Manifestaciones clínicas y resultados materno-perinatales del COVID-19 asociado al embarazo: Una revisión sistemática
Palabras clave:
Evaluación de síntomas, Complicaciones del embarazo, Infecciones por Coronavirus, Resultado del embarazo
Resumen
Objetivos: Evaluar las manifestaciones clínicas y resultados materno-perinatales de la infección por COVID-19 asociada al embarazo. Material y métodos: Se revisaron ocho bases de datos electrónicas (Science Direct, Pubmed, Lilacs, Scielo, Redalyc, LitCovid, EBSCO y Scopus). Se consideraron estudios primarios a texto completo en idioma español e inglés; publicados entre el 01 de enero y 15 de mayo de 2020; y realizados en gestantes con diagnóstico confirmado de COVID-19 (reacción en cadena polimerasa con transcripción inversa [RT-PCR]. Resultados: Se incluyeron 15 estudios que informaron 224 casos de infección por COVID-19 asociada al embarazo, principalmente en gestantes del tercer trimestre (13/15). La tos y fiebre fueron las principales manifestaciones clínicas reportadas en todas las investigaciones. Menos de la tercera parte de estudios muestran al dolor abdominal como manifestación obstétrica que motiva la búsqueda de atención. El antecedente epidemiológico de exposición y las alteraciones en exámenes auxiliares de laboratorio (linfopenia y PCR elevado, principalmente) son reportadas con regular frecuencia. La enfermedad por COVID-19 asociado al embarazo se presenta principalmente de forma leve; asimismo, la mortalidad e ingreso a UCI son resultados maternos exclusivamente asociados a las pocas presentaciones severas. La cesárea es la vía de culminación mayormente empleada, siendo en pocos casos la neumonía por COVID-19 la indicación citada. El bajo peso al nacer y el ingreso a UCIN son resultados perinatales descritos en 9 de 15 estudios, existiendo poca mortalidad perinatal. Solo en tres estudios se reporta que existe transmisión vertical. Conclusión: La enfermedad por COVID-19 asociado al embarazo se reporta principalmente en gestantes de tercer trimestre, con fiebre y tos presentes a la admisión, siendo mayormente casos leves. Asimismo, genera pocas complicaciones materno-perinatales; sin embargo, en casos severos la morbimortalidad se hace más frecuente.
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Silasi M, Cárdenas I, Racicot K, Kwon J, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015; 73(3): 199-213. doi: 10.1111/aji.12355.
Stumpfe F, Titzman A, Schneider M, Stelzl P, Kehl S, Fasching P, et al. SARS-CoV-2 Infection in Pregnancy – a Review of the Current Literature and Possible Impact on Maternal and Neonatal Outcome. Geburtshilfe Frauenheilkd. 2020; 80(4): 380-390. doi: 10.1055/a-1134-5951.
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Cao D, Yin H, Chen J, Tang F, Peng M, Li R, et al. Clinical analysis of ten pregnant women with COVID-19 in Wuhan, China: A retrospective study. Int J Infect Dis. 2020; 95: 294-300. doi: 10.1016/j.ijid.2020.04.047.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226): 809-815. doi: 10.1016/S0140-6736(20)30360-3.
Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9(1): 51-60. doi: 10.21037/tp.2020.02.06.
Yang P, Wang X, Liu P, Wei C, Be H, Zheng J, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020; 127: 104356. doi: 10.1016/j.jcv.2020.104356.
Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical Features and Obstetric and Neonatal Outcomes of Pregnant Patients With COVID-19 in Wuhan, China: A Retrospective, Single-Centre, Descriptive Study. Lancet Infect Dis. 2020; 20(5): 559-564. doi: 10.1016/S1473-3099(20)30176-6.
Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol. 2020; 01-06. doi: 10.1002/jmv.25789.
Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, et al. Coronavirus disease 2019 in pregnancy. Int J Infect Dis. 2020; 95: 376-383. doi: 10.1016/j.ijid.2020.04.065.
Yang H, Sun G, Tang F, Peng M, Gao Y, Peng J, et al. Clinical Features and Outcomes of Pregnant Women Suspected of Coronavirus Disease 2019. J Infect. 2020 Apr 12; doi: 10.1016/j.jinf.2020.04.003.
Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases. Am J Obstet Gynecol. 2020 Apr 23; doi: 10.1016/j.ajog.2020.04.014. [Epub ahead of print].
Hantoushzadeh S, Shamshirsaz A, Aleyasin A, Seferovic M, Kazemi S, Arian S, et al. Maternal Death Due to COVID-19 Disease. Am J Obstet Gynecol. 2020 Apr 28; doi: 10.1016/j.ajog.2020.04.030. [Epub ahead of print].
Buosenso D, Costa S, Sanguinetti M, Cattani P, Posteraro B, Marchetti S, et al. Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Am J Perinatol. 2020 May 2; doi: 10.1055/s-0040-1710541. [Epub ahead of print].
