1- What do we know about Corona virus infection during pregnancy?
The new Corona virus infection (COVID-19), also called SARS-COV-2, was diagnosed as an urgent global public health problem in Wuhan, China, in December 2019. After it was first seen in Turkey, it spread rapidly and turned into a pandemic. The World Health Organization declared a pandemic on March 12, and in February 2020, it defined the disease as COVID-19 and the causative virus as "Severe Acute Respiratory Syndrome Corona virus 2 (SARS-COV-2)".
Other coronavirus Infections include common cold (HCOV 229E, NL63, OC43 AND HKU1), Middle East Respiratory Syndrome Corona Virus/MERS-COV and Severe Acute Respiratory Syndrome Corona virus/SARS-COV viruses.
In the World Health Organization's report dated March 3, 2020, the global mortality rate for COVID-19 infection is estimated to be approximately 3.4%. A mortality rate of 10% for SARS-COV and 37% for MERS-COV was previously reported.
COVID-19 spreads through droplets and direct contact. The virus can be transmitted from sick individuals through droplets released from coughing and sneezing, and from contaminated surfaces through contact with the patient's hand and the mucosa of the eyes, mouth and nose. It is known that the droplet does not travel beyond approximately 2 meters. Transmission has also been reported from individuals with no clinical findings. The incubation period is thought to be an average of 5 days (2-14 days). However, among the latest cases, there are also those who have no evidence of contact with infected people.
2- How does the coronavirus epidemic affect pregnant women? Does corona infection pose a different risk for pregnant women?
Pregnancy is an immunosuppressive condition, that is, a situation in which the immune response is suppressed. Since the tissues and organs of the baby in the womb are different and foreign to the mother, the mother's immune system is suppressed so that she does not perceive this as a foreign tissue. In organ transplants, you can think of it as giving immunosuppressive treatment to prevent the organ from being rejected and expelled by the recipient. In addition, during pregnancy, oxygen consumption increases, diaphragm increases, respiratory rate per minute increases. � increased, sore nose area edematous, congested. This situation brings about the risk of pregnant women being infected with respiratory viruses and developing more severe diseases.
Pregnant women were more affected in previous SARS-COV and MERS-COV virus outbreaks, both We know that the epidemic also has more severe clinical courses during pregnancy (including the need for intubation, the need for intensive care unit, renal failure and death). Pregnant women also faced more serious problems during the H1N1 flu (swine flu) epidemic. The case fatality rate due to SARS-COV infection in pregnant women was approximately 25%. In 2009, 1% of patients infected with influenza A subtype H1N1 virus were pregnant, and pregnant women accounted for 5% of all H1N1-related deaths. However, the data we have so far regarding this new type of Coronavirus does not indicate that pregnant women are more susceptible to COVID-19 infection or that those with COVID-19 infection are prone to developing more severe pneumonia and have higher mortality rates. This shows us that Corona virus 19 does not affect pregnant women as seriously as other SARS epidemics. Although the available data show that there is no increased sensitivity compared to society, expectant mothers need to be more cautious against the epidemic since it is the first time the world has encountered Covid 19.
There is no evidence yet that it is transmitted to the baby in the womb. . No virus was detected in amniotic fluid, placenta, cord, vaginal discharge and breast milk. According to our information so far, there is no evidence yet that the Corona virus causes miscarriage, congenital anomalies, disabilities in the baby, or any other pregnancy problem. However, we know that high fever for any reason in the early period of pregnancy, when organ development takes place, can lead to disabilities in the baby. At the same time, severe lung infection in the last months of pregnancy can lead to premature birth. As a matter of fact, some pregnant women gave birth prematurely due to Corona virus infection. In this case, there is not enough evidence to directly blame the virus.
3- How should pregnant women be protected from coronavirus?
According to our current knowledge, there is no treatment for COVID-19 infection. So be protected Health is very important for pregnant women as it is for everyone else. The precautions to be taken during pregnancy are no different from other members of the society. Pregnant women should be careful not to leave the house, work from home if possible, and not accept visitors at home. It is necessary to wash hands with soap and water for 20 seconds and avoid contact of hands with mouth, nose and eyes. In cases where hands cannot be washed, hand disinfectants containing at least 60 percent alcohol can also be used during pregnancy. In cases where it is necessary to leave the house, a protective mask should be worn, one should stay away from crowded environments and there should be at least a 1.5 meter distance between them and other people.
If any family members leave the house and enter, they take off their shoes in front of the door and put them on a high shelf when they enter the house. Then hands should be washed and clothes should be changed. In this case, it may be appropriate to pay attention to social distance at home.
4- In which complaints in pregnant women should Corona infection be suspected? Or what should be done when there is a suspicious contact?
Pregnant women should definitely call their doctor when they come across a suspicious contact, tell them what happened, do not leave the house for 14 days if there are no symptoms, symptoms such as fever or cough or any complaints. When it occurs, they need to immediately apply to a health institution for testing.
