The new type of Coronavirus (COVID-19) was defined as a deadly pandemic that spread to the world from the city of Wuhan in China at the end of 2019, infecting a large number of people. Although this infection, which has a high contagiousness and low mortality rate compared to other Coronavirus infections, is mostly seen between the ages of 30-79, its mortality is very high in the population over 80 years of age. Although we have limited data in terms of the course of the disease and fetal-neonatal effects in pregnant women, there are some issues that should be considered in terms of protecting mother and baby health. The fact that the most affected age group is the age group, which includes reproductive women, has become important in terms of the course of the disease during pregnancy and what can be done in terms of mother and baby. The follow-up of pregnant women with suspected or definite diagnosis, the birth process, and the postpartum relationship between the mother and the baby are important questions. Although the data we have on these issues is limited, global and local institutions such as the World Health Organization, Center of Disease (CDC), Public Health Institution of Turkey (THSK), The American College of Obstetricians and Gynecologists (ACOG) publish warning texts as a guide and this information is frequently used. is updated frequently.
The critical point in the management of any infectious disease is the care of the vulnerable population. It is known that pregnant women are disproportionately affected by respiratory diseases associated with increased infectious morbidity and maternal mortality rate. Although most coronavirus infections are mild, Two β-coronavirus epidemics, severe acute respiratory syndrome coronavirus (severe acute respiratory syndrome coronavirus, SARS-CoV) and Middle East respiratory syndrome (Middle East respiratory syndrome coronavirus, MERS-CoV) have been reported 10 times in the last 20 years. It caused over a thousand cumulative cases, 10% mortality for SARSCoV and 37% for MERS-CoV.
EFFECTS OF CORONAVIRUS ON PREGNANT AND REPRODUCTIVE WOMEN
In the WAPM study, which is the largest study in the world in which 388 pregnant women were evaluated, 6 first trimester pregnancy losses were reported. Those who have had COVID-19 infection during pregnancy do not carry a higher risk than non-pregnant patients, and COVID-19 infection does not cause more severe infection in pregnant patients, unlike other respiratory tract infections. COVID-19 infection can also affect people's plans to conceive. According to the Italy study in which 1482 people were evaluated, 37.3% of the people who had a previous pregnancy plan gave up on the pregnancy plan. According to a study published in Turkey, sexual desire and frequency of sexual intercourse increased in women during the COVID-19 pandemic, while the desire for pregnancy decreased.
A CASE OF COVİD 19 İN PREGNANCY
When it comes to COVID-19 infection in pregnancy, the first reports were published from this country, as COVID-19 first appeared in China. The first study includes the Wuhan pregnant patient population, and 9 pregnant women diagnosed between January 20, 2020 and January 31, 2020 were reported. The second article is 'Hubei pregnant patient population' and reported the results of 9 patients and 10 newborns. The clinical course of 19 pregnant patients in these first 2 studies were similar to those of non-pregnant patients; all pregnant women developed pneumonia and chest CT scans showed typical infiltrates. None of the pregnant women needed mechanical ventilation and no death was reported. PROM developed in a total of 5 patients. While 17 of the patients in these 2 studies delivered by cesarean section, vaginal delivery occurred in 2 patients. No infection was detected in the babies and placentas of these patients. While an increase in cardiac enzymes was observed in one baby in the Wuhan group, DIC-related death was observed in a baby born at 34.5 gestational weeks in the Hubei patient group, but no COVID-19 infection was detected in this baby.
PREGNANCY COMPLICATIONS
The frequency of preterm birth and cesarean section increases in cases with COVID-19 during pregnancy. Fever and hypoxemia may increase preterm labor due to premature rupture of membranes and abnormal fetal heart rate patterns. However, preterm birth can be seen in patients without serious respiratory disease.
Table 1. Symptom frequencies in pregnant and non-pregnant COVID-19 patients of reproductive age.
|
SYMPTOM
|
FREQUANCY IN PREGNANCY
|
FREQUANCY IN NON-PREGNANCY (%)
|
|
Cough
|
51,8
|
53,7
|
|
Shortness of Breath
|
30,1
|
30,3
|
|
Fever
|
34,3
|
42,1
|
|
Headache
|
40,6
|
52,2
|
|
Throat ache
|
27,1
|
31,2
|
|
Dıarrhea
|
14,3
|
23,1
|
|
Nausea- Vomıtıng
|
19,6
|
15,5
|
APROACH TO DIAGNOSIS
The possibility of COVID-19 should be considered in patients with new-onset chills/fever, respiratory tract symptoms (cough, dyspnea, etc.) and signs of severe lower respiratory tract diseases. SARSCoV-2 RNA RT-PCR test should be performed on nasopharyngeal swab samples in cases meeting the test criteria. A positive RT-PCR test confirms COVID-19 infection. In a negative test, the possibility of false negativity should be considered, especially if it is within the first 4 days of the onset of symptoms, and this has also been shown in pregnant women. If the suspicion persists after the negative test, a new test should be performed 24 hours after the first test and within a few days. Two negative tests are generally considered sufficient to rule out COVID-19. Initial chest radiography is sufficient for the initial evaluation in hospitalized COVID-19 cases. Fetal doses of a single chest radiograph are very low. In addition, lung tomography can be taken safely if indicated. Fetal doses of lung tomography are very low and its association with fetal anomaly and pregnancy loss has not been demonstrated. Another method that can be used for rapid lung evaluation of COVID-19 patients during pregnancy is lung ultrasonography.
INTRAPARTUM DİRECTİON
• Maternal fever, saturation, respiratory rate, pulse and blood pressure should be closely monitored.
• Fetal cardiotocography and electronic fetal monitoring should be performed continuously.
• Oxygen saturation should be above >94%.
• There is no clear recommendation on the mode of delivery. In the series, deliveries were mostly made by cesarean section. There is no evidence that vaginal secretion poses a risk of transmission to the baby.
• Regional anesthesia should be preferred first for vaginal delivery and cesarean section.
• If the patient's condition worsens, the transition from vaginal delivery to cesarean delivery should be considered.
• In cases whose symptoms increase or get tired during vaginal delivery, the second stage of labor should be shortened.
• Delayed cord clamping is recommended.
POSTPARTUM DİRECTİON
• All babies should be tested for COVID-19. If the first test is negative, a second test should be done at 48 hours postpartum. The test to be done between 24-48 hours is sufficient.
• The test should be taken as a swab from the fetal nasopharynx, oropharynx and nasal region.
• It is recommended to keep the mother and baby together in terms of feeding and bonding.
BREAST-FEEDING
There is currently no evidence that the virus can be carried in breast milk. The well-known benefits of breastfeeding are therefore thought to outweigh the potential risk of transmission of the coronavirus through breast milk.
• Hands must be washed before touching your baby, bottles or pumps.
• While feeding the baby at the breast, a face mask should be worn.
• Strict sterilization rules should be followed and a patient-specific pump should be used.
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