Breslin N, Baptiste C, Gyamfi C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020; 2(2): 100118. doi: 10.1016/j.ajogmf.2020.100118.
Schnettler W, Ahwell Y, Suhag A. Severe acute respiratory distress syndrome incoronavirus disease 2019einfected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM. 2020 Apr 10; doi: 10.1016/j.ajog.2020.0 4.005 [Epub ahead of print].
Alzamora M, Paredes T, Cáceres D, Webb C, Valdez L, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. Am J Perinatol. 2020 Apr 18; doi: 10.1055/s-0040-1710050. [Epub ahead of print].
Londero A, Rosseti E, Pittini C, Cagnacci A, Driul L. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2019; 19(261): doi: 10.1186/s12884-019-2400-x.
Qiao J. What are the risks of COVID-19 infection in pregnant women? The Lancet. 2020; 395(10226): 760-762. doi: 10.1016/S0140-6736(20)30365-2.
Li X, Xu S, Yu M, Wang K, Tao Y, Zhao Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Inmunol. 2020 Apr 12; doi: 10.1016/j.jaci.2020.04.006 [Epub ahead of print].
Matsushita K, Ding N, Kou M, Hu X, Chen M, Gao Y, et al. The relationship of COVID-19 severity with cardiovascular disease and its traditional risk factors: A systematic review and meta-analysis. BMC Yale. 2020 Apr 6; doi: 10.1101/2020.04.05.20054155. [Epub ahead of print].
Moriconi D, Masi S, Rebelos E, Virdis A, Manca M, De Marco S, et al. Obesity prolongs the hospital stay in patients affected by COVID-19, and may impact on SARS-COV-2 shedding. Obes Res Clin Pract. 2020 Jun 4; doi: 10.1016/j.orcp.2020.05.009. [Epub ahead of print].
Kalligeros M, Shehadeh F, Mylona E, Benitez G, Beckwith C, Chan P, et al. Association of Obesity With Disease Severity Among Patients With Coronavirus Disease 2019. Obesity (Silver Spring). 2020 Apr 20; doi: 10.1002/oby.22859. [Epub ahead of print].
Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020; 80(6): 656-665. doi: 10.1016/j.jinf.2020.03.04.
Escobar G, Matta J, Taype W, Ayala R, Amado J. Características clínicoepidemiológicas de pacientes fallecidos por COVID-19, en un hospital nacional de Lima, Perú. Rev. Fac. Med. Hum. 2020; 20(2): 180-185. doi: 10.25176/RFMH.v20i2.2940.
Fang Z, Yi F, Wu K, Lai K, Sun X, Zhong N, et al. Clinical Characteristics of Coronavirus Pneumonia 2019 (COVID-19): An Updated Systematic Review. Eur PMC. 2020 Mar 09; doi: 10.1101/2020.03.07.20032573. [Epub ahead of print].
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Feb 26; doi: 10.1148/radiol.2020200642. [Epub ahead of print].
Sun Z, Zhang N, Li Y, Xu X. A systematic review of chest imaging findings in COVID-19. Quant Imaging Med Surg. 2020; 10(5): 1058-1079. doi: 10.21037/qims-20-564.
Chen J, Qi T, Liu L, Ling Y, Qian Z, Li T, et al. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect. 2020; 80(5): e1-e6. doi: 10.1016/j.jinf.2020.03.004.
Lopes J, Sass N, Martins S. Preeclampsia. Rev Bras Ginecol Obtet. 2017; 39(9): 496-512. doi: 10.1055/s-0037-1604471.
American College of Obstetricians and Gynecologists (ACOG), Society for Maternal Fetal Medicine (SFTM). Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 2010(3): 179-193. doi: 10.1016/j.ajog.2014.01.026.
Putra M, Kesavan M, Brackney K, Hackney D, Roosa M. Forecasting the Impact of Coronavirus Disease During Delivery Hospitalization: An Aid for Resources Utilization. Am J Obstet Gynecol MFM. 2020 Apr 25; doi: 10.1016/j.ajogmf.2020.100127
Mimouni F, Lakshminrusimha S, Pearlman S, Raju T, Gallagher P, Mendlovic J. Perinatal aspects on the covid-19 pandemic: a practical resource for perinatal-neonatal specialists. J Perinatol. 2020; 40(5): 820-826. doi: 10.1038/s41372-020-0665-6.
Rasmussen S, Jamieson D. Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation. Obstet Gynecol. 2020; 135(5): 999-1002. doi: 10.1097/AOG.0000000000003873.
Huang C, Wang Y, Li W, Ren L, Zhao J, Hu L, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497-506. doi: 10.1016/S0140-6736(20)30183-5.
