ROSSANA PULCINELI VIEIRA FRANCISCO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/57 - Laboratório de Fisiologia Obstétrica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- The Influenza Vaccine May Protect Pregnant and Postpartum Women against Severe COVID-19(2022) PAGANOTI, Cristiane de Freitas; RODRIGUES, Agatha Sacramento; FRANCISCO, Rossana Pulcineli Vieira; COSTA, Rafaela Alkmin daThe SARS-CoV-2 pandemic has imposed a huge challenge on the antenatal care of pregnant women worldwide, with the maternal mortality rate being raised to alarming levels. While COVID-19 vaccines were developed, some studies highlighted a possible relationship between influenza vaccination and lower odds of COVID-19 infection. As obstetric patients belong to a high-risk group for respiratory diseases, this study evaluated whether influenza vaccination reduces the severity of COVID-19 infection and mortality among pregnant and postpartum women. We conducted a retrospective cohort study on 3370 pregnant and postpartum women from the Brazilian national database, where they were grouped according to their influenza vaccination status before the onset of COVID-19 symptoms. The intensive care unit admission and intubation rates were significantly higher among subjects in the unvaccinated group (p = 0.002 and p < 0.001, respectively). The odds of mortality risk among those who received the vaccine was 0.33, with a 95% confidence interval of 0.23-0.47. The numbers of patients who needed to be vaccinated to avoid a case of intensive care unit admission, intubation, or death due to COVID-19 were 11, 15, and 11, respectively. Influenza vaccines could confer protection against severe COVID-19 infection in pregnant and postpartum women.
- Placental pathological findings in coronavirus disease 2019: Perinatal outcomes(2022) ARCOS JUNIOR, Gelson Farias; FRANCISCO, Rossana Pulcineli Vieira; KILL, Beatriz; PERES, Stela Verzinhasse; GIBELLI, Maria Augusta B. C.; IBIDI, Silvia Maria; CARVALHO, Werther Brunow de; SIMOES, Angelica Braz; BRIZOT, Maria de Lourdes; SCHULTZ, Regina; CARVALHO, Mariana AzevedoIntroduction: Placental alterations caused by severe acute respiratory coronavirus-2 (SARS-CoV-2) infection have already been described, but most studies used small sample groups and the difference according to the severity of the disease has not been verified. Our objective was to describe placental alterations in patients with coronavirus disease 2019 (COVID-19) and analyze the association of pathological placental findings with the clinical pa-rameters of COVID-19 and perinatal results.Methods: This was a nested study within a prospective cohort study involving 109 symptomatic pregnant women with COVID-19. The prevalence of observed placental alterations was described, and the associations of path-ological findings with the clinical parameters of COVID-19 severity and with perinatal outcomes were assessed.Results: The frequency of types of placental features was poor maternal vascular perfusion in 45% of cases, poor fetal vascular perfusion in 33.9%, hematogenous origin infection in 32.1%, and morphological changes corre-sponding to ascending infection in 21.1%. Hematogenous infection differed significantly according to COVID-19 severity (p = 0.008), with a prevalence ratio (PR) of 1.74 (95% confidence interval, 1.02-2.98) in the moderate COVID-19 group compared to the mild COVID-19 group. Among the perinatal outcomes, there was an unex-pected inverse association between prematurity and placental infection of hematogenous origin, with lower rates of prematurity among cases with inflammation of hematogenous origin (p = 0.029).Discussion: Moderate SARS-Cov-2 infection presented a higher prevalence of placental pathological findings. There was no association of placental findings with adverse perinatal outcomes.
