 5 (8.8%) and 42 (84.0%) (χ2 = 61.2; p < 0.001) respectively, increased aspartate aminotransferase – 4 (7.0 %) and 38 (76.0 %) (χ2 = 53.15; p < 0.001), lactate dehydrogenase (LDH) – 0 (0.0 %) and 12 (24.0 %) (χ2 = 15.41; p < 0.001), C-reactive protein (CRP) – 6 (10.5 %) and 49 (98.0 %) (χ2 = 81.58; p < 0.001), creatinine reduction – 0 (0.0 %) and 11 (22.0 %) (χ2 = 13.98; p < 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase; a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level.

Conclusion

Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity.

Введение

Введение. Сегодня, спустя 2 года после первой вспышки новой коронавирусной инфекции (НКИ) COVID-19 по-прежнему недостаточно данных для полноценной оценки рисков и характера течения данного инфекционного заболевания у беременных.

Цель

Цель: провести сравнительный анализ перинатальных исходов беременностей и клинико-лабораторных данных пациенток с НКИ COVID-19 на момент родов и перенесших заболевание при беременности.

Материалы и методы

Материалы и методы. Проведено ретроспективное сравнительное исследование в результате анализа историй беременностей и родов у 191 женщин, родоразрешенных в трех родовспомогательных медицинских организациях Санкт-Петербурга в период 2020–2021 гг. Проанализированы перинатальные исходы беременности и клинико-лабораторные данные у пациенток, перенесших НКИ COVID-19 в период беременности: группа 1 – 57 пациенток с бессимптомной и легкой формой установленной НКИ COVID-19; группа 2 – 50 пациенток с НКИ COVID-19 средней и тяжелой степенью течения; группа 3 – 52 пациентки, перенесших НКИ COVID-19 в III триместре беременности. Группу 4 (контрольную) составили 32 женщины без НКИ COVID-19.

Результаты

Результаты. Сравнение исходов родоразрешения пациенток группы 1 с группой 2 выявило достоверно большее (χ2 = 7,76) число срочных родов – 54 (94,7 %) и 38 (76,0 %), достоверно меньшее (χ2 = 7,76) число преждевременных родов – 3 (5,3 %) и 12 (24,0 %). Сравнение группы 1 с группой 3 показало достоверно меньшее (χ2 = 6,63) число родов через естественные родовые пути – 33 (57,8 %) и 42 (80,8 %), но большее (χ2 = 6,63) число операций кесарева сечения – 24 (42,0 %) и 10 (19,2 %). Сравнение группы 1 с группой 4 установило достоверно большее (χ2 = 6,05) число женщин с острой и прогрессирующей гипоксией плода (дистресс плода) – 16 (28,1 %) и 2 (6,3 %). Эти данные позволяют констатировать влияние тяжести течения инфекционного процесса, вызванного SARS-CoV-2, и времени его течения относительно срока беременности на сроки и способ родоразрешения. Не получено достоверных данных, позволивших бы утверждать, что непосредственно инфекционный процесс послужил причиной увеличения частоты преждевременных родов у беременных со средним и тяжелым течением НКИ COVID-19. При поступлении и при выписке у пациенток с легкими и бессимптомными формами достоверно реже в сравнении с пациентками с тяжелым течением встречались нейтрофилез – 5 (8,8 %) и 42 (84,0 %) (χ2 = 61,2; р < 0,001), повышение уровней аспартатаминотрансферазы – 4 (7,0 %) и 38 (76,0 %) (χ2 = 53,15; р < 0,001), лактатдегидрогеназы (ЛДГ) – 0 (0,0 %) и 12 (24,0 %) (χ2 = 15,41; р < 0,001), С-реактивного белка (СРБ) – 6 (10,5 %) и 49 (98,0 %) (χ2 = 81,58; р < 0,001), снижение креатинина – 0 (0,0 %) и 11 (22,0 %) (χ2 = 13,98; р < 0,001). В группах с тяжелыми, легкими и бессимптомными формами НКИ COVID-19 установлена сильная прямая корреляционная связь между содержанием СРБ и числом лейкоцитов, между концентрациями СРБ и аланинаминотрансферазы; менее заметная связь определена между значениями СРБ и ЛДГ, СРБ и уровнем общего белка.

Заключение

Заключение. Показано отсутствие специфического влияния инфекции SARS-CoV-2 на большинство показателей нормального течения родового акта, а также на состояние новорожденных у пациенток с НКИ COVID-19 различной степени тяжести. У пациенток с НКИ COVID-19 на момент родоразрешения изменения клинико-лабораторных показателей соответствовали степени тяжести заболевания.

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The authors declare that there are no conflicts of interest present.