Gebelikte Coronavirüs Enfeksiyonu (COVID-19) ve Yönetimi

Yıl 2020, , 348 - 358, 15.06.2020

Koray Gök , Osman Köse , Selçuk Özden

https://doi.org/10.31832/smj.723129

Cited By: 1

Öz

2019’un sonunda Çin’in Hubei eyaleti Wuhan şehrinde ortaya çıkan ve yayılan SARS-CoV-2 virüsü sonucu meydana gelen COVID-19 pandemisi halen ciddi bir halk sağlığı problemi olarak etkisini sürdürmektedir. Hızlı yayılması, tedavisinin olmaması ve ölümcül seyretmesi virüsün yarattığı etkiyi önemli kılmaktadır. Pnömoninin maternal morbidite ve mortalitenin önemli bir nedeni olduğu düşünüldüğünde, COVID-19'un ortaya çıkışı ve küresel yayılması, bu salgının gebe kadınlar ve fetüsleri üzerindeki etkileri hakkında endişeleri artırmıştır. Gebelerde enfeksiyon ile ilgili olarak kısıtlı sayıda bilgi mevcuttur ve şimdilik yönetimin gebe olmayanlar gibi yapılması önerilmektedir. Halen geç gebelikte COVID-19 pnömonisi gelişen kadınlarda vertikal geçişin neden olduğu intrauterin enfeksiyona dair kanıt yoktur. Gebelikte COVID-19 'un yönetim prensipleri erken izolasyon, agresif enfeksiyon kontrol prosedürleri, oksijen tedavisi, aşırı sıvı yüklenmesinin önlenmesi, ampirik antibiyotiklerin (sekonder bakteriyel enfeksiyon riski) değerlendirilmesi, virüs ve koenfeksiyon için laboratuvar testi, fetal ve uterin monitorizasyon, ilerleyici solunum yetmezliği için erken mekanik ventilasyon, bireyselleşmiş doğum planlamasını içerir. COVID-19 enfekte gebe hastanın yönetimi multidisipliner bir takım tarafından düzenlenmelidir.
Abstract
The COVID-19 pandemic, which occurred as a result of the SARS-CoV-2 virus that spread in the city of Wuhan, Hubei province in late 2019, still continues to be a serious public health problem. Its rapid spread, lack of treatment and lethal course make the effect of the virus important. Given that pneumonia is an important cause of maternal morbidity and mortality, the emergence and global spread of COVID-19 has raised concerns about the implications of this outbreak for pregnant women and their fetuses. There is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. Principles of management of COVID-19 in pregnancy include early isolation, aggressive infection control procedures, oxygen therapy, avoidance of fluid overload, consideration of empiric antibiotics (secondary to bacterial infection risk), laboratory testing for the virus and coinfection, fetal and uterine monitoring, early mechanical ventilation for progressive respiratory failure, individualized delivery planning, and a team-based approach with multispecialty consultations. Management of COVID-19-infected pregnant women should be undertaken by a multidisciplinary team.

Anahtar Kelimeler

gebelik, covid-19, fetal, enfeksiyon

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

Teşekkürler...

