COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi Ve Yönetimi

Year 2020, Volume: 17 Issue: 2, 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

References

• 1. Novel Coronavirus (2019-nCoV) technical guidance 2020 [Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance 2. Guan Wei-jie, Ni Zheng-yi, Hu Yu, Liang Wen-hua, Ou Chun-quan, He Jian-xing, et al. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020. 3. COVID-19 (SARS-CoV-2 Enfeksiyonu) Rehberi 2020 [Available from: https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi.pdf. 4. Zhou P., Yang X. L., Wang X. G., Hu B., Zhang L., Zhang W., et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3. 5. van Doremalen N., Bushmaker T., Morris D. H., Holbrook M. G., Gamble A., Williamson B. N., et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. The New England journal of medicine. 2020. 6. Chen W., Lan Y., Yuan X., Deng X., Li Y., Cai X., et al. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerging microbes & infections. 2020;9(1):469-73. 7. Wang W., Xu Y., Gao R., Lu R., Han K., Wu G., et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. Jama. 2020. 8. Dhama Kuldeep, Sharun Khan, Tiwari Ruchi, Sircar Shubhankar, Bhat Sudipta, Malik Yashpal Singh, et al. Coronavirus Disease 2019–COVID-19. 2020. 9. Wu Z., McGoogan J. M. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. Jama. 2020. 10. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J., et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. Jama. 2020. 11. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020;395(10223):497-506. 12. Zhao W., Zhong Z., Xie X., Yu Q., Liu J. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. AJR American journal of roentgenology. 2020:1-6. 13. Zhao J., Yuan Q., Wang H., Liu W., Liao X., Su Y., et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020. 14. Liu D., Li L., Wu X., Zheng D., Wang J., Yang L., et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. AJR American journal of roentgenology. 2020:1-6. 15. Breslin Noelle, Baptiste Caitlin, Gyamfi-Bannerman Cynthia, Miller Russell, Martinez Rebecca, Bernstein Kyra, et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. 16. COVID CDC. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019—United States, February 12–March 28, 2020. 2020. 17. Mullins E., Evans D., Viner R. M., O'Brien P., Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2020. 18. Liu H., Wang L. L., Zhao S. J., Kwak-Kim J., Mor G., Liao A. H. Why are pregnant women susceptible to COVID-19? An immunological viewpoint. J Reprod Immunol. 2020;139:103122. 19. Qiao Jie. What are the risks of COVID-19 infection in pregnant women? The Lancet. 2020;395(10226):760-2. 20. Obstetricians American College of, Gynecologists. Practice Advisory: Novel Coronavirus 2019 (COVID-19). 2020. 21. Boelig Rupsa C, Saccone Gabriele, Bellussi Federica, Berghella Vincenzo. MFM Guidance for COVID-19. American Journal of Obstetrics & Gynecology MFM. 2020:100106. 22. Francesca Donders MD, Lonnee-Hoffmann Risa, Mendling MD, de Oliveira José Martinez, Judlin Philippe, Fengxia Xue, et al. ISIDOG recommendations concerning COVID-19 and pregnancy. 23. Coronavirus (COVID-19) infection and pregnancy Version 7 2020 [updated 09/04/2020. Available from: https://www.rcog.org.uk/coronavirus-pregnancy. 24. Poon Liona C, Yang Huixia, Lee Jill CS, Copel Joshua A, Leung Tak Yeung, Zhang Yuanzhen, et al. ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals. Ultrasound in Obstetrics & Gynecology. 2020. 25. Poon Liona C, Shennan Andrew, Hyett Jonathan A, Kapur Anil, Hadar Eran, Divakar Hema, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2019;145:1. 26. Gebelikte Coronavirüs Enfeksiyonu (COVID-19) Hakkında Görüş (3. Bilgilendirme,03.04.2020) Türkiye2020 [Available from: http://www.tmftp.org/tr/covid-19-detay/3-bilgilendirme-icin-tiklayin. 27. Zaigham M, Andersson O. Maternal and Perinatal Outcomes with COVID-19: a systematic review of 108 pregnancies. Acta obstetricia et gynecologica Scandinavica. 2020. 28. Karami P., Naghavi M., Feyzi A., Aghamohammadi M., Novin M. S., Mobaien A., et al. Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Med Infect Dis. 2020:101665. 29. Chen Huijun, Guo Juanjuan, Wang Chen, Luo Fan, Yu Xuechen, Zhang Wei, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 2020;395(10226):809-15. 30. Chen Siyu, Liao E, Shao Yong. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. Journal of Medical Virology. 2020. 31. Li Yang, Zhao Ruihong, Zheng Shufa, Chen Xu, Wang Jinxi, Sheng Xiaoli, et al. Early Release-Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. 2020. 32. Fan Cuifang, Lei Di, Fang Congcong, Li Chunyan, Wang Ming, Liu Yuling, et al. Perinatal Transmission of COVID-19 Associated SARS-CoV-2: Should We Worry? Clinical Infectious Diseases. 2020. 33. Zhu Huaping, Wang Lin, Fang Chengzhi, Peng Sicong, Zhang Lianhong, Chang Guiping, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Translational pediatrics. 2020;9(1):51. 34. Zambrano Lysien I, Fuentes-Barahona Itzel Carolina, Bejarano-Torres Daysi Anabell, Bustillo Carolina, Gonzales Gloria, Vallecillo-Chinchilla Gissela, et al. A pregnant woman with COVID-19 in Central America. Travel Med Infect Dis. 2020;101639. 