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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:523" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "New evidences that discard the possible vertical transmission of SARS-CoV-2 during pregnancy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "523" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevas evidencias descartan la posible transmisión vertical del SARS CoV-2 durante el embarazo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jianghui Cai, Yingzi Zhang, Mi Tang" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Jianghui" "apellidos" => "Cai" ] 1 => array:2 [ "nombre" => "Yingzi" "apellidos" => "Zhang" ] 2 => array:2 [ "nombre" => "Mi" "apellidos" => "Tang" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621002060?idApp=UINPBA00004N" "url" => "/23870206/0000015600000010/v1_202105151030/S2387020621002060/v1_202105151030/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "524" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jesús Joaquín Hijona Elósegui, Antonio Luis Carballo García, Ana Cristina Fernández Risquez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Jesús Joaquín" "apellidos" => "Hijona Elósegui" "email" => array:1 [ 0 => "jesushijona@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Antonio Luis" "apellidos" => "Carballo García" ] 2 => array:2 [ "nombre" => "Ana Cristina" "apellidos" => "Fernández Risquez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Obstetricia y Ginecología, Hospital Universitario Materno-Infantil de Jaén, Jaén, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">First of all, we would like to thank Drs. Jianghui Cai, Yingzi Zhang and Mi Tang for their interest in our paper,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> recently published in your prestigious magazine, as well as their kind comments on it, concerning which we would like to make the following observations:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0010" class="elsevierStylePara elsevierViewall">We fully agree with our Chinese colleagues that the concept of vertical transmission of pathogens includes the transfer of such microorganisms during pregnancy, delivery or even in the postpartum period, and we apologise if the title of our paper is misleading, as the reference to “possible vertical transmission during pregnancy” may not have made sufficiently clear that our intention was not to assess the possible transfer of SARS-CoV-2 during delivery and the neonatal period, but only and exclusively during gestation.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0015" class="elsevierStylePara elsevierViewall">We also fully agree that it is advisable to extend the study of the possible presence of coronavirus to different levels, using different maternal biological samples, but we must take into consideration that this sometimes involves invasive techniques that are not free of both maternal and foetal risks, and that in no case can they be justified for exclusive research purposes.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Obviously, the best evidence for a possible intrauterine transmission of SARS-CoV-2 would be the confirmation of its presence and replication in foetal lung tissue, but this is technically unfeasible. For this reason, we consider that placenta, amniotic fluid and/or cord blood viral isolations are indirect, but relatively reliable indicators of possible congenital transmission, provided that these samples are collected during pregnancy or immediately after delivery and when sampling has been carried out in conditions that minimise the inevitable risk of contamination.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand, it is well known that histological examination of placentas of women affected by COVID-19 in the peripartum usually reveals the presence of viral particles in the thickness of the placenta, as well as areas of hypoperfusion and inflammation. The scarcity of placental co-expression of ACE-2 and TMPRSS2, 2 receptors involved in the cytoplasmic entry of SARS-CoV-2, could explain their relative insensitivity to transplacental infection, but even so, we do not know whether viral interactions can use membrane receptors other than those mentioned, so the susceptibility of the tissue to transplacental infection could be broader than what is currently known.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Finally, and in relation to the extremely interesting contribution of Dr. Alexandre J. Vivanti,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> we consider it important to point out that:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">In his article there is no clear description of the method used by the author to obtain samples of amniotic fluid and cord blood during caesarean section.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">It does not seem unlikely that inadvertent contamination of the maternal/neonatal samples could have occurred, taking into account that these were obtained in a hospital setting with patients admitted for COVID-19, that the caesarean section was performed using general anaesthesia with maternal orotracheal intubation and that the neonate was also subjected to orotracheal intubation. Unquestionably, neonatal viral isolation in the postpartum period, regardless of how early it may have been, does not allow horizontal transmission to be ruled out.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">An important gap in our current knowledge of COVID-19 is precisely whether its severity can condition perinatal transmission rates and, if so, the prognosis of infected newborns.</p></li></ul></p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">We do not want the above to be interpreted as a negationist criticism of Dr. Vivanti's brilliant contributions,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> as his information will be of great help to us in future research on the subject. The recent emergence of COVID-19 makes almost any conclusions about the infection provisional at this stage, and it will take time and close observation of future cases to clarify the true magnitude of the disease during pregnancy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hijona Elósegui JJ, Carballo García AL, Fernández Risquez AC. Respuesta. Med Clin (Barc). 2021;156:524.</p>" ] 1 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article DOI: 10.1016/j.medcle.2020.09.005.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New evidences that discard the possible vertical transmission on SARS-CoV-2 during pregnancy. Letter to the editor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Cai" 1 => "Y. Zhang" 2 => "M. Tang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2020.09.021" "Revista" => array:2 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2020" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms and evidence of vertical transmission of infections in pregnancy including SARS-CoV-2" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.P. Mahyuddin" 1 => "A. Kanneganti" 2 => "J.L.J. Wong" 3 => "P.S. Dimri" 4 => "L.L. Su" 5 => "A. Biswas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/pd.5765" "Revista" => array:4 [ "tituloSerie" => "Prenat Diagn" "fecha" => "2020" "volumen" => "12" "paginaInicial" => "10" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transplacental transmission of SARS-CoV-2 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Vivanti" 1 => "C. Vauloup-Fellous" 2 => "S. Prevot" 3 => "V. Zupan" 4 => "C. Suffee" 5 => "J. Do Cao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41467-020-17436-6" "Revista" => array:5 [ "tituloSerie" => "Nat Commun" "fecha" => "2020" "volumen" => "11" "paginaInicial" => "3572" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32665677" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infección por SARS-CoV-2 en el embarazo y posibilidad de transmisión al neonato: una revisión sistemática" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Cabero-Perez" 1 => "I. Gómez Acebo" 2 => "T. Dierssen-Sotos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semergen" "fecha" => "2020" "volumen" => "46" "paginaInicial" => "47" "paginaFinal" => "54" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000010/v1_202105151030/S2387020621001959/v1_202105151030/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000010/v1_202105151030/S2387020621001959/v1_202105151030/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621001959?idApp=UINPBA00004N" ]
Journal Information
Vol. 156. Issue 10.
Pages 524 (May 2021)
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Vol. 156. Issue 10.
Pages 524 (May 2021)
Letter to the Editor
Reply
Respuesta
Visits
6
Jesús Joaquín Hijona Elósegui
, Antonio Luis Carballo García, Ana Cristina Fernández Risquez
Corresponding author
Servicio de Obstetricia y Ginecología, Hospital Universitario Materno-Infantil de Jaén, Jaén, Spain
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