PREGNANCY IN THE PERIOD OF THE DELTA VARIANT OF CORONAVIRUS DISEASE: SOMATIC AND PERINATAL ASPECTS
Authors: Petrenko N. , Rasevych L. 
Published: May 2023

The purpose of this study is to investigate the clinical symptoms of the delta variant of the coronavirus disease in pregnant women, and to analyze the course of pregnancy in this period.

Materials and methods. An assessment of the courses of the coronavirus disease and pregnancy in the period from September to November 2021 was carried out.

The clinical manifestations of the disease are characterized by moderate severity due to respiratory disorders (86.2%), subfebrile body temperature and weakened breathing (20.6%), accompanied by wheezing (17.2%). A significant proportion of patients (20.6%) require oxygen support due to the respiratory complications. Common laboratory findings include anaemia and lymphopenia (11.5±1.1%), as well as elevated levels of ferritin (123.5±19.1 ng/mg), C-reactive protein (12.9±1.6 mg/l), prothrombin time (12.4±1.4 sec), and D-dimer (0.76±0.04 µg FEU/ml).

The recommended treatment for this condition includes the administration of antipyretics, LMH (presumably low molecular weight heparin), antibiotics (in the case of bacterial complications), and corticosteroids.

Pregnant women are particularly vulnerable during the second trimester (II trimester) of pregnancy. This vulnerability is attributed to the rapid growth of the uterus and the subsequent increase in central blood volume, which places additional strain on the cardiovascular system. As a result, the disease tends to have a more severe course during the second trimester compared to the first and third trimesters. Consequently, pregnant patients in the second trimester require hospitalization more frequently.

Pregnant women with the delta variant of coronavirus disease can demonstrate various obstetric manifestations. These include oligohydramnios (6.8%) and polyhydramnios (3.4%), as well as placental thinning (10.3%) and placental thickening (3.4%). Additionally, moderate preeclampsia (6.8%) and gestational pyelonephritis (10.3%) have been reported. Changes in Doppler parameters such as a decrease in STV (systolic time interval) to 3.3±0.3 ms (in 29% of cases), an increase in PI (pulsatility index) to 0.8±0.05, and an increase in SDS (systolic-diastolic ratio) to 3.3±0.03, as well as an increase in IR (resistance index) to 0.8±0.05 in the umbilical cord artery have been observed. Preterm labour occurs in 6.9% of cases between 34 and 36+6 weeks, and in 3.4% of cases before 34 weeks. Other obstetric complications include primary uterine inertia (13.8%), secondary uterine inertia (10.3%), cephalopelvic disproportion (6.9%), fetal distress (3.4%), bleeding in the third stage of labour (3.4%), and caesarean section (17.2%) due to obstetric reasons.

Neonates born to mothers with the delta variant of coronavirus disease may exhibit the following manifestations: the Apgar score at 1 minute is generally 7.8 ± 0.4 points, and at 5 minutes it is 8.2 ± 0.2 points; Respiratory functional impairment (10.3%) and low weight for gestational age (6.9%) have been observed, necessitating respiratory support in 6.9% of cases.

Conclusion: The delta variant of coronavirus disease in pregnant women is characterized by respiratory disorders, tachycardia, hyperthermia, infiltrative lung changes, elevated inflammatory markers, hypercoagulability, and lymphopenia. The disease tends to have a more severe course during the second trimester due to increased cardiovascular and respiratory strain. Obstetric complications, such as changes in amniotic fluid volume and placental thickness, preeclampsia, gestational pyelonephritis, and compensated placental dysfunction, are thought to arise from inflammatory, hypercoagulable, and endothelial changes in the placenta. However, complications during childbirth and the condition of newborns do not appear to be directly related to the maternal disease.