35. Gidlöf Sebastian, Savchenko Julia, Brune Thomas, Josefsson Hampus. COVID-19 in pregnancy with comorbidities: More liberal testing strategy is needed. Acta obstetricia et gynecologica Scandinavica. 2020. 36. Yu Nan, Li Wei, Kang Qingling, Xiong Zhi, Wang Shaoshuai, Lin Xingguang, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. The Lancet Infectious Diseases. 2020. 37. Breslin Noelle, Baptiste Caitlin, Miller Russell, Fuchs Karin, Goffman Dena, Gyamfi-Bannerman Cynthia, et al. COVID-19 in pregnancy: early lessons. American Journal of Obstetrics & Gynecology MFM. 2020:100111. 38. Iqbal Sara N, Overcash Rachael, Mokhtari Neggin, Saeed Haleema, Gold Stacey, Auguste Tamika, et al. An Uncomplicated Delivery in a Patient with Covid-19 in the United States. New England Journal of Medicine. 2020. 39. Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed patient. Korean journal of anesthesiology. 2020. 40. Ferrazzi E. M., Frigerio L., Cetin I., Vergani P., Spinillo A., Prefumo F., et al. COVID-19 Obstetrics Task Force, Lombardy, Italy: executive management summary and short report of outcome. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2020. 41. Wu X., Sun R., Chen J., Xie Y., Zhang S., Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2020. 42. Xiong X., Wei H., Zhang Z., Chang J., Ma X., Gao X., et al. Vaginal Delivery Report of a Healthy Neonate Born to a Convalescent Mother with COVID-19. J Med Virol. 2020. 43. Khan S., Jun L., Nawsherwan, Siddique R., Li Y., Han G., et al. Association of COVID-19 infection with pregnancy outcomes in healthcare workers and general women. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2020. 44. Kerr Stephen M, Parker Samantha E, Mitchell Allen A, Tinker Sarah C, Werler Martha M. Periconceptional maternal fever, folic acid intake, and the risk for neural tube defects. Annals of epidemiology. 2017;27(12):777-82. e1. 45. Schwartz D. A. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Archives of pathology & laboratory medicine. 2020. 46. Di Mascio Daniele, Khalil Asma, Saccone Gabriele, Rizzo Giuseppe, Buca Danilo, Liberati Marco, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1-19) during pregnancy: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. 2020:100107. 47. Dong L., Tian J., He S., Zhu C., Wang J., Liu C., et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. Jama. 2020. 48. Zeng L., Xia S., Yuan W., Yan K., Xiao F., Shao J., et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr. 2020. 49. Zeng H., Xu C., Fan J., Tang Y., Deng Q., Zhang W., et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. Jama. 2020. 50. Kimberlin D. W., Stagno S. Can SARS-CoV-2 Infection Be Acquired In Utero?: More Definitive Evidence Is Needed. Jama. 2020. 51. Tremblay Emilie, Thérasse Eric, Thomassin-Naggara Isabelle, Trop Isabelle. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics. 2012;32(3):897-911. 52. Moro F., Buonsenso D., Moruzzi M. C., Inchingolo R., Smargiassi A., Demi L., et al. How to perform lung ultrasound in pregnant women with suspected COVID-19 infection. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2020. 53. Tang Wei, Cao Zhujun, Han Mingfeng, Wang Zhengyan, Chen Junwen, Sun Wenjin, et al. Hydroxychloroquine in patients with COVID-19: an open-label, randomized, controlled trial. medRxiv. 2020:2020.04.10.20060558. 54. Parke Ann. Antimalarial drugs and pregnancy. The American journal of medicine. 1988;85(4):30-3. 55. Mulangu S., Dodd L. E., Davey R. T., Jr., Tshiani Mbaya O., Proschan M., Mukadi D., et al. A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. The New England journal of medicine. 2019;381(24):2293-303. 56. Sanders James M, Monogue Marguerite L, Jodlowski Tomasz Z, Cutrell James B. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020. 57. Barnes B. J., Adrover J. M., Baxter-Stoltzfus A., Borczuk A., Cools-Lartigue J., Crawford J. M., et al. Targeting potential drivers of COVID-19: Neutrophil extracellular traps. The Journal of experimental medicine. 2020;217(6). 58. Rasmussen Sonja A, Smulian John C, Lednicky John A, Wen Tony S, Jamieson Denise J. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. American journal of obstetrics and gynecology. 2020. 59. Ashokka Balakrishnan, Loh May-Han, Tan Cher Heng, SU Lin Lin, Young Barnaby Edward, Lye David Chien, et al. Care of the Pregnant Woman with COVID-19 in Labor and Delivery: Anesthesia, Emergency cesarean delivery, Differential diagnosis in the acutely ill parturient, Care of the newborn, and Protection of the healthcare personnel. American Journal of Obstetrics and Gynecology. 2020. 60. Yuan Jing, Kou Shanglong, Liang Yanhua, Zeng JianFeng, Pan Yanchao, Liu Lei. PCR Assays Turned Positive in 25 Discharged COVID-19 Patients. Clinical Infectious Diseases. 2020. 61. Tu Yung-Fang, Chien Chian-Shiu, Yarmishyn Aliaksandr A, Lin Yi-Ying, Luo Yung-Hung, Lin Yi-Tsung, et al. A Review of SARS-CoV-2 and the Ongoing Clinical Trials. International Journal of Molecular Sciences. 2020;21(7):2657. 62. Shi Y, Wang N, Zou QM. Progress and challenge of vaccine development against 2019 novel coronavirus (2019-nCoV). Zhonghua yu Fang yi xue za zhi [Chinese Journal of Preventive Medicine]. 2020;54:E029-E.