Kaynakça

• Kaynaklar: 1.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 2020; 395: 497– 506. 2.World Health Organization. Novel coronavirus ‐ China. Disease outbreak news: Update. 12 January 2020. https://www.who.int/csr/don/12‐january‐2020‐novel‐coronavirus‐china/en/ [Accessed 7 March 2020]. 3.Coronavirus COVID‐19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6. 4. Su S, Wong G, Shi W, Liu J, Lai ACK, Zhou J, et al . Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol 2016; 24: 490– 502. 5. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al.; SARS Working Group. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003; 348: 1953– 1966. 6. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med 2012; 367: 1814– 1820. 7. World Health Organization. Emergencies preparedness, response. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. 8. World Health Organization. Middle East respiratory syndrome coronavirus (MERS‐CoV). MERS Monthly Summary, November 2019. http://www.who.int/emergencies/mers‐cov/en/. 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 2004; 191: 292– 297. 10. Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: report of two cases and review of the literature. J Microbiol Immunol Infect 2019;52:501-503. 11. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395: 565– 574. 12. Report of the WHO‐China Joint Mission on Coronavirus Disease 2019 (COVID‐19). 16‐24 February 2020. https://www.who.int/docs/default‐source/coronaviruse/who‐china‐joint‐mission‐on‐covid‐19‐final‐report.pdf [Accessed 9 March 2020]. 13. WHO Director‐General's opening remarks at the media briefing on COVID‐19 ‐ 3 March 2020.https://www.who.int/dg/speeches/detail/who‐director‐general‐s‐opening‐remarks‐at‐the‐media‐briefing‐on‐covid‐19‐‐‐3‐march‐2020). 14. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al.; Pandemic H1N1 Influenza in Pregnancy Working Group. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA 2010; 303: 1517– 1525. 15. RCOG. Royal College of Obstetrics and Gynaecology: Coronavirus (COVID-19) Infection in pregnancy. Information for healthcare professionals. Version 4.202025 March 2020]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-21-covid19-pregnancy-guidance-2118.pdf. 16. ACOG. Practice Advisory: Novel Coronavirus 2019 (COVID19).2020 https://www.acog.org/ClinicalGuidance-andPublications/PracticeAdvisories/Practice Advisory-Novel-Coronavirus2019?IsMobileSet=false,(12-03-2020). 17. T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü. COVID-19 Rehberi.https://hsgm.saglik.gov.tr/depo/covid19/rehberler/COVID-19_Rehberi.pdf (02-04-2020). 18. McIntosh K. Coronavirus disease 2019 (COVID-19). In:UpToDate Hirsch CH, Bloom H (ed), UpToDate 2020. 19. RCOG Coronavirus (COVID-19) infection in pregnancy, 18/03/2020. https://www.rcog.org.uk/globalassets/documents/guidelines/coronaviruscovid-19-infection in- pregnancy-v3-20-03-18.pdf. 20. Centers for Disease Control and Prevention. Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection, Updated February 12, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html (Accessed on February 14, 2020). 21. WHO. Global surveillance for COVID-19 disease caused by human infection with the2019 novel coronavirus. Interim guidance. 27 February 2020. https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov) [Accessed 7 March 2020]. 22. Li X, Xia L. Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management. AJR Am J Roentgenol. 2020 Mar 4:1-7. doi: 10.2214/AJR.20.22954. [Epub ahead of print] 23. 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 Am J Roentgenol. 2020 Mar 3:1-6. doi: 10.2214/AJR.20.22976. [Epub ahead of print] 24. Ai T. Yang Z, Hou H, Zhan C, Chen C, Lv W,et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 2020 Feb 26:200642. doi:10.1148/radiol.2020200642. [Epub ahead of print] 25. Kong W, Argawal PP. Chest imaging appearance of COVID-19 infection. Radiology 2020;2. DOI:10.1148/ryct.2020200028. 26. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 585 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; published 586 online Feb 24. DOI:10.1016/S1473-3099(20)30086-4. 27. Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 2007;27:1705–22. 28. National Library of Medicine. Gadopentetate. In: Drugs and Lactation Database (LactMed). Available at: http://toxnet.nlm.nih.gov/cgibin/sis/search2/r?dbs+lactmed:@term+@DOCNO +519. Accessed 7 March 2020. 29. Miller RW. Discussion: severe mental retardation and cancer among atomic bomb survivors exposed in utero. Teratology 1999;59:234–5. 30. Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol 2017; 130(4):e210e216.DOI:10.1097/AOG.0000000000002355.23 31. American College of Radiology. ACR-SPR practice parameter for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation (2018). https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Pregnant-Pts.pdf. 32. Tremblay E, Thérasse E, Thomassin-Naggara I, et al. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics, 2012,32(3):897-911. DOI: 10.1148/rg.323115120. 31. 33. Levy A, Yagil Y, Bursztyn M, Barkalifa R, Scharf S, Yagil C. ACE2 expression and activity are enhanced during pregnancy. Am J Physiol Regul Integr Comp Physiol 2008;295:1953-61. 34. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020. 35. Schwartz DA. 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. Arch Pathol Lab Med 2020. 36. Dong L, Tian J, He S, et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA 2020. 37. Zeng L, Xia S, Yuan W, 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. 38. Zeng H, Xu C, Fan J, et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA 2020. 39. Kimberlin DW, Stagno S. Can SARS-CoV-2 Infection Be Acquired In Utero?: More Definitive Evidence Is Needed. JAMA 2020. 40. The Lancet. Emerging understandings of 2019‐nCoV. Lancet 2020; 395: 311. 