COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi Ve Yönetimi

Year 2020, , 378 - 387, 25.06.2020

Atakan Tanacan , Seyit Ahmet Erol , Aykan Yücel

https://doi.org/10.38136/jgon.724118

Cited By: 1

Abstract

Koronavirüs hastalığı 2019 (COVID-19) tüm dünyayı etkisi altına almış olan bir pandemidir. İlk ortaya çıktığı 2019 yılı sonundan günümüze kadar çok hızlı bir yayılım göstermiş, ülkelerdeki sağlık sistemleri üzerinde ciddi bir yük oluşturmuştur. Öte yandan enfekte ettiği hastaların %15’ine yakınında pnömoni tablosu yaratmış, %5’ine yakınında da mortal olarak seyretmiştir. Virüsün ana bulaş yolu enfekte solunum damlacıklarının göz, burun ve ağızdaki müköz membranlar ile temasıdır. Daha çok komorbit hastalığı mevcut olan ileri yaş hastalarda kötü prognoz göstermekle beraber genç hastalarda da ağır klinik tablolara yol açabilmekte ve daha önemlisi bu hastalar üzerinden risk grubundaki bireylere bulaş göstererek ciddi bir toplum sağlığı sorunu oluşturabilmektedir. Şu an için hastalığın aktif bir tedavisi ve aşısı mevcut değildir. Enfeksiyonla mücadelede en önemli adım bulaşı önlemek olarak görünmektedir. Hidroksiklorokin, azitromisin, oseltamivir, favipravir ve lopinavir/ritonavir gibi ilaçlar üzerinde hastalığın prognozu için olumlu olabilecekleri yönünde çalışmalar mevcuttur. Bilindiği üzere gebelik pek çok immünolojik adaptif değişikliği beraberinde getirmektedir ve gebe popülasyon enfeksiyon hastalıklarına karşı daha duyarlıdır. Bu yüzden hastalığın gebe hastalardaki gidişatı, obstetrik komplikasyonlarla ilişkisi, güvenli tedavi yaklaşımları, prenatal takip ve intrapartum yönetim gibi konular üzerinde tartışmalar devam etmektedir. Virüsün gebelerde genel popülasyon ile benzer semptomlara yol açtığı düşünülmektedir. Çoğunlukla soğuk algınlığı ve grip benzeri bir klinik tablo mevcuttur. Buna karşın bazı çalışmalarda fetal distres ve preterm eylem riskini arttırabileceği gösterilmiştir. Yine bu vakalarda artmış sezaryen oranları dikkat çekmektedir. Vertikal geçiş ile ilgili net bilgi olmamakla beraber literatürde şüpheli vakalar mevcuttur. Sadece 30 hafta 3 günlük gebeliği olan bir vakada maternal ölüm bildirilmiştir. Gebe hastaların tedavisinde hidroksiklorokin ve lopinavir/ritonavir kombinasyonu tercih edilmektedir. Gebe popülasyonu korumak amacı ile prenatal takip sayısının ve muayene süresinin azaltılması önerilmektedir. Ayrıca hem sağlık personeli hem de muayene olan gebeler bulaş riskini azaltmak için gerekli kişisel önlemlerini almalıdır. Yine sağlık kuruluşları personelini ve diğer hasta popülasyonu korumak amacı ile uygun yönetim şeması oluşturmalıdır. Şüpheli vakaların yönetimi multidisipliner bir ekip tarafından sağlanmalıdır. Doğum yapacak hastalarda maternal sağlığın yanında sağlık personelinin de korunması hedeflenmeli, hastaneler bu hastaların doğumu için negatif basınçlı izole özel alanlar belirlemelidir. Kişisel koruyucu ekipman kullanımı konusunda gerekli bilgilendirme yapılmalı, bu hastaların yönetiminde belirlenmiş olan kurallara titizlikle uyulmalıdır. Postpartum dönemde neonatal bulaş riski ile beraber emzirmenin önemi de göz önünde bulundurulmalı, gerekli önlemler alınarak anne-bebek bağlanması sağlanmalıdır. Bu derlemeyi yazmamızdaki amaç COVID-19 enfeksiyonu olan gebelerin sonuçlarını uluslararası literatür bazında gözden geçirmek ve bahsi geçen gebelerin obstetrik olarak yönetiminde klinisyenlere katkıda bulunmaktır.

Keywords

COVID-19, gebelik, prenatal takip, intrapartum yönetim, tedavi, prognoz

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