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Attack on coronavirus disease 2019 from American Journal of Obstetrics & Gynecology MFM

      This issue of the American Journal of Obstetrics & Gynecology MFM (AJOG MFM), the “pink” Journal, has 8 of the first scientific manuscripts
      • Berghella V.
      Now! protection for obstetrical providers and patients.
      • Breslin N.
      • Baptiste C.
      • Miller R.
      • et al.
      Coronavirus disease 2019 in pregnancy: early lessons.
      • Breslin N.
      • Baptiste C.
      • Gyamfi-Bannerman C.
      • et al.
      Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals.
      • Boelig R.C.
      • Saccone G.
      • Bellussi F.
      • Berghella V.
      • et al.
      MFM guidance for COVID-19.
      • Boelig R.C.
      • Manuck T.
      • Oliver E.A.
      • et al.
      Labor and delivery guidance for COVID-19.
      • Di Mascio D.
      • Khalil A.
      • Saccone G.
      • et al.
      Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis.
      • Juusela A.
      • Nazir M.
      • Gimovsky M.
      Two cases of coronavirus 2019—related cardiomyopathy in pregnancy.
      • Webster C.M.
      • Smith K.A.
      • Manuck T.A.
      Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series.
      describing coronavirus disease 2019 (COVID-19) during pregnancy. My mother, sister and her family members, brother (also an obstetrician-gynecologist) and his wife, as well as some of my best friends live in Italy. I understood from them and Italian news, loud and clear, how bad COVID-19 was for humans, and for pregnant women, early on.
      Hence, AJOG MFM went early into attack. Like New York Governor Cuomo said, what most people have done is being reactive or defensive to the COVID-19 pandemic. COVID-19 should instead be attacked aggressively first and foremost by prevention and, if prevention fails, by proper care, including in pregnant women.
      AJOG MFM wants to thank the authors of these 8 manuscripts and those of the manuscripts in progress. These early manuscripts provided initial data and guidance for obstetrical providers during the COVID-19 pandemic. I want to thank the AJOG MFM Editorial Board, who provided most of the peer reviews that improved the manuscripts. I also want to thank Elsevier, in particular Andrea Bocelli, Donna Stroud, and Brian Arnold, without whom these manuscripts would not have been promptly processed, and the information would have been too old to help us all early in this quest to save lives. I cannot thank enough all the members of the MFM Division at Jefferson for their team work and passion for exceptional evidence-based compassionate care, even in these difficult times.
      These manuscripts highlight the importance of proper personal protective equipment (PPE) for everyone, both healthcare workers (HCWs) and patients, in outpatient and inpatient settings, and of testing asymptomatic pregnant women presenting for care.
      • Berghella V.
      Now! protection for obstetrical providers and patients.
      • Breslin N.
      • Baptiste C.
      • Miller R.
      • et al.
      Coronavirus disease 2019 in pregnancy: early lessons.
      • Breslin N.
      • Baptiste C.
      • Gyamfi-Bannerman C.
      • et al.
      Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals.
      They offer guidance on how to decrease patient-HCW interactions and still provide essential obstetrical and maternal-fetal medicine care both in outpatient
      • Boelig R.C.
      • Saccone G.
      • Bellussi F.
      • Berghella V.
      • et al.
      MFM guidance for COVID-19.
      and inpatient settings, including labor and delivery (L&D).
      • Boelig R.C.
      • Manuck T.
      • Oliver E.A.
      • et al.
      Labor and delivery guidance for COVID-19.
      They report the first meta-analysis of coronavirus pregnancy cases including COVID-19 cases from China.
      • Di Mascio D.
      • Khalil A.
      • Saccone G.
      • et al.
      Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis.
      We thank our New York-area colleagues for sharing some of their early experience that warned us about the possibility of critical COVID-19 infection developing quickly in asymptomatic women presenting to L&D.
      • Breslin N.
      • Baptiste C.
      • Miller R.
      • et al.
      Coronavirus disease 2019 in pregnancy: early lessons.
      In the largest—still small—series (n=43) published so far of pregnant women in the United States who received a diagnosis of COVID-19, 37 (86%) had mild, 4 (9.3%) severe, and 2 (4.7%) critical disease
      • Breslin N.
      • Baptiste C.
      • Gyamfi-Bannerman C.
      • et al.
      Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals.
      ; these percentages are similar to those described for nonpregnant adults with COVID-19 (about 81% mild, 14% severe, and 5% critical disease), based on the COVID-19 disease severity characteristics described by Wu and McGoogan.
      • Wu Z.
      • McGoogan J.M.
      Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.
      Although this is reassuring, obstetrical providers should be cognizant of possible quick progression from asymptomatic admission to transfer to the intensive care unit for respiratory failure and mechanical ventilation,
      • Breslin N.
      • Baptiste C.
      • Miller R.
      • et al.
      Coronavirus disease 2019 in pregnancy: early lessons.
      as well as cardiomyopathy, in pregnant women with COVID-19.
      • Juusela A.
      • Nazir M.
      • Gimovsky M.
      Two cases of coronavirus 2019—related cardiomyopathy in pregnancy.
      The possibility of needing extracorporeal membranous oxygenation (ECMO) has been discussed in the care of pregnant women with COVID-19: we thank the authors of the retrospective study of ECMO use in pregnancy, a timely subject.
      • Webster C.M.
      • Smith K.A.
      • Manuck T.A.
      Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series.
      UpToDate has published their free guidance on COVID-19 in pregnancy. Dr Manuck, AJOG MFM associate editor, helped develop a dedicated website, www.pregnancycovid19.com, with invaluable information for both providers and pregnant women. A US registry has started (https://priority.ucsf.edu/), which will soon provide information about the management and outcomes on hundreds of pregnant women in the United States with COVID-19. There is no need to panic. I feel this is what we’ll talk about with our grandchildren, like my grandfather and father (I miss him!) talked to me about World War-II and the Americans coming to save Italy. Help is coming this time too, guidance will continue to evolve, and AJOG MFM is glad to be in a position to offer some of this precious assistance.

      References

        • Berghella V.
        Now! protection for obstetrical providers and patients.
        Am J Obstet Gynecol MFM. 2020; 2100109
        • Breslin N.
        • Baptiste C.
        • Miller R.
        • et al.
        Coronavirus disease 2019 in pregnancy: early lessons.
        Am J Obstet Gynecol MFM. 2020; 2100111
        • Breslin N.
        • Baptiste C.
        • Gyamfi-Bannerman C.
        • et al.
        Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals.
        Am J Obstet Gynecol MFM. 2020; 2100118
        • Boelig R.C.
        • Saccone G.
        • Bellussi F.
        • Berghella V.
        • et al.
        MFM guidance for COVID-19.
        Am J Obstet Gynecol MFM. 2020; 2100106
        • Boelig R.C.
        • Manuck T.
        • Oliver E.A.
        • et al.
        Labor and delivery guidance for COVID-19.
        Am J Obstet Gynecol MFM. 2020; 2100110
        • Di Mascio D.
        • Khalil A.
        • Saccone G.
        • et al.
        Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis.
        Am J Obstet Gynecol MFM. 2020; 2100107
        • Juusela A.
        • Nazir M.
        • Gimovsky M.
        Two cases of coronavirus 2019—related cardiomyopathy in pregnancy.
        Am J Obstet Gynecol MFM. 2020; 2100113
        • Webster C.M.
        • Smith K.A.
        • Manuck T.A.
        Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series.
        Am J Obstet Gynecol MFM. 2020; 2100108
        • Wu Z.
        • McGoogan J.M.
        Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.
        JAMA. 2020; ([Epub ahead of print])