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Radiology
Coronavirus Disease 2019
Built from Obstetric Imaging
What’s inside
9 sections · 78 slides
Overview
- Coronavirus disease 2019: origin and naming
- 750 million+
- Continuing relevance in pregnancy
- Scope of this topic
Viral structure and life cycle
What SARS-CoV-2 is built from, and why each part matters.
- SARS-CoV-2 particle under the electron microscope
- Viral family and genome
- The four major structural proteins
- Function of the spike protein
- Functions of the membrane, envelope and nucleocapsid proteins
- Clinical value of understanding viral structure
Disease pathophysiology
How the virus travels from the nose to the lung, and how illness becomes severe.
- ACE2 as the entry receptor
- The asymptomatic phase
- Onset of upper respiratory symptoms
- Progression to the lower respiratory tract
- Cytokine storm and diffuse alveolar damage
- From viral entry to respiratory failure
Transmission and clinical manifestations
How the virus passes between people, and the range of illness it causes.
- Routes of horizontal transmission
- Airborne transmission and aerosol-generating procedures
- Incubation period and presymptomatic spread
- Spectrum of clinical severity
- National Institutes of Health Classification of COVID-19 Disease Severity
- National Institutes of Health Classification of COVID-19 Disease Severity (continued)
- Common symptoms of COVID-19
- Extrapulmonary manifestations
- Recovery after acute infection
- Post-COVID conditions
COVID-19 in pregnancy and obstetric outcomes
Maternal risk, outcomes for the baby, and what happens at the placenta.
- Physiologic adaptations of pregnancy
- Maternal risk of severe disease
- Adverse perinatal and obstetric outcomes
- Factors contributing to obstetric risk
- The placenta as a barrier to infection
- Biologic plausibility for vertical transmission
- WHO categories for timing of mother-to-child transmission
- Current evidence on vertical transmission
- SARS-CoV-2 placentitis
- Mechanism of fetal injury in placentitis
Evaluation, testing and fetal radiation safety
Making the diagnosis, and deciding whether imaging is safe in pregnancy.
- Clinical history in suspected COVID-19
- Specimen types for SARS-CoV-2 testing
- Nucleic acid amplification testing
- Antigen testing
- Comparison of NAAT and antigen testing
- Role of medical imaging in COVID-19
- Fetal risk from diagnostic radiation
- Radiation-Induced Teratogenesis
- Radiation effects and dose thresholds by gestational age
- Imaging safety during pregnancy
Chest imaging findings
What COVID-19 looks like on radiography, lung ultrasound and CT.
- Chest radiography as a first-line study
- Radiographic findings in COVID-19
- Peripheral lower-zone opacities on chest radiography
- Bilateral hazy lung opacity on a portable chest film
- Lung ultrasound in the obstetric population
- Sonographic findings in COVID-19
- B-line artefacts and pleural thickening on lung ultrasound
- Diagnostic sensitivity of chest computed tomography
- Computed tomography findings in COVID-19
- Consolidation ringed by ground-glass opacity on chest CT
- Peripheral ground-glass opacities on two axial CT slices
- Limitations of chest CT
Obstetric imaging during the pandemic
Running an ultrasound service safely, and what the scan may show.
- Operational concerns in obstetric ultrasound units
- ISUOG consensus statements
- Measures to limit cross-contamination
- Fetal findings on obstetric ultrasound
- Placental findings on targeted ultrasound
- Doppler assessment of the placenta
Management in pregnancy
Matching care to illness severity, and what must never be withheld.
- Management according to illness severity
- Multidisciplinary care and level of care
- Pharmacologic therapy in pregnancy
- Treatment and vaccination must not be withheld
- Key points: the virus and the illness
- Key points: pregnancy, imaging and care
- References
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- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition