Gebe Kadınlarda Covid 19 - Retrospektif Kohort Çalışması

Yıl 2021, , 181 - 186, 28.05.2021

Kazibe Koyuncu , Yasemin Alan , Önder Sakin , Burçin Karamustafaoğlu Balcı , Ramazan Denizli , Ali Doğukan Anğın , Abdülmecit Öktem

https://doi.org/10.47115/jshs.793218

Cited By: 2

Öz

Amaç: Amacımız, benzer yaş aralığında COVID-19 enfeksiyonu olan gebe olmayan kadınlarla, COVID-19 enfeksiyonu bulunan gebe kadınların klinik belirti, semptom, tedavi ve prognozunu özetlemektir.
Yöntem: Bu çalışma 15 Mart - 31 Mayıs 2020 tarihleri arasında COVID-19 ile enfekte olantüm semptomatik gebe kadınların tıbbi kayıtlarının geriye dönük inceleme yapıldı. Aynı zaman aralığında ve COVID-19 tanısı ile üçüncü basamak bir hastaneye başvuran gebe kadınlar çalışma grubunu (n=21), üreme çağındaki semptomatik, gebe olmayan kadınlar (n=90) kontrol grubuna dahil edilmiştir. Yedi gebe kadın ve onbeş gebe olmayan kadın SARS-CoV-2 pozitif ve asemptomatik olması sebebiyle çalışma dışı bırakılmış ve 14 gebe ve 75 gebe olmayan kadın ile tamamlanmıştır. COVID-19 hastalığının teşhisi, bilgisayarlı tomografi (BT) taramalarına dayandırılmıştır. PCR ile laboratuvar onayı için, nazofaringealsürüntü örnekleri toplanmış olup Bio-Rad Laboratories tarafından sağlanan kan bazlı immünolojik test kiti ile SARS-CoV-2 için test edilmiştir.
Bulgular: Semptomların görülme sıklığı açısından iki grup arasında istatistiksel olarak anlamlı bir fark bulunmadı (p>0.05). Erken evre, Covid-19 hastalığında sık görülen, periferik ve subplevral bölgede yer alan buzlu cam opasiteleri (GGO) ile karakterizedir. Klinik seyrin ciddiyeti ile ilgili olarak; gebe grubunda hastanede yatış ihtiyacı, hastanede kalış süresi, mekanik ventilasyon ihtiyacı istatistiksel olarak anlamlı derecede yüksekti. Her iki gruba da benzer oranda Hidroksiklorokin ve antiviral ilaçlar reçete edildi, ancak antibiyotik ve düşük molekül ağırlıklı heparin kullanımı gebe grupta istatistiksel olarak anlamlı olarak daha yüksekti.
Sonuçlar ve Öneriler: COVID-19 enfeksiyonunun gebe olan ve olmayan kadınlarda benzer klinik özelliklere sahip olduğunu ve gebe kadınlarda benzer pnömoni oranına sahip olduğunu gözlemledik. Ancak kesin bir sonuca varmak için ileride yapılacak araştırmalara ihtiyaç vardır   

