COVID-19 Enfeksiyonu ile Komplike Gebe Hastalarda Maternal ve Neonatal Sonuçların Değerlendirilmesi

Öz

Özet Amaç: Çalışmanın amacı; gebelik sırasında maternal Coronavirus Disease 2019 (COVID-19) enfeksiyonunun anne sağlığı üzerine etkilerinin belirlenmesi ve neonatal sonuçlar üzerine etkisinin değerlendirilmesidir. Gereç- yöntem: Bu çalışmada, 1 Şubat 2020- 1 mart 2021 tarihleri arasında yayınlanmış makalelerin, Pubmed ve Google Scholar üzerinden kapsamlı bir literatür taraması yapılmıştır. Anahtar kelimeler ‘COVID-19, SARS-CoV-2, pregnancy, maternal complications, fetal complications, maternal mortality, fetal mortality’ şeklinde olup ingilizce dil kısıtlaması yapılmıştır. Bu kriterlere uygun 8 çalışma dahil edilmiştir. Toplam 724 nazal sürüntü örneğinde polimeraz zincir reaksiyonu (PCR) ile COVID-19 enfeksiyonu doğrulanmış gebe hasta ve kontrol grubu olarak nazal sürüntü örneğinde COVID-19 PCR ile enfeksiyon olmadığı kanıtlanmış olan 6001 gebe dahil edilmiştir. Analiz edilen değişkenler: maternal yaş, eşlik eden komorbidite durumu, COVID-19 hastalık semptomları, pnömoni varlığı, maternal yoğun bakım ihtiyacı, maternal mortalite, abortus varlığı, preterm doğum oranı, doğum şekli, yenidoğan yoğun bakım ihtiyacı, yenidoğan COVID-19 PCR durumu ve COVID-19‘a bağlı yenidoğan mortalite oranıdır. Bulgular: Maternal COVID-19 enfeksiyonu vakalarının %50’sinde asemptomatik seyretti. Klinik semptomlar %39 ile öksürük, %34 ateş, %24 koku kaybı, %16 dispne şeklindedir. Maternal enfeksiyonda hastaların %13’ünde hastanede yatış gerekliliği belirlendi. Akciğer tutulumu %14 olup, hastaların %2’si yoğun bakım şartlarında tedavi edilmiştir. Maternal mortalite %0,7 olarak saptanmıştır. Maternal ve neonatal sonuçlar için yenidoğan yoğun bakım ihtiyacı oranı dışında anlamlı fark saptanmadı. Yenidoğan COVID-19 PCR taramasında %2 pozitiflik saptanmasına rağmen COVID-19 enfeksiyonuna bağlı yenidoğan ölümü saptanmadı. Sonuçlar: COVID-19 enfeksiyonu ile komplike gebe hastalarda, maternal ve neonatal sonuçların kötüleştiğine dair belirgin ilişki saptanmadı. Doğum şekli obstetrik endikasyonlara göre belirlenmelidir. Anneden bebeğe vertikal geçiş gösterilmemekle beraber %2 yenidoğan PCR ile pozitiflik oranı bildirilmiştir. Hiçbir yenidoğanda hastalık bulgusu saptanmadı ve ölüm bildirilmedi.

Anahtar Kelimeler

• COVID-19
• SARS-Cov-2
• maternal komplikasyonlar
• maternal enfeksiyonlar
• fetal komplikasyonlar

Evaluation of Maternal and Neonatal Outcomes in Pregnant Patients Complicated by COVID-19 İnfection