Liu K, Fang Y, Deng Y, Liu W, Wang M, Ma J, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020; 133(9): 1025-1031. doi: 10.1097/CM9.0000000000000744.
Wang D, Yin Y, Hu C, Liu X, Zhang X, Zhou S, et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care. 2020; 24: 188. doi: 10.1186/s13054-020-02895-6.
Prabhudas M, Bonney E, Caron E, Dey S, Erlebacher A, Fazleabas A, et al. Immune mechanisms at the maternal-fetal interface: perspectives and challenges. Nat Immunol. 2015; 16(4): 328-334. doi: 10.1038/ni.3131.
Racicot K, Mor G. Risks associated with viral infections during pregnancy. J Clin Invest. 2017; 127(5): 1591-1599. doi: 10.1172/JCI87490.
Silasi M, Cárdenas I, Racicot K, Kwon J, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015; 73(3): 199-213. doi: 10.1111/aji.12355.
Stumpfe F, Titzman A, Schneider M, Stelzl P, Kehl S, Fasching P, et al. SARS-CoV-2 Infection in Pregnancy – a Review of the Current Literature and Possible Impact on Maternal and Neonatal Outcome. Geburtshilfe Frauenheilkd. 2020; 80(4): 380-390. doi: 10.1055/a-1134-5951.
Zhao X, Jiang Y, Zhao Y, Xi H, Liu C, Qu F, et al. Analysis of the susceptibility to COVID-19 in pregnancy and recommendations on potential drug screening. Eur J Clin Microbiol Infect Dis. 2020 Apr 23; doi: 10.1007/s10096-020-03897-6. [Epub ahead of print].
Jeong S, Sung S, Hung J, Ahn S, Kang E, Chang Y, et al. MERS-CoV Infection in a Pregnant Woman in Korea. J Korean Med Sci. 2017; 32(10): 1717–1720. doi: 10.3346/jkms.2017.32.10.1717.
Martens M, Kalgi B. Middle Eastern Respiratory Syndrome and Pregnancy [18J]. Obstet. Gynecol. 2016; 127: S85-S86. doi: 10.1097/01.AOG.0000483787.93122.d5
Wong S, Chow K, Leung T, Ng W, Ng T, Shek C, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am. J. Obstet. Gynecol. 2004; 191: 292-297. doi: 10.1016/j.ajog.2003.11.019.
Yuen K, Ye Z, Fung S, Chang C, Jin D. SARS-CoV-2 and COVID-19: The most important research questions. Cell Biosci. 2020; 10: 40. doi: 10.1186/s13578-020-00404-4.
Urrútia G, Bonfill X. Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis. Med Clin (Barc). 2010; 135(11): 507-511. doi: 10.1016/j.medcli.2010.01.015.
Murad M, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018; 23(2): 60-63. doi: 10.1136/bmjebm-2017-110853.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9): 603-605. doi: 10.1007/s10654-010-9491-z.
Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. Am J Roetgenol. 2020 Jul; doi: 10.2214/AJR.20.23072. [Epub ahead of print].
Cao D, Yin H, Chen J, Tang F, Peng M, Li R, et al. Clinical analysis of ten pregnant women with COVID-19 in Wuhan, China: A retrospective study. Int J Infect Dis. 2020; 95: 294-300. doi: 10.1016/j.ijid.2020.04.047.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226): 809-815. doi: 10.1016/S0140-6736(20)30360-3.
Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9(1): 51-60. doi: 10.21037/tp.2020.02.06.
Yang P, Wang X, Liu P, Wei C, Be H, Zheng J, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020; 127: 104356. doi: 10.1016/j.jcv.2020.104356.
Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical Features and Obstetric and Neonatal Outcomes of Pregnant Patients With COVID-19 in Wuhan, China: A Retrospective, Single-Centre, Descriptive Study. Lancet Infect Dis. 2020; 20(5): 559-564. doi: 10.1016/S1473-3099(20)30176-6.
Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol. 2020; 01-06. doi: 10.1002/jmv.25789.
Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, et al. Coronavirus disease 2019 in pregnancy. Int J Infect Dis. 2020; 95: 376-383. doi: 10.1016/j.ijid.2020.04.065.
Yang H, Sun G, Tang F, Peng M, Gao Y, Peng J, et al. Clinical Features and Outcomes of Pregnant Women Suspected of Coronavirus Disease 2019. J Infect. 2020 Apr 12; doi: 10.1016/j.jinf.2020.04.003.
Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases. Am J Obstet Gynecol. 2020 Apr 23; doi: 10.1016/j.ajog.2020.04.014. [Epub ahead of print].
Hantoushzadeh S, Shamshirsaz A, Aleyasin A, Seferovic M, Kazemi S, Arian S, et al. Maternal Death Due to COVID-19 Disease. Am J Obstet Gynecol. 2020 Apr 28; doi: 10.1016/j.ajog.2020.04.030. [Epub ahead of print].