- Risk factors for oxygen requirement in hospitalized pregnant and postpartum women with COVID-19(2022) BAPTISTA, Fernanda Spadotto; PAGANOTI, Cristiane Freitas; GOMEZ, Ursula Trovato; PERES, Stela Verzinhasse; MALBOUISSON, Luiz Marcelo; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli VieiraObjective: To identify risk factors for Oxygen (O-2) needs in pregnant and postpartum women with COVID-19. Methods: Prospective cohort involving pregnant women hospitalized with COVID-19 from April to October 2020. The oxygen need was analyzed regarding risk factors: demographic characteristics, clinical and laboratory parameters at hospital admission, and chest Computer Tomography (CT) findings. Poisson univariate analysis was used to estimate the Relative Risk (RR) and 95% Confidence Intervals. Results: 145 patients, 80 who used and 65 who did not use O-2, were included. Body mass index >= 30, smoking, and chronic hypertension increased the risk of O-2 need by 1.86 (95% CI 1.10-3.21), 1.57 (95% CI 1.16-2.12), and 1.46 (95% CI 1.09-1.95), respectively. Patients who were hospitalized for COVID-19 and for obstetric reasons had 8.24 (95% CI 2.8-24.29) and 3.44 (95% CI 1.05-11.31) times more use of O-2 than those admitted for childbirth and abortion. Respiratory rate >= 24 breaths/min and O-2 saturation < 95% presented RR for O-2 requirements of 2.55 (1.82-3.56) and 1.68 (95% CI 1.27-2.20), respectively. Ground Glass (GG) < 50% and with GG >= 50%, the risk of O-2 use were respectively 3.41-fold and 5.33-fold higher than in patients who haven't viral pneumonia on CT. The combination of C-reactive protein >= 21 mg/L, hemoglobin < 11.0 g/dL, and lymphopenia < 1500 mm(3) on hospital admission increased the risk of O-2 use by 4.97-times. Conclusions: In obstetric patients, clinical history, laboratory, clinical and radiological parameters at admission were identified as a risk for O-2 need, selecting the population with the greatest chance of worsening.
- COVID-19: Impact of Original, Gamma, Delta, and Omicron Variants of SARS-CoV-2 in Vaccinated and Unvaccinated Pregnant and Postpartum Women(2022) SERRA, Fabiano Elisei; ROSA JUNIOR, Elias Ribeiro; ROSSI, Patricia de; FRANCISCO, Rossana Pulcineli Vieira; RODRIGUES, Agatha SacramentoThis study compares the clinical characteristics and disease progression among vaccinated and unvaccinated pregnant and postpartum women who tested positive for different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using the Brazilian epidemiological data. Data of pregnant or postpartum patients testing positive for SARS-CoV-2 and presenting with coronavirus disease 2019 (COVID-19) from February 2020 to July 2022 were extracted from Brazilian national database. The patients were grouped based on vaccination status and viral variant (original, Gamma, Delta, and Omicron variants), and their demographics, clinical characteristics, comorbidities, symptoms, and outcomes were compared retrospectively. Data of 10,003 pregnant and 2361 postpartum women were extracted from the database. For unvaccinated postpartum women, intensive care unit (ICU) admission was more likely; invasive ventilation need was more probable if they tested positive for the original, Gamma, and Omicron variants; and chances of death were higher when infected with the original and Gamma variants than when infected with other variants. Vaccinated patients had reduced adverse outcome probability, including ICU admission, invasive ventilation requirement, and death. Postpartum women showed worse outcomes, particularly when unvaccinated, than pregnant women. Hence, vaccination of pregnant and postpartum women should be given top priority.
- Post-Viral Fatigue Following SARS-CoV-2 Infection during Pregnancy: A Longitudinal Comparative Study(2022) OLIVEIRA, Ana Maria da Silva Sousa; CARVALHO, Mariana Azevedo; NACUL, Luis; CABAR, Fabio Roberto; FABRI, Amanda Wictky; PERES, Stela Verzinhasse; ZACCARA, Tatiana Assuncao; O'BOYLE, Shennae; ALEXANDER, Neal; TAKIUTI, Nilton Hideto; MAYAUD, Philippe; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli VieiraStudies reported post-COVID-19 fatigue in the general population, but not among pregnant women. Our objectives were to determine prevalence, duration, and risk factors of post-viral fatigue among pregnant women with SARS-CoV-2. This study involved 588 pregnant women with SARS-CoV-2 during pregnancy or delivery in Brazil. Three groups were investigated: G1 (n = 259, symptomatic infection during pregnancy); G2 (n = 131, positive serology at delivery); G3 (n = 198, negative serology at delivery). We applied questionnaires investigating fatigue at determined timepoints after infection for G1, and after delivery for all groups; fatigue prevalence was then determined. Cox regression was used to estimate hazard ratio (HR) and 95% CI of the risk of remaining with fatigue in G1. Overall fatigue prevalence in G1 at six weeks, three months and six months were 40.6%, 33.6%, and 27.8%, respectively. Cumulative risk of remaining with fatigue increased over time, with HR of 1.69 (95% CI: 0.89-3.20) and 2.43 (95% CI: 1.49-3.95) for women with moderate and severe symptoms, respectively. Multivariate analysis showed cough and myalgia as independent risk factors in G1. Fatigue prevalence was significantly higher in G1 compared to G2 and G3. Post-viral fatigue prevalence is higher in women infected during pregnancy; fatigue's risk and duration increased with the severity of infection.
