Browsing by Author "Eckert, Nicole"

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    Being Born into a Pandemic: COVID-19 and Pregnancy
    (2021) Swiezy, Sarah; Campbell, Meredith; Eckert, Nicole
    Case #1: 34yo Asian female G2P1001 presents COVID19+ in 1st trimester. PMH insignificant. Meds: prenatal vitamins. Surg Hx: c/s healthy boy (2017). No h/o GHTN, GDM, or eclampsia. D/t COVID19+ infection, frequent fetal u/s monitoring done at 32w5d, 34w5d, 38w0d. Fetal growth over time: 63.4%, 48.8%, 14.3%. Fluid over time: AFI 8.58cm, MVP 4.52cm; AFI 10.86, MVP 3.52; AFI 2.73, MVP <2. Oligohydramnios diagnosed at 38w0d; emergent repeat c/s performed. Mother and baby healthy s/p delivery, d/c home on PPD#2. Pathology of placental tissue shows increases in villous fibrin accumulation and maternal vascular malperfusion. Case #2: 29yo Caucasian female G1P0 presents to ED at 18w4d with c/o runny nose, cough, and headache; temp. 100.3*F; tests COVID+. PMH insignificant. Meds: prenatal vitamins. No h/o GHTN, GDM, or eclampsia. 21w0d u/s: growth 71.4%, normal anatomy. 30w0d u/s: growth at 82.3%, AFI 15.10cm, MVP 5.38cm. At 39w1d, healthy infant boy (7lb12oz) via VAVD. Mother and baby healthy s/p delivery, d/c home on PPD#2. Placenta not sent for surgical pathology. Conclusion Due to the short time course of the COVID19 pandemic, adequate evidence to link maternal-fetal outcomes to infection during pregnancy is just now becoming available. Other coronaviruses, SARS and MERS, are preferentially fatal in pregnant mothers; and, adverse perinatal outcomes in COVID19+ women are appearing. Case reports have associated COVID19 with preterm birth; one study reported 47% preterm deliveries in COVID19+ mothers. Molecular studies have confirmed ACE2 (receptor allowing viral cellular entry) mRNA overexpression in placentas. Placental histopathology has shown maternal-placental interfacing blood vessel anomalies. Clinical Significance COVID19 represents a monumental threat to public health. Pregnant women and fetuses may be at increased risk for complications compared to the general public. As yet, the relationship between COVID19 and pregnancy remains to be clarified and will require further investigations to understand associations and promote evidence-based treatment practices.
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    A Case Series of COVID-19 and Pregnancy Outcomes
    (2021) Swiezy, Sarah; Eckert, Nicole; Campbell, Meredith
    Introduction: COVID-19 has been the largest public health crisis of our lifetime. Much of the morbidity and mortality caused by COVID-19 has been due to lack of adequate research and understanding of the virus. In the absence of data for COVID-19, scientists have used evidence collected during other coronavirus outbreaks, including SARS and MERS, to forecast outcomes in different populations. Both of these coronavirus outbreaks were preferentially fatal in pregnant women, suggesting that COVID-19 may also have grave consequences for gravid women and their fetuses. Given that molecular studies have confirmed that COVID-19 enters cells through the ACE-2 receptor, which is also present on human placental cells, there is potential for COVID-19-induced abnormalities in the interface between mom and baby, leading to maternal-fetal morbidity or mortality. To date, several case series have demonstrated adverse perinatal outcomes in COVID-19-positive pregnant women, including placental abnormalities and pre-term birth; however, these studies have been limited in scale and scope. More data is needed to fully understand the implications of COVID-19 infection in pregnancy so that evidence- based treatment recommendations can be made to OB/GYNs caring for COVID+ patients. Methods: We reviewed the charts of all of the pregnant women presenting for routine obstetric care to the UAP OB/GYN offices in Terre Haute, IN between Nov 2020 and Feb 2021. We identified 33 women who were pregnant at the time of COVID-19 infection. Data were input into a Qualtrics survey for ease of viewing the results. Results/Conclusions: We are currently waiting for 6 (18%) of the patients in our sample to deliver in the next 4-6 weeks To date we have a sample of mostly Caucasian women infected in their 2nd and 3rd trimester. Here we evaluate their pre-, peri-, and immediate post-partum maternal and infant outcomes.
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    Retrospective Chart Review Comparing CKD COVID-19 Positive Patient Outcomes to non-CKD Patient Outcomes
    (Indiana University, 2020) Eckert, Nicole; Sankari, Safiya; Allen, Katie; Hui, Siu Lui; Mendonca, Eneida; Health Policy and Management, School of Public Health
    Background/Objective: Since January 2020, there have been over 3 million individuals infected with the coronavirus in the United States, quickly spreading across at least 171 countries. The severity and morbidity of patients with COVID-19 are significantly increased when comorbidities, such as Chronic Kidney Disease (CKD), are present. Because the main target of SARS-CoV-2 is ACE2, patients with CKD may be a more vulnerable population. The goal of this study was to determine if COVID-19 positive patients with CKD had increased mortality, inpatient admission, and ED visitation rates compared to those without CKD. Methods: This retrospective chart review includes patients from over 100 separate healthcare entities who were diagnosed with COVID-19 between January 1, 2020 and July 13, 2020 and are over the age of 18. The subjects were first separated into those diagnosed with CKD and those without, basic descriptive calculations were computed, and a Chi Square test was used to analyze outcomes. Results: The CKD COVID-19 positive population was compromised of 47.5% men and 52.5% women while the non-CKD control group was made up of 45.4 % men, 54.1% women, and 0.5% other. The median Charlson index for the CKD and non-CKD population was 4 and 1, respectively. The interest and control groups were further divided into subpopulations by age and race and analyzed accordingly. Chi square tests demonstrated that there is a statistically significant difference (p<0.05) in all clinical outcomes tested of CKD patients diagnosed with COVID-19 compared to non-CKD patients. The CKD population had increased mortality, inpatient admission, and ED visitation rates when compared. Discussion: This study demonstrates that comorbidities, more specifically CKD, may be associated with a higher severity of COVID-19 than those without. Future studies are needed to explore the relationship more extensively, analyze other outcomes, and manage confounding variables.