Buosenso D, Costa S, Sanguinetti M, Cattani P, Posteraro B, Marchetti S, et al. Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Am J Perinatol. 2020 May 2; doi: 10.1055/s-0040-1710541. [Epub ahead of print].
Breslin N, Baptiste C, Gyamfi C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020; 2(2): 100118. doi: 10.1016/j.ajogmf.2020.100118.
Schnettler W, Ahwell Y, Suhag A. Severe acute respiratory distress syndrome incoronavirus disease 2019einfected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM. 2020 Apr 10; doi: 10.1016/j.ajog.2020.0 4.005 [Epub ahead of print].
Alzamora M, Paredes T, Cáceres D, Webb C, Valdez L, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. Am J Perinatol. 2020 Apr 18; doi: 10.1055/s-0040-1710050. [Epub ahead of print].
Londero A, Rosseti E, Pittini C, Cagnacci A, Driul L. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2019; 19(261): doi: 10.1186/s12884-019-2400-x.
Qiao J. What are the risks of COVID-19 infection in pregnant women? The Lancet. 2020; 395(10226): 760-762. doi: 10.1016/S0140-6736(20)30365-2.
Li X, Xu S, Yu M, Wang K, Tao Y, Zhao Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Inmunol. 2020 Apr 12; doi: 10.1016/j.jaci.2020.04.006 [Epub ahead of print].
Matsushita K, Ding N, Kou M, Hu X, Chen M, Gao Y, et al. The relationship of COVID-19 severity with cardiovascular disease and its traditional risk factors: A systematic review and meta-analysis. BMC Yale. 2020 Apr 6; doi: 10.1101/2020.04.05.20054155. [Epub ahead of print].
Moriconi D, Masi S, Rebelos E, Virdis A, Manca M, De Marco S, et al. Obesity prolongs the hospital stay in patients affected by COVID-19, and may impact on SARS-COV-2 shedding. Obes Res Clin Pract. 2020 Jun 4; doi: 10.1016/j.orcp.2020.05.009. [Epub ahead of print].
Kalligeros M, Shehadeh F, Mylona E, Benitez G, Beckwith C, Chan P, et al. Association of Obesity With Disease Severity Among Patients With Coronavirus Disease 2019. Obesity (Silver Spring). 2020 Apr 20; doi: 10.1002/oby.22859. [Epub ahead of print].
Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020; 80(6): 656-665. doi: 10.1016/j.jinf.2020.03.04.
Escobar G, Matta J, Taype W, Ayala R, Amado J. Características clínicoepidemiológicas de pacientes fallecidos por COVID-19, en un hospital nacional de Lima, Perú. Rev. Fac. Med. Hum. 2020; 20(2): 180-185. doi: 10.25176/RFMH.v20i2.2940.
Fang Z, Yi F, Wu K, Lai K, Sun X, Zhong N, et al. Clinical Characteristics of Coronavirus Pneumonia 2019 (COVID-19): An Updated Systematic Review. Eur PMC. 2020 Mar 09; doi: 10.1101/2020.03.07.20032573. [Epub ahead of print].
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020 Feb 26; doi: 10.1148/radiol.2020200642. [Epub ahead of print].
Sun Z, Zhang N, Li Y, Xu X. A systematic review of chest imaging findings in COVID-19. Quant Imaging Med Surg. 2020; 10(5): 1058-1079. doi: 10.21037/qims-20-564.
Chen J, Qi T, Liu L, Ling Y, Qian Z, Li T, et al. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect. 2020; 80(5): e1-e6. doi: 10.1016/j.jinf.2020.03.004.
Lopes J, Sass N, Martins S. Preeclampsia. Rev Bras Ginecol Obtet. 2017; 39(9): 496-512. doi: 10.1055/s-0037-1604471.
American College of Obstetricians and Gynecologists (ACOG), Society for Maternal Fetal Medicine (SFTM). Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 2010(3): 179-193. doi: 10.1016/j.ajog.2014.01.026.
Putra M, Kesavan M, Brackney K, Hackney D, Roosa M. Forecasting the Impact of Coronavirus Disease During Delivery Hospitalization: An Aid for Resources Utilization. Am J Obstet Gynecol MFM. 2020 Apr 25; doi: 10.1016/j.ajogmf.2020.100127
Mimouni F, Lakshminrusimha S, Pearlman S, Raju T, Gallagher P, Mendlovic J. Perinatal aspects on the covid-19 pandemic: a practical resource for perinatal-neonatal specialists. J Perinatol. 2020; 40(5): 820-826. doi: 10.1038/s41372-020-0665-6.
Rasmussen S, Jamieson D. Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation. Obstet Gynecol. 2020; 135(5): 999-1002. doi: 10.1097/AOG.0000000000003873.
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2020-07-03
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