Öz

Abstract Objectives: The purpose of the study; Determining the effects of maternal Coronavirus Disease 2019 (COVID-19) infection during pregnancy on maternal health and evaluating its effect on neonatal outcomes. Materials and methods: In this study, a comprehensive literature review was carried out on Pubmed and Google Scholar for articles published between February 1, 2020 and March 1, 2021. The keywords are 'COVID-19, SARS-CoV-2, pregnancy, maternal complications, fetal complications, maternal mortality, fetal mortality' and English language restriction has been applied. Eight studies were included. Pregnant patients with confirmed COVID-19 infection by polymerase chain reaction (PCR) in a total of 724 nasal swab samples and 6001 pregnant women who were proven to be free of infection by COVID-19 PCR in the nasal swab sample were included as a control group. The variables analyzed: maternal age, comorbidity status, symptoms of COVID-19 disease, presence of pneumonia, maternal intensive care need, maternal mortality, presence of abortion, preterm delivery rate, delivery type, neonatal intensive care need, neonatal COVID-19 PCR status and neonatal mortality rate due to COVID-19. Results: It was asymptomatic in 50% of the cases of maternal COVID-19 infection. Clinical symptoms are 39% cough, 34% fever, 24% loss of smell, 16% dyspnea. The requirement for hospitalization was determined in 13% of the patients in maternal infection. Lung involvement is 14%, and 2% of the patients have been treated in intensive care conditions. Maternal mortality was found to be 0.7%. No significant difference was found for maternal and neonatal outcomes, except for the rate of neonatal intensive care need (p=0,03). Although 2% positivity was detected in the newborn COVID-19 PCR scan, no neonatal death due to COVID-19 infection was detected. Conclusions: There was no significant correlation between maternal and neonatal outcomes in pregnant patients complicated by COVID-19 infection. Delivery method should be determined according to obstetric indications. Although vertical transmission from mother to baby was not shown, a positivity rate of 2% with neonatal PCR has been reported. There were no signs of disease in any newborns, and no deaths were reported.

Anahtar Kelimeler

• maternal complications
• COVID-19
• SARS-Cov-2
• maternal infections
• fetal complications

Kaynakça

1. 1. Ng PC. Infection control for SARS in a tertiary neonatal centre. Arch Dis Child - Fetal Neonatal Ed [Internet]. 2003 Sep 1;88(5):405F – 409.
2. 2. Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect [Internet]. 2019 Jun;52(3):501–3.
3. 3. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ [Internet]. 2020;
4. 4. Yanes-Lane M, Winters N, Fregonese F, Bastos M, Perlman-Arrow S, Campbell JR, et al. Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis. PLoS One. 2020;
5. 5. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep [Internet]. 2020 Nov 6;69(44):1641–7.
6. 6. Cosma S, Carosso AR, Cusato J, Borella F, Carosso M, Bovetti M, et al. Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients. Am J Obstet Gynecol [Internet]. 2020 Oct 8;
7. 7. Liu W, Wang Q, Zhang Q, Chen L. Coronavirus disease 2019 (COVID-19) during pregnancy: a case series. Preprint. 2020;
8. 8. Simões e Silva AC, Leal CRV. Is SARS-CoV-2 Vertically Transmitted? Front Pediatr [Internet]. 2020 May 15;8.

9. 9. Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol [Internet]. 2004 Jul;191(1):292–7.
10. 10. Mullins E, Evans D, Viner RM, O’Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound in Obstetrics and Gynecology. 2020.
11. 11. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis [Internet]. 2020 May;20(5):559–64.
12. 12. Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, et al. Coronavirus disease 2019 in pregnancy. Int J Infect Dis [Internet]. 2020 Jun;95:376–83.
13. 13. Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol [Internet]. 2020 Jul;223(1):36–41.
14. 14. Ashraf MA, Keshavarz P, Hosseinpour P, Erfani A, Roshanshad A, Pourdast A, et al. Coronavirus disease 2019 (COVID-19): A systematic review of pregnancy and the possibility of vertical transmission. Journal of Reproduction and Infertility. 2020.
15. 15. Salem D, Katranji F, Bakdash T. COVID‐19 infection in pregnant women: Review of maternal and fetal outcomes. Int J Gynecol Obstet [Internet]. 2021 Mar 27;152(3):291–8.
16. 16. Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, et al. Pregnancy and neonatal outcomes of COVID-19 – co-reporting of common outcomes from the PAN-COVID and AAP SONPM registry. medRxiv. 2021;