Anahtar Kelimeler

Koronavirüs, COVID-19, SARS-CoV-2, Obstetrik tedavi, Gebelik, Ateş

COVID 19 IN PREGNANT WOMEN - A RETROSPECTIVE COHORT STUDY

Öz

Aim: Our aim is to summarize the clinical signs, symptoms, treatment andprognosis of pregnant women with COVID-19 comparing with non pregnant women with COVID-19 at similar age interval.
Method: A retrospective study was conducted by reviewing the medical records of all symptomatic pregnant women infected with COVID-19 between March 15 and May 31, 2020. Pregnant women (n=21) who applied to tertiary hospital during the same time period and with covid-19 diagnosis formed our working group, and control group (n=90) consisted of women who were symptomatic of reproductive age and not pregnant. Seven pregnant women and fifteen non pregnant women were excluded due to being asymptomathic and SARS- CoV-2 positive. COVID-19 infection was diagnosed with computed tomography (CT) scans. For laboratory confirmation with PCR, patients were asked to give nasopharyngeal swab samples and tested for SARS-CoV-2 with the blood-based immunoassay kit launchedprovided by Bio-Rad Laboratories.
Results: Between March 15 to May 31, 2020, there were 21 pregnant women and 90 non-pregnant women who have confirmed infection for COVID-19. Seven pregnant women and 15 non-pregnant women were SARS-CoV-2 positive and asymptomatic; they are not included in the study. Fourteen pregnant women and 75 non-pregnant women are included in the study. There were no statistically significant difference between groups concerning the incidence of the symptoms (p> 0.05). Early stage is characterized by the ground glass opacities (GGO), which is common in Covid-19 disease, located in the peripheral and subpleural area. In what concerns the severity of the clinical course; the need for hospitalization, the length of hospital stay, the need for mechanical ventilation were statistically significantly higher in pregnant group. All the two groups were prescribed Hydroxychloroquine and antivirals at a similar rate but the use of antibiotics and low molecular weight heparin was statistically significantly higher in pregnant group.
Conclusion and Suggestions: We found that COVID-19 infection hassimilar clinical characteristics and a similar rate of pneumonia in pregnant women. But more studies are needed in the field to define a definitive outcome.

Anahtar Kelimeler

Coronavirus, COVID-19, SARS-CoV-2, obstetric management, pregnancy, fever

Kaynakça

• Baron SA, Devaux C, Colson P, Raoult D, Rolain JM. Teicoplanin: an alternative drug for the treatment of COVID-19? International journal of antimicrobial agents. Apr 2020;55(4):105944
• Bhatnagar T, Murhekar MV, Soneja M, et al. Lopinavir/ritonavir combination therapy amongst symptomatic coronavirus disease 2019 patients in India: Protocol for restricted public health emergency use. The Indian journal of medical research. Mar 11 2020
• Breslin N, Baptiste C, Gyamfi-Bannerman C, 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. American journal of obstetrics & gynecology MFM. Apr 9 2020:100118
• Dashraath P, Jing Lin Jeslyn W, Mei Xian Karen L, Li Min L, Sarah L, Biswas A, ArjandasChoolani M, Mattar C, Lin SL, Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy, American Journal of Obstetrics and Gynecology (2020), doi: https://doi.org/10.1016/j.ajog.2020.03.021.
• Dembinski J. [Oseltamivir in pregnancy, lactation and neonatal period--comparison of international recommendations]. Zeitschrift fur Geburtshilfe und Neonatologie. Apr 2010;214(2):52-54
• Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience trends. Mar 16 2020;14(1):72-73
• Kaplan YC, Ozsarfati J, Nickel C, Koren G. Reproductive outcomes following hydroxychloroquine use for autoimmune diseases: a systematic review and meta-analysis. British journal of clinical pharmacology. May 2016;81(5):835-848
• Karunajeewa HA, Salman S, Mueller I, Baiwog F, Gomorrai S, Law I, Page-Sharp M, Rogerson S, Siba P, Ilett KF, Davis TME. Pharmacokinetics of chloroquine and monodesethylchloroquine in pregnancy. Antimicrobial agents and chemotherapy. Mar 2010;54(3):1186-1192
• National Institute of Health, https://www.covid19treatmentguidelines.nih.gov/antiviral-therapy/
• Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. Journal of thrombosis and haemostasis : JTH. Apr 17 2020
• Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. Jama. Apr 13 2020
• Sarah K Dotters-Katz, Brenna L Hughes. Considerations for Obstetric Care During the COVID-19 Pandemic . Am J Perinatol, 2020 Apr 17. doi: 10.1055/s-0040-1710051
• WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Available at https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020). Accessed March 12, 2020.