- The Effect of Being Pregnant during Respiratory Pandemics: A Comparison between 2009/10 Flu and 2020/21 COVID-19 Pandemic in Brazil(2022) ZANON, Ana Beatrice Bonganha; ROSA JUNIOR, Elias Ribeiro; MONROY, Nataly Adriana Jimenez; GODOI, Luciana Graziela de; MATTOS, Bruna Rodrigues de; PAGANOTI, Cristiane de Freitas; FRANCISCO, Rossana Pulcineli Vieira; RODRIGUES, Agatha Sacramento; COSTA, Rafaela Alkmin daPregnant women undergo physiological changes that make them a challenging group of patients during pandemic respiratory diseases, as previously found during H1N1 2009 pandemic and recently ratified in COVID-19 pandemic. We conducted a retrospective cohort analysis on 5888 hospitalized women for H1N1 flu pandemic (2190 pregnant and 3698 non-pregnant) and 64,515 hospitalized women for COVID-19 pandemic (5151 pregnant and 59,364 non-pregnant), from the Brazilian national database, to compare demographic profile, clinical aspects, and mortality in childbearing aged women during both pandemics. Additionally, the effect of being pregnant was compared between both pandemics. In both pandemics, pregnant women were younger than non-pregnant women. Overall, pregnant women had lower frequencies of comorbidities and were less symptomatic. Among hospitalized women, pregnant women presented lower mortality rates than non-pregnant women (9.7% vs. 12.6%, p = 0.002 in the H1N1 pandemic and 9.7% vs. 17.4%, p < 0.001 in the COVID-19 pandemic) and this difference was statistically more pronounced in the COVID-19 pandemic, even after balancing pregnant and non-pregnant groups regarding age and chronic diseases.
- Impact of SARS-CoV-2 on pregnancy and neonatal outcomes: An open prospective study of pregnant women in Brazil(2022) GOMEZ, Ursula Trovato; FRANCISCO, Rossana Pulcineli Vieira; BAPTISTA, Fernanda Spadotto; GIBELLI, Maria Augusta B. C.; IBIDI, Silvia Maria; CARVALHO, Werther Brunow de; PAGANOTI, Cristiane de Freitas; SABINO, Ester Cerdeira; SILVA, Lea Campos de Oliveira da; JAENISCH, Thomas; MAYAUD, Philippe; BRIZOT, Maria de LourdesObjectives: To determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARSCoV-2 infection severity in pregnant women. Method: Open prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis. Results: 734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87-20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84-8.75), preterm birth (aOR = 5.51; 95% CI 1.47-20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36-2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.8663.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93-20.13) , preterm birth (aOR = 3.60; 95% CI 1.45-9.27). Mild COVID-19 was asso-ciated with oligohydramnios (aOR = 3.77; 95% CI 1.56-9.07). Conclusion: Adverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 sta-tus , risk increased with disease severity.
- Prone Positioning: A Safe and Effective Procedure in Pregnant Women Presenting with Severe Acute Respiratory Distress Syndrome(2022) JR, Gilmar de Souza Osmundo; PAGANOTTI, Cristiane de Freitas; COSTA, Rafaela Alkmin da; SILVA, Thiago Henrique dos Santos; BOMBONATI, Paula Carolina; MALBOUISSON, Luiz Marcelo Sa; FRANCISCO, Rossana Pulcineli VieiraProne positioning (PP) improves oxygenation and survival in patients with severe acute respiratory distress syndrome (ARDS). Data regarding feasibility and effectiveness of PP in pregnancy are lacking. This subgroup analysis of a cohort study that included mechanically ventilated pregnant women presenting with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS who underwent PP aims to assess the efficacy and safety of PP. Ventilatory and gasometric parameters were evaluated at baseline (T-0) and in prone (T-1) and supine (T-2) positions. Obstetric outcomes were also assessed. Sixteen cases at an average of 27.0 (22.0-31.1) gestational weeks of pregnancy were included. Obesity and hypertension were frequent comorbidities. PP was associated with a >20% increase in PaO2 levels and in PaO2/FiO(2) ratios in 50% and 100% of cases, respectively. The PaO2/FiO(2) ratio increased 76.7% (20.5-292.4%) at T-1 and 76.9% (0-182.7%) at T-2. PP produced sustained improvements in mean PaO2/FiO(2) ratio (p < 0.001) and PaCO2 level (p = 0.028). There were no cases of emergency delivery or suspected fetal distress in pregnancies >= 25 weeks during the 24 h period following PP. PP is safe and feasible during pregnancy, improving PaO2/FiO(2) ratios and helping to delay preterm delivery in severe ARDS.
