How Risky is Covid-19 in Pregnant Women?

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Added On: 11 April 2020, Saturday, 16:22
Last Edited On: 11 April 2020, Saturday, 20:17

How Risky is Covid-19 in Pregnant Women?
Near East University Hospital Department of Obstetrics and Gynecology member Assist. Prof. Dr. Özlen Emekçi Özay pointed out the effects of Covid-19, which has affected the whole world, on pregnancy and the baby, and recommended that methods of protection for everyone are also valid for pregnant women.

Coronaviruses are a large family of viruses that can cause disease in humans. In humans, several coronaviruses are known to cause diseases, from a simple cold to more severe respiratory infections. Coronary virus is caused by the “Covid-19” virus. The New Type of Coronavirus “Covid-19” was first identified as a result of research conducted in a group of patients developing with respiratory symptoms (fever, cough, shortness of breath) in Wuhan City of China. It spread from person to person and spread to the People’s Republic of China, especially Wuhan City, and from there to many countries including our country. The virus can be transmitted by coughing, sneezing droplets from infected individuals and contact with the patient’s hand, eye, mouth and nasal mucosa and from contaminated surfaces. There are few data regarding the effect of Covid-19 especially on women and babies during pregnancy and the course of the disease. However, due to the immune system and physiological changes during pregnancy, it is known that women during pregnancy may be more severely affected by influenza and other respiratory infections.

Assist. Prof. Dr. Özlen Emekçi Özay; “It is not yet possible to make definitive conclusions about the course of coronary infection during pregnancy due to the limited number of cases.”
Stating that there is not enough information about the Covid-19 effects in pregnant women due to the low number of cases. Özay said, “Nevertheless, pregnant women should be considered as a population at risk for Covid-19. There is no evidence to date that it causes infection in the mother’s womb and causes congenital infection and anomaly ”. She noted that clinical findings in a series of cases including 9 pregnant women with Covid-19 showed similarities with non-pregnant women, fever in seven cases, cough in four, muscle pain in three, sore throat and malaise in two. Assist. Prof. Dr. Özlen Emekçi Özay stated that there was a decrease in lymphocytes from the body’s defensive cells in five cases, an increase in liver enzymes in three cases, and there was no need for mechanical ventilation in all cases.

Assist. Prof. Dr. Özlen Emekçi Özay reported that in six cases out of 9 pregnant women, the baby in her mother’s womb developed in good health, while six of the babies were born prematurely. Noting that it is too early to draw definitive conclusions, Özay continued her explanations regarding the health of mothers and babies in cases as follows; “In both series, maternal death did not occur, whereas infants were not infected. It is believed that there is no transition of the disease from the womb to the baby. In 32 pregnants (including the series above) diagnosed with Covid-19 to date, 7 (22%) cases progressed without any clinical findings. While two cases (6%) received intensive care support, one of them was reported to be connected to the device that provides respiratory and circulatory support. 27 of the cases were delivered by cesarean and two by vaginal delivery. Preterm birth occurred in 15 cases (47%), in one case, infant death in the womb and in one case, newborn death. In 25 cases that were studied, there was no transition to the baby in the womb. In addition, there was no evidence of infection in samples taken from the placenta, amniotic fluid, throat swab sample of newborn and umbilical cord of newborn. ”

Assist. Prof. Dr. Özlen Emekçi Özay; “In the event of an infection during pregnancy, expectant mothers should allow X-ray and tomography imaging provided that the necessary protection measures are taken for the baby.” Noting that, despite all precautions, the necessary treatments of the mothers who had coronavirus infection during pregnancy should be started in the quarantine hospitals. Özlen Emekçi Özay said that the treatment and follow-up process during pregnancy is not different than that of other individuals and especially pointed out that x-ray and tomography shots may affect the baby during pregnancy and cause anxiety in mothers. Assist. Prof. Dr. Özlen Emekçi Özay pointed out that the expectant mothers should allow these examinations to be carried out provided that the necessary protection measures for the baby. Reminding that maternal health is always a priority, Özay said that the virus had an incubation period of approximately 14 days after ingestion, and that even if findings have not been revealed in infected pregnant women close to birth, findings of the disease can be seen after birth.

Assist. Prof. Dr. Özlen Emekçi Özay; “The mode of delivery and birth time in pregnant women with coronavirus infection should be individualized according to the clinical status of the mother and baby.”
Stating that it is wondered whether coronavirus infection is decisive in the form of delivery, Özlen Emekçi Özay stated that according to the results obtained from the cases and results of studies all over the world, the type of delivery and the time of delivery should be individualized in accordance with the clinical condition of the mother and the baby and the week of gestation. In cases where birth pains start spontaneously in a pregnant woman infected with coronavirus, normal vaginal delivery may be allowed if the pregnancy shows ideal progress. In these patients, interventional vaginal delivery (vacuum/forceps application) may be considered in order to reduce the second stage of labor and strain. Since there may be a high chance of infection by droplets from the infected pregnant woman during the strain phase, a surgical mask should be worn to the pregnant patient and healthcare professionals must comply with all precautions during this process.”

Özlen Emekçi Özay noted that if there are serious problems related to infection in the general condition of the mother, such as the multiple organ failure in the mother, shock table, and if the baby’s mother’s womb deteriorates, an emergency cesarean should be applied.

Özlen Emekçi Özay; “Beginning and continuing breastfeeding should be determined by the mother in coordination with family members and health practitioners.”
Stating that there is no evidence that the virus can be carried in breast milk at the moment, Assist. Prof. Dr. Özlen Emekçi Özay pointed out that, considering the well-known benefits of breastfeeding, breastfeeding should be supported by taking protective measures. “Beginning or continuing breastfeeding should be determined by the mother in coordination with family members and healthcare practitioners. The primary concern now is not whether the virus will be transmitted through breast milk, but whether an infected mother will transmit the virus through respiratory droplets during breastfeeding.” Özlen Emekçi Özay noted that a mother with a confirmed Covid-19 should take all possible measures to prevent the spread of the virus to her baby, including washing her hands before touching the baby and, if possible, wearing a face mask while breastfeeding. Noting that if the mother’s milk is milked by hand or with an electric breast pump, hands should also be washed before touching the pump or bottle part. Assist. Prof. Dr. Özlen Emekçi Özay emphasized that pump cleaning should be done properly after each use.

Özay; “The recommended precautions and measures taken for preventing the spread of coronavirus are also Valid for pregnant women.”
Assist. Prof. Dr. Özlen Emekçi Özay stated that the methods and measures applicable to everyone in coronavirus protection are also valid for pregnant women, hands should be washed with normal soap and water for at least 20 seconds, alcohol-based hand antiseptics can be used in the absence of soap and water, especially in countries where the disease occurs. Entering to crowded and closed environments must be avoided as much as possible, and if it is necessary, a medical mask should be used to cover the mouth and nose.

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