(SARS) SARS 5 (1) 5 SARS( 2 ) SARS, Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome

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1 Chin J Obstet Gynecol August 2003 Vol138 No18 (SARS) SARS 5 (1) 5 SARS( 2 ) 2 3 ; 3 2 (2) 5 (5/ 5) (3) X 5 (4) 5 (5) ( 1 ) SARS 1 SARS SARS ; ; Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome ZHANG Jian2ping WANG Yun2hui CHEN Lei2ning ZHANG Rui XIE Yu2fen. Department of Obstetrics and Gynecology Sun Yat2sen Memorial Hospital Guangzhou China Abstract Objective To explore and analyze the clinical manifestation diagnosis management and maternal2 perinatal prognosis of severe acute respiratory syndrome ( SARS) 2complicated pregnancy in second and third trimesters1 Methods Clinical data of 5 inpatients with SARS2complicated pregnancy in second and third trimesters from 4 th February to 17 th March 2003 were analyzed retrospectively1 Results Five patients were all primigravida (including 2 twins). Two were infected in second trimester while the other 3 in third trimester with 2 hospital2acquired infections and 3 community2acquired infections. All patients had fever (5/ 5) 3 chills or rigor 4 cough; 2 with decreased lymphocyte 2 decreased platelet 3 elevated alanine aminotransferase ( ALT) 4 hypoalbuminemia 5 abnormal chest radiographs. All 5 patients were cured with 1 requiring intensive care. 5 neonates including 1 twins have been followed up without evidence of SARS infections up to now. In a twin2 prgnancy 1 fetus was lost while the pregnant s situation is stable1 Conclusions Common diagnostic criteria were Suitable for SARS2complicated pregnancy in second and third trimesters but attention should be paid to the interaction between SARS and special pathological changes during pregnancy. Patients should be isolated and monitored intensively with timely cesarean section in severe cases which could significantly decrease the maternal2 perinatal mortality. The use of corticosteroids and psychological supports need further study. Key words Pregnancy complications infectious ; Pneumonia viral ; Coronavirus infections ( severe acute respiratory syndrome SARS) SARS 5 SARS SARS [1 ] : Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved

2 Chin J Obstet Gynecol August 2003 Vol138 No SARS SARS SARS IgM IgG 5 1 RNA ; ( SARS (CDC) [2 SARS ] : (1) (38 ) ; (2) SARS5 1 X ; (3) SARS ; (4) SARS ( ) [3 SARS IgM IgG ] ( ) ; WHO Carlo Urbani [4 SARS WHO ] 3 SARS IgM IgG X WHO SARS % [9 ] 2 SARS SARS [10 ] WHO 2 3 ;1 SARS [11 ] [12 ] A B C D E 5 ( ) A B C SARS ; A SARS SARS SARS ;B C SARS A SARS A 3 6 D E SARS SARS ) ; ; 5 [2 3 ] [5 ] [6 7 ] CDC SARS [8 ] SARS ( ) Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.

3 Chin J Obstet Gynecol August 2003 Vol138 No ( ) A B C D ( 39.3 ) PO / Apgar 9 ( / kg ) 10 9 / L ICU ml 10 9 / L IVIG ( 39 ) PO 2 38 Apgar / L kg 0. 2 ; 3 d / 100 L ml ( 37.9 ) PO / L IVIG / L ( 38.8 ) PO Apgar 10 IVIG / L kg ml / L E ( ) PO / L / L Apgar 10 PO 2 IVIG kg 300 ml :IVIG( ) ;- / 11 SARS : SARS SARS SARS ; SARS Lee [2 ] Peiris [5 ] SARS ( 26 % 33 %) (68 %69 %) APTT (42. SARS 8 %) (40 % 45 %) (40 %) SARS [13 ] SARS Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved. SARS

4 Chin J Obstet Gynecol August 2003 Vol138 No SARS SARS : (1) [14 ] SARS SARS SARS ; (2) SARS [15 ] Donnelly [16 ] SARS [1 19 ] ( 60 ) SARS Peiris [5 ] SARS [20 ] Seto [21 ] - ICU Lee [2 ] 138 SARS SARS ICU SARS ; (2) : [22 ] : (1) ; (2) ; ; (3) ; (4) SARS [1 21SARS : ] So [19 ] ( ) SARS [17 ] SARS [17 ] ; - (3) : 5 ( ) SARS / 5 : 4 1 SARS 1. : (1) : SARS PO 2 ; Hon [18 ] ; SARS ; A Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.

5 Chin J Obstet Gynecol August 2003 Vol138 No18 (4) : 5 2 SARS 326 : : SARS SARS SARS SARS SARS SARS SARS 361 : Wenzel RP Edmond MB. Managing SARS amidst Uncertainty. N Engl J Med : Lee N Hui D Wu A et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med : Tsang KW Ho PL Ooi GC et al. A Cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med : Reilley B Herp MV Sermand D et al. SARS and carlo urbani. N Engl J Med : Peiris JSM Lai ST Poon LLM et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet : WHO. Issues global alert about cases of atypical pneumonia : cases of severe repiratory illness may spread to hospital staff. Geneva : World Health Organization Zambon M. Severe acute respiratory syndrome revisited. BMJ Severe acute respiratory syndrome (SARS). Atlanta :centers for disease control and preverntion (http :/ / www. cdc. gov/ ncidod/ sars/. ). 9 WHO. Cumulative number of reported probable cases of severe acute respiratory syndrome ( SARS). ( http :/ / www. who. int/ csr/ sarscountry/ en/ ). 10 Holmes KV. SARS2Associated Coronavirus. N Engl J Med : World Health Organization multicentre collaborative network for severe acute respiratory syndrome (SARS) diagnosis. A multicentre collaboration to investigate the cause of severe acute respiratory syndrome. Lancet : Anand K Ziebuhr J Wadhwani P et al. Coronavirus main proteinase (3CL pro ) structure : basis for design of anti2sars drugs. Nature : Preliminary clinical description of severe acute respiratory syndrome. MMWR Morb Mortal Wkly Rep : : : Donnelly CA Ghani AC Leung GM et al. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet : Cunningham FG Gant NF Leveno KJ et al. Williams Obstetrics 21st. : Hon KLE Leung CW Cheng WTF et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet So LKY Lau ACW Yam LYC et al. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet : Li TST Buckley TA Yap FHYet al. Severe acute respiratory syndrome (SARS) : infection control. Lancet : Seto WH Tsang D Yung RWH et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome ( SARS). Lancet : : ( : ) ( : ) ( ) sti. ac. cn : http :/ / www. cmaph. com. cn Tsinghua Tongfang Optical Disc Co. Ltd. All rights reserved.