41. Maxwell C, McGeer A, Tai KFY, Sermer M. No. 225 ‐ Management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syndrome (SARS). J Obstet Gynaecol Can 2017; 39: e130– e137. 42. Centers for Disease Control. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID‐19). https://www.cdc.gov/coronavirus/2019‐ncov/hcp/clinical‐guidance‐management‐patients.html [Accessed 8th March 2020]. 43. Boseley S. China trials anti‐HIV drug on coronavirus patients. The Guardian [cited 15 February 2020]. https://www.theguardian.com/world/2020/feb/07/china‐trials‐anti‐hiv‐drug‐coronavirus‐patients. 44. NIH clinical trial of remdesivir to treat COVID‐19 begins. 25 February 2020. https://www.nih.gov/news‐events/news‐releases/nih‐clinical‐trial‐remdesivir‐treat‐covid‐19‐begins [Accessed 9 March 2020]. 45. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K,et al. ; on behalf of the American Thoracic Society and Infectious Diseases Society of America. Diagnosis and Treatment of Adults with Community‐acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45– e67. 46. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID‐19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020. DOI: 10.1016/j.ajog.2020.02.017. 47. Schultz MJ, Dunser MW, Dondorp AM, Adhikari NKJ, Iyer S, Kwizera A, et al. Current challenges in the management of sepsis in ICUs in resource‐poor settings and suggestions for the future. Intensive Care Med 2017; 43: 612– 624. 48. Plante LA, Pacheco LD, Louis JM. SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. Am J Obstet Gynecol 2019; 220: B2– B10. 49. Røsjø H, Varpula M, Hagve TA, Karlsson S, Ruokonen E, Pettila V, et al. ; FINNESEPSIS Study Group. Circulating high sensitivity troponin T in severe sepsis and septic shock: distribution, associated factors, and relation to outcome. Intensive Care Med 2011; 37: 77– 85. 50. Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature. J Anaesthesiol Clin Pharmacol 2016; 32: 431– 439. 51. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. Interim guidance. 28 January 2020. https://www.who.int/publications‐detail/clinical‐management‐of‐severe‐acute‐respiratory‐infection‐when‐novel‐coronavirus‐(ncov)‐infection‐is‐suspected [Accessed 7 March 2020]. 52. Clowse ME, Magder L, Witter F et al. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 2006;54(11):3640. 53. CDC.Treatment of Malaria: Guidelines For Clinicians. 2019. https://www.cdc.gov/ malaria/resources/ pdf/clinicalguidance.pdf (20-03-2020). 54. Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral Pregnancy Registry International Interim Report for 1January 1989 through 31 July 2019. Wilmington, NC: Registry Coordinating Center; 2019. www.APRegistry.com. 55. Ehrenstein, V., Kristensen, N.R., Monz, B.U. et al. Oseltamivir in pregnancy and birth outcomes. BMC Infect Dis 18, 519 (2018). https://doi.org/10.1186/s12879-018-3423-z. 56. https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics (Accessed on March 30, 2020). 57. COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics (Accessed on March 25, 2020). 58. https://dgs-urgent.sante.gouv.fr/dgsurgent/inter/detailsMessageBuilder.do?id=30500&cmd=visualiserMessage (Accessed on March 19, 2020 59. Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ 2020; 368:m1086. 60. Updated: WHO Now Doesn't Recommend Avoiding Ibuprofen For COVID-19 Symptoms. Science Alert 2020. https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms (Accessed on March 19, 2020). 61.European Medicines Agency. EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19 https://www.ema.europa.eu/en/news/ema-gives-advice-use-non-steroidal-anti-inflammatories-covid-19 (Accessed on March 19, 2020). 62. Francesca Donders, ,ISIDOG recommendations concerning COVID-19 and pregnancy. ISIDOG COVID-19 guideline Version 3.2 Date 01/04/2020. 63. Madinger NE, Greenspoon JS, Ellrodt AG. Pneumonia during pregnancy: has mod-ern technology improved maternal and fetal outcome? Am J Obstet Gynecol 1989;161: 657–662. 64. Favre G, Pomar L, Qi X, Nielsen-Saines K, Musso D, Baud D. Guidelines forpregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis 2020. https://doi.org/10.1016/S1473-3099(20)30157-2. 65. ChenH, GuoJ, WangC, LuoF, YuX, ZhangW, et al. Clinical characteristics and intrauterine vertical transmis-sion potential of COVID-19 infection in nine pregnant women: a retrospective reviewof medical records. Lancet 2020. https://doi.org/10.1016/S0140-6736(20)30360-3. 66. Qi H, Chen D, Feng L, Zou L, Li J. Obstetric considerations on delivery issues forpregnant women with COVID-19 infection. Chin J Obstet Gynecol 2020; 55: E001. 67. Yang H, Wang C, Poon LC. Novel coronavirus infection and pregnancy. Ultrasound Obstet Gynecol 2020.DOI:10.1002/uog.22006. 68. Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Lim WS. Corticosteroids as adjunc-tive therapy in the treatment of influenza. Cochrane Database Syst Rev 2016; 3:CD010406. 69. Mullins E, Evans D, Viner R, O’Brien, P , Morris E. Coronavirus in pregnancy anddelivery: rapid review and expert consensus. medRxiv 8 March 2020. https://doi.org/10.1101/2020.03.06.20032144. 70. Poon LC, Yang H, Lee JCS, Copel JA, Leung TY, Zhang Y, et al. ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals.Ultrasound Obstet Gynecol. 2020 Mar 11. doi: 10.1002/uog.22013. [Epub ahead of print] 71. Zhu Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G,et al. Clinicalanalysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr2020; 9. DOI: 10.21037/tp.2020.02.06. 72. Centers for Disease Control. Interim Considerations for Infection Prevention andControl of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Health-care Settings. https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html#anchor_;1582067966715. [Accessed 8 March 2020]. 73. Chua MSQ, Lee JCS, Sulaiman S, Tan HK. From the frontlines ofCOVID-19 – How prepared are we as obstetricians: a commentary. BJOG 2020.DOI:10.111/1471-0528.16192.