- Postpartum depressive symptoms of Brazilian women during the COVID-19 pandemic measured by the Edinburgh Postnatal Depression Scale(2022) GALLETTA, Marco Aurelio Knippel; OLIVEIRA, Ana Maria da Silva Sousa; ALBERTINI, Jessica Gorrao Lopes; BENUTE, Glaucia Guerra; PERES, Stela Verzinhasse; BRIZOT, Maria de Lourdes; FRANCISCO, Rossana Pulcineli VieiraBackground: The COVID-19 pandemic gave rise to concerns about its potential impact on the mental health of pregnant and postpartum women as the general postpartum depression rates increased. Methods: Three postpartum questionnaires (Edinburgh Postnatal Depression Scale - EPDS; Anxiety and Depression Scale - HAD; and a demographic questionnaire about isolation and information acquisition) were used to evaluate the mental health of women with and without COVID-19 and determine the factors associated with depressive symptoms (EPDS >= 12). Results: Data from 184 participants with a mean of 56 postpartum days were analyzed. The rate of symptoms compatible with postpartum depression (PPD) was 38.8%, with a 14.3% positive response to item 10 on the EPDS (suicidal ideation - SI). Listening to the news about COVID-19 averaged 4.45 hours a day. Factors related to PPD were concerns about lack of hospital beds (OR = 2.45), absence of a partner (OR = 2.70), and anxiety symptoms (OR = 10). Factors related to SI were anxiety symptoms (OR = 1.56) and friends as a source of information (OR = 5.60). Limitations: Considering the rapidly changing epidemiological conditions of this pandemic, this study may only be the photograph of an instant. Conclusions: Higher rates of PPD in the Brazilian population are related not only to anxiety but also to an inadequate family environment, kind of information acquisition and concerns about the lack of hospital beds.
- Clinical characteristics and evolution of 71 neonates born to mothers with COVID-19 at a tertiary center in Brazil(2022) DUARTE, Bruna de Paula; KREBS, Vera Lucia Jornada; CALIL, Valdenise Martins Laurindo Tuma; CARVALHO, Werther Brunow de; GIBELLI, Maria Augusta Bento Cicaroni; FRANCISCO, Rossana Pulcineli VieiraIntroduction: Limited data are available on pregnant women with COVID-19 and their neonates.Objective: This study aimed to describe clinical characteristics and evolution from birth to discharge of a retrospec-tive cohort of 71 neonates, with one set of twins, born to women with COVID-19 diagnosed at the end of preg-nancy. The authors included all newborns admitted into a neonatal unit of a tertiary hospital in Brazil, between March 2020 and March 2021, whose unvaccinated mothers had COVID-19 symptoms and RT-PCR (Real-Time Polymerase Chain Reaction) for SARS-CoV-2 positive within fourteen days prior to delivery. Newborns to mothers with COVID-19 symptoms and negative tests for SARS-CoV-2 were excluded. Results: The main route of birth delivery was cesarean, corresponding to 60 pregnant women (84.5%). The fore-most indications for cesarean were pregnant with critical disease (24.6%) and acute fetal distress (20.3%). The mean birth weight was 2452 g (865-3870 g) and the mean gestational age was 345/7 weeks (25-40 weeks). There were 45 premature newborns (63.3%), of which 21 newborns (29.5%) were less than 32 weeks of gestational age. RT-PCR for SARS-CoV-2 on oropharyngeal swabs was positive in 2 newborns (2.8%) and negative in the other 69 newborns (97.2%). Most newborns (51.4%) needed respiratory support. Therapeutic interventions dur-ing hospitalization were inotropic drugs (9.9%), antibiotics (22.8%), parenteral nutrition (26.8%), and photother-apy (46.5%).Conclusion: Maternal COVID-19 diagnosticated close to delivery has an impact on the first days of neonatal life.