According to published scientific data, the most common symptoms of infection in pregnant women are fever, dry cough and postpartum fever. Muscle aches, fatigue, sore throat, shortness of breath and diarrhea are other presenting complaints. The clinical picture may be mild, moderate or severe. In cases where the clinical picture is mild, the complaints are mild and there are no signs of pneumonia, which we call pneumonia, while in moderate-severe infections, fever, respiratory distress and pneumonia are also observed in pregnant women. In severe cases, pneumonia and severe acute respiratory infection develop. In critical patients, there may be a need for ventilation, that is, being connected to a respirator, shock, kidney failure and other organ failures, or even death.
In doubtful cases, diagnosis is made from the lower (more sensitive) and/or upper respiratory tract. determined by PCR analysis of the samples taken It is like. The test is repeated in highly suspicious pregnant women whose first test is negative. If both PCR analyses are negative, COVID-19 is excluded. If your doctor deems it appropriate, a single computed tomography (CT) scan performed by protecting the abdominal area is below the minimum dose that may cause negative consequences for the baby. In pregnant women diagnosed with COVID-19, ground glass opacities, which are typical findings on CT, were observed in 56.4%. No radiological findings were observed in 17.9% of non-severe cases. Lymphopenia was seen in 83.2% of patients. The average hospitalization period of the cases is 12 days.
5- How often should pregnancy follow-ups be done? What should be taken into consideration when going to examinations?
The possibility of contracting the Corona virus increases in crowded environments where social distance is not maintained. The hospital environment is also among the places where the risk of transmission of the virus is highest. The World Health Organization recommends pregnancy follow-up examinations at least 4 times during the entire pregnancy, with different follow-up protocols in high-risk pregnancies. The first examination is a double test and detailed ultrasound between 11-14 weeks, a detailed ultrasound for anomaly screening and pregnancy vaccinations between 20-22 weeks, the 3rd examination between 28-32 weeks and the fourth examination between 36-40 weeks. In emergency situations, it is necessary to immediately consult a health institution. Apart from these 4 examinations recommended by the World Health Organization, it is recommended to apply to health institutions as little as possible in risk-free pregnant women who do not have any problems in pregnancy follow-up during the epidemic period. You can talk to your doctor by phone during periods other than examinations and discuss your problems. Your doctor may ask you to follow the baby's movements and take blood pressure measurements. Let the number of people accompanying you to the examinations be as small as possible.
6-What is done in pregnant women positive for coronavirus, how is the treatment process progressing?
In pregnant women, treatment is arranged according to the clinical picture of the person, as in other people. The clinical presentation may be mild, moderate, severe or critical. Depending on the clinical picture, treatment can be received on an outpatient basis, inpatient or in intensive care. Pregnant women who require coronavirus positive hospitalization are referred to a designated 3rd Step multi-disciplinary hospital. It is more appropriate to treat them in hospitals where the approach can be applied and where negative pressure isolation rooms are available. Hydroxy chloraquine, lopinavir, titonavir, azithromycin can be used in pregnant women. Mild infections tend to heal in 2 weeks, moderate and severe infections tend to heal in 3-6 weeks.
7- Can babies get Corona virus infection, how is the infection transmitted to the baby?
If Coronavirus positivity is detected in babies. It is thought that this disease is not transmitted to the baby in the womb. Generally, the most common way of transmission from mother to baby is through droplets from coughing or sneezing from the patient or surrogate mother or another person. In a newly published case report from America, 16 hours after the birth of a COVID-positive mother, the baby was found to have a positive PCR test and negative antibodies, raising the question of whether it is transmitted from the womb to the baby. However, there is no evidence yet that the Corona virus infection acquired in the late stages of pregnancy is transmitted to the baby before or during birth.
8- Is the virus transmitted from a Covid-positive pregnant woman to the baby at birth? What should be the method of birth?
When deciding on the method of birth, the most appropriate method for the health of the mother and the baby is decided according to the current conditions. Unless there is an emergency, Coronavirus infection does not affect the timing or method of birth (normal vaginal birth or cesarean birth). She can have a normal vaginal birth. After birth, it is recommended to leave the cream-like, sticky and anti-infection layer that covers the baby's skin, which we call vernix cazeosa, on the baby's skin for the first 24 hours and not to wash the baby.
Babies born to corona-positive mothers are isolated and monitored by neonatal doctors for a while. . During the Corona pandemic, it is best to have only one companion in the hospital and no visitors or very few visitors. When returning home after birth, it is important to pay close attention to social distance rules and not accept visitors.
9- How should the COVID-positive mother-baby contact be after birth? Can the mother breastfeed the baby? How should she protect her baby against infection?
Breast milk is the best nutrition method and protects babies against many diseases.
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