How Shall We Follow Pregnancies?
Covid-19, the coronavirus epidemic, which started in Wuhan province of China and gradually threatened the world, was defined by the World Health Organization as GLOBAL PANDEMIA.
This epidemic is not the first coronavirus outbreak in the world. The first epidemic, “Severe Acute Respiratory Syndrome” (SARS-CoV), appeared in 2003. It was determined that 8000 cases were infected and 770 deaths were reported. In this outbreak, the mortality rate during pregnancy was determined as 25%. In 2013, an outbreak of ‘Middle East Respiratory Syndrome Coronavirus’ (MERS Co-V) occurred. In this outbreak, the number of infected cases was 2500 and 860 deaths were reported. In this epidemic, the mortality rate in pregnancy was determined as 23%.
The SARS-CoV-2 virus that threatens us in the new pandemic is genetically similar to 79% with SARS-Cov and 50% with the MERS-CoV virus.
What is the risk of infection in pregnant women and infants?
We know that the immunity of pregnant women in general decreases from time to time and therefore may be more susceptible to infections. However, there is no clear information about Covid-19 that pregnant women are more sensitive or pose a great threat to pregnancy. There is no report of an increased frequency of congenital anomaly in infants of infected mothers. There is no evidence of the transmission of the virus from mother to baby (vertical transmission). However, you will appreciate that the number of cases is very low and it is not possible to provide safe and precise information in any subject.
How can we be protected from the Covid-19 outbreak?
For protection, you must comply with early isolation conditions, avoid going out as much as possible, avoid bodily contact with people, wash your hands as often and duly as possible, wear gloves if public transport will be used, wear masks in crowded places, not visit hospitals unless it is mandatory, stay connected with your doctor,
It is appropriate to provide a healthy diet that will increase the intake of regular and nutritional supplements and to benefit from the open air when you can go to nature, to separate the towels and personal belongings at home completely, to ventilate the house frequently, not to accept risky visitors to the house.
What complaints do pregnant women come with?
The current publication of 9 pregnant women infected with Covid-19 received fever, cough, muscle pain, sore throat and weakness. Lung infection was detected in all pregnant women, but none of them required breathing apparatus.
How are pregnant women followed and treated?
Under the management of infected pregnant women, patients are immediately quarantined and protected from additional infections. Antibiotics were given and oxygen therapy was applied to reduce the risk of additional infections. Meanwhile, necessary precautions have been taken against the mechanical breathing apparatus requirement. Babies are very well monitored in the womb. It was determined that the risk of stress (fetal distress) increases in infants in the womb. Apart from this, the risk of preterm birth has increased. If the threat of preterm labor develops during follow-up, cortisone applications used for babies’ lung maturation should not be performed in pregnant women infected with covid-19, if possible, because it can only be done with very careful indications because it may cause worsening of the lung infection in the mother. . It is appropriate not to overdo it and to control fluid treatment.
As always, there is great benefit in late clamping the cord.
What should be the mode of delivery and anesthesia used at birth?
We know that women infected with Covid-19 have an increased risk of preterm labor and babies will be more easily stressed in the womb. There is no harm in trying normal birth. However, it is useful to shorten the second phase of birth. Fetal heart beat should be monitored very frequently at birth. When the risks related to the fetus arise, unnecessary insistence should not be made in normal delivery and cesarean decision should be made easier.
Epidural-spinal (regional) anesthesia should be preferred as much as possible during normal delivery or cesarean and general anesthesia should be avoided if possible.
Can an infected mother breastfeed after childbirth?
Considering the great benefits of breastfeeding, breastfeeding decision is superior even when compared to risks. All the immune factors will come with the most beautiful diet to protect the baby. When breastfeeding the baby, a face mask should be worn and wash hands very frequently, and if the pump is used, the sterilization conditions should be taken into consideration.
The number of infected cases worldwide was 167.676 and the reported loss was 6456 around the date of 15.3.2020 and st: 21.40. We all experience a first in this sense and we try to learn about the disease and what society means for all ages and special conditions, risks, protection, in short, what action plan we can be for each individual. In this sense, we should be able to use this period to return to our essence and to be one with ourselves first and then around us, without harming the sense of panic.
I hope that these days will pass with health, patience and calm and our good fortune and vaccine chances will come true as soon as possible.
Egemen Koyuncu, MD
Gynecology and Obstetric Surgeon