Hsu Phern Chong

Intravenous (IV) cefuroxime and cefazolin are used prophylactically in caesarean sections (CS). Currently, there are concerns regarding sub-optimal dosing in obese pregnant women compared to lean pregnant women prior to CS. The current study used a physiologically based pharmacokinetic (PBPK) approach to predict cefazolin and cefuroxime pharmacokinetics in obese pregnant women at the time of CS as well as the duration that these drug concentrations remain above a target concentration (2, 4 or 8 µg/mL or µg/g) in plasma or adipose tissue. Cefazolin and cefuroxime PBPK models were first built using clinical data in lean and in obese non–pregnant populations. Models were then used to predict cefazolin and cefuroxime pharmacokinetics data in lean and obese pregnant populations. Both cefazolin and cefuroxime models sufficiently described their total and free levels in the plasma and in the adipose interstitial fluid (ISF) in non–pregnant and pregnant populations. The obese pregnant cefazolin model predicted adipose exposure adequately at different reference time points and indicated that an IV dose of 2000 mg can maintain unbound plasma and adipose ISF concentration above 8 µg/mL for 3.5 h post dose. Predictions indicated that an IV 1500 mg cefuroxime dose can achieve unbound plasma and unbound ISF cefuroxime concentration of ≥8 µg/mL up to 2 h post dose in obese pregnant women. Re-dosing should be considered if CS was not completed within 2 h post cefuroxime administration for both lean or obese pregnant if cefuroxime concentrations of ≥8 µg/mL is required. A clinical study to measure cefuroxime adipose concentration in pregnant and obese pregnant women is warranted.

Background: Asymptomatic carriage of COVID-19 in pregnant women has been reported and could lead to outbreaks in maternity units. We sought to ascertain the impact of rapid isothernal nucleic acid based testing for COVID-19 in an unselected cohort of pregnant women attending our maternity unit. We also assessed the correlation between community prevalence and asymptomatic carriage. Methods: Data for the retrospective cohort study were collected from a large UK tertiary maternity unit over a 4-week period using computerised hospital records. Literature searches were performed across multiple repositories. COVID-19 prevalence was extracted from online repositories. Results: Nasopharyngeal and oropharyngeal swabs were obtained from 457/465 (98%) women during the study period. The median turnaround time for results was 5.3 h (interquartile range (IQR) 2.6–8.9 h), with 92% of the results returned within 24 h. In our cohort, only one woman tested positive, giving a screen positive rate of 0.22% (1/457; 95% CI: 0.04–1.23%). One woman who tested negative developed a fever postnatally following discharge but was lost to follow-up. From our literature review, we did not find any correlation between asymptomatic carriage in pregnant women and the reported regional prevalence of COVID-19. Conclusions: Testing using the SAMBA-II machine was acceptable to the vast majority of pregnant women requiring admission and had a low turnaround time. Asymptomatic carriage is low, but not correlated to community prevalence rates. Screening pregnant women on admission will remain an important component in order to minimise nosocomial infection.

OBJECTIVE: Asymptomatic carriage of COVID-19 in pregnant women has been reported and could lead to outbreaks in maternity units. We sought to ascertain the impact of rapid isothernal nucleic acid based testing for COVID-19 in an unselected cohort of pregnant women attending our maternity unit. We also assessed the correlation between community prevalence and asymptomatic carriage.DESIGN: Retrospective cohort analysis and literature reviewSETTING: Tertiary hospital in Cambridge, UKPOPULATION: Pregnant women (with gestation age between 12-42 weeks) admitted to a single maternity unit over a 4-week period (07/05/2020-06/06/2020) METHODS: Data were collected using computerised hospital records. Literature searches were performed across multiple repositories. COVID-19 prevalence was extracted from online repositories.RESULTS: NP and OP swabs were obtained from 457/465 women during the study period (98%). The median turnaround time for results was 5.3 hours (interquartile range (IQR) 2.6-8.9 hours). 92% of results were returned within 24 hours. In our cohort, only one woman tested positive, giving a screen positive rate of 0.22% (1/457; 95% confidence interval: 0.04-1.23%). One woman who tested negative developed a fever postnatally following discharge but was lost to follow-up. From our literature review, we did not find any correlation between asymptomatic carriage in pregnant women and the reported regional prevalence of COVID-19. CONCLUSIONS: Testing using the SAMBA-II machine was acceptable to the vast majority of pregnant women requiring admission and had a low turnaround time. Asymptomatic carriage is low, but not correlated to community prevalence rates. Screening pregnant women on admission will remain an important component in order to minimise nosocomial infection.

Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012–30/09/2016. Data were collected using computerised hospital records. CD was classified according to the modified WHO classification (mWHO). The primary outcome measure was estimated blood loss (mL). A total of 5413 women with a singleton fetus in the cephalic presentation delivered during the study period (159 women with CD and 5254 controls). In the CD group, active management of the third stage of labour was consistent with that used in low risk women in 98% (152/155) of cases. Multivariable analyses demonstrated no significant difference in EBL between women with CD vs controls. The adjusted average blood losses were 247.2 ml, 241.8 ml and 295.9 ml in the control group, mWHO 1–2 and 3–4, respectively (p = 0.165). Women with CD have comparable EBL to low risk women when management of the active third stage of labour is the same.

Introduction The number of women of reproductive age with an implantable cardioverter-defibrillator (ICD) is increasing, many with Adult Congenital Heart Disease or inherited cardiomyopathy. Safe management of these patients during pregnancy, labour and delivery is paramount. Guidelines exist for ICD management in non-obstetric surgical procedures but there is little information for outcomes in pregnancy or management of ICDs in elective and emergency obstetric surgery. AIMS To investigate knowledge of health care workers about the management of ICDs in pregnancy, prior to drafting new guidelines. Methods Paper and electronic copies of the focused questionnaire were distributed to healthcare workers within the departments of cardiology, anaesthetics and obstetrics at a large quaternary cardiothoracic centre and separate but co-located tertiary obstetric unit Results 87 responses were returned (58% Obstetrics, 33% Cardiology, 9% Anaesthetics). Most respondents were trainees (37%) followed by consultants (28%), midwives (20%), physiologists (11%) and others (4%). Most (59%) of the cardiology team had treated a pregnant woman with an ICD. Overall, only 30% of respondents were confident about inactivating an ICD in an emergency using a magnet (4% obstetrics, 79% cardiology, 12% anaesthetists) and only 20% were aware of the magnet's location in delivery suite. Most respondents (53%) were unsure about when to inactivate an ICD (70% of obstetric team, 32% cardiologists, 50% cardiac physiologists) and whether to inactivate in an emergency Caesarian section. When seeking guidance, most respondents (64%) would contact the cardiology team, 46% the cardiac physiologists and 13% the anaesthetist. However, 88% of cardiologists said they would contact the physiologist whereas most (83%) physiologists would contact the cardiologist. Conclusions Knowledge of ICD use in pregnancy was poor amongst those surveyed. It is of concern that most obstetricians would call the cardiology SpR or physiologists, many of whom are not confident in the emergency management of ICDs in pregnancy. We plan to introduce guidelines, signposting stickers on obstetric notes and training involving the cardiology, obstetrics and anaesthetic departments regarding its use and then re-assess knowledge to optimise patient safety. There is an urgent need for coordinated national guidelines and registries on the management of implantable cardiac devices in pregnancy.