Sars-Cov-2 Pandemisinin Sağlıklı Kadınlarda Doğum Yönetimine ve Gebelik Komplikasyonlarına Etkisi

Amaç: SARS-CoV-2 pandemisinin, SARS-CoV-2 enfeksiyonu tespit edilmeyen sağlıklı gebelerde doğum yönetimi ve gebelik komplikasyonları üzerine etkisini araştırmaktır. Yöntemler: Dünya sağlık örgütü (WHO)’nün pandemi ilan ettiği tarih olan 11 Mart 2020 tarihinden sonra tekil doğum yapan 750 gebe çalışma grubunu, önce doğum yapan 750 gebe kontrol grubunu oluşturdu. Klinik veya SARS-CoV-2 seroloji testi ile enfeksiyon tespit edilmemiş gebeler çalışmaya dahil edildi. Gruplar demografik özellikleri, doğum şekli ve süresi, doğum haftası, sezaryen endikasyonu, gebelik komplikasyonları yönleri ile karşılaştırıldı. Bulgular: Pandemi dönemindeki gebeler Median±IQR 38±2 hafta’da, pandemi öncesinde gebeler ise Median±IQR: 39±1 hafta’da doğum yapmışlardır (p<0,001). Pandemi dönemindeki fetal doğum ağırlığı (Mean±SD:3078±688), pandemi öncesindeki fetal doğum ağırlığından (Mean±SD: 3182±633) daha düşük saptanmıştır (p=0,002). Primer sezaryen oranı pandemi döneminde, pandemi öncesine göre artmıştır (% 61,2-% 50,8, p=0,002). Pandemi döneminde maternal anksiyete ve ilerlemeyen doğum eylemi endikasyonu nedenli sezaryen, pandemi öncesi döneme göre yüksektir (Sırasıyla; 24,3% vs 10%, p=<0,001 ve 18,3% vs 10,4%, p=0,002). Vajinal doğum için yatırılan hastaların doğuma (vajinal ya da sezaryen) kadar geçen süre pandemi döneminde, pandemi öncesi döneme göre daha kısadır (Mean±SD: 9,09±3,85 vs 10,13±3,75, p<0,001). Yine vajinal doğum sürecinde ilerlemeyen doğum eylemi saptanan ve sezaryene alınan hastaların ilerlemeyen doğum tanı anına anına kadar geçen süre pandemi döneminde, pandemi öncesi döneme göre de daha kısadır (Mean±SD: 3,56±3,04 vs 13,70±8,76, p<0.001). Sonuçlar: Pandemi döneminde doğum için başvuran gebeler SARS-CoV-2 enfeksiyonu tespit edilmemiş sağlıklı gebeler dahi olsa doğum süreçlerindeki yönetimlerinde pandemi öncesine göre farklılıklar yaşamışlardır. Bu süreçte yaşanan sonuçların ve nedenlerinin tespiti devam eden ve gelecek pandemilerde gerekli önlemlerin alınmasını sağlayacağı kanaatindeyiz.

Anahtar Kelimeler:

SARS-CoV-2, Covid-19, Pandemi, Sezaryen, Doğum, Maternal anksiyete

Effect of Sars-Cov-2 Pandemic On Obstetric Management And Pregnancy Complications In Healthy Women

Objective: We aimed to investigate the effect of the SARS-CoV-2 pandemic on obstetric management and pregnancy complications in healthy pregnant women without SARS-CoV-2 infection. Methods: A total of 750 pregnant women who delivered singleton infants after 11 March 2020, the date when the World Health Organization (WHO) declared a pandemic, formed the study group, while 750 pregnant women who gave birth before this date formed the control group. The study included pregnant women who were found to have no infection clinically or by SARS-CoV-2 serology testing. The groups were compared in terms of demographic characteristics, type and duration of delivery, gestational age, indication for cesarean section, and pregnancy complications. Results: The median±IQR gestational age at delivery was 38±2 weeks in pregnant women who gave birth during the pandemic and 39±1 weeks in women who gave birth before the pandemic (p<0.001). Fetal birth weight was lower during the pandemic (Mean±SD: 3078±688) compared to the pre-pandemic period (Mean±SD: 3182±633) (p=0.002). The rate of primary cesarean section increased during the pandemic compared to the pre-pandemic period (61.2-50.8%, p=0.002). The rate of cesarean section due to maternal anxiety and failure to progress in labor indications was higher during the pandemic compared to the pre-pandemic period (24.3% vs. 10%, p=<0.001 and 18.3% vs. 10.4%, p=0.002, respectively). The time to delivery (vaginal or cesarean section) of patients admitted for vaginal delivery was shorter during the pandemic compared to the pre-pandemic period (Mean±SD: 9.09±3.85 vs. 10.13±3.75, p<0.001). Furthermore, the time to the diagnosis of failure to progress in labor was shorter in patients who were found to have a failure to progress in labor during the vaginal delivery process and who underwent cesarean section during the pandemic compared to the pre-pandemic period (Mean±SD: 3.56±3.04 vs 13.70±8.76, p<0.001). There was no increase in negative obstetric outcomes during the pandemic.

Keywords:

SARS-CoV-2, Covid-19, Pandemic, Cesarean, Delivery, Maternal anxiety,

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1. Phoswa WN, Khaliq OP. Is pregnancy a risk factor of COVID-19? Eur J Obstet Gynecol Reprod Biol 2020;252:605-9. doi: 10.1016/j.ejogrb.2020.06.058.
2. Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, Nahabedian J, Anderson K, Gilboa SM. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status. MMWR Morb Mortal Wkly Rep 2020; 69(25):769-75. doi:10.15585/mmwr.mm6925a.
3. Chen Y, Li Z, Zhang YY, Zhao WH, Yu ZY. Maternal health care management during the outbreak of coronavirus disease 2019. J Med Virol 2020; 92(7):731-9. doi: 10.1002/jmv.25787.
4. Fırtına Tuncer S. COVID-19 Pandemisinde gebelerin psikolojik iyilik halleri. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2021;18(3):921-6. doi: https://doi.org/10.38136/jgon.872653.
5. Nanjundaswamy MH, Shiva L, Desai G, Ganjekar S, Kishore T, Ram U, Satyanarayana V, Thippeswamy H, Chandra PS. COVID-19-related anxiety and concerns expressed by pregnant and postpartum women-a survey among obstetricians. Arch Womens Ment Health 2020;23(6):787-90. doi: 10.1007/s00737-020-01060-w.
6. Schmitt N, Mattern E, Cignacco E, Gregor Seliger, Martina König-Bachmann, Sabine Striebich, Ayerle GM. Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review. BMC Health Serv Res 2021;21(1):1364. doi: 10.1186/s12913-021-07377-1.
7. Qi H, Chen M, Luo X, Liu X, Shi Y, Liu T, Zhang H, Zhang J, u Zhao Y, Tong C, Baker PN. Management of a delivery suite during the COVID-19 epidemic. Eur J Obstet Gynecol Reprod Biol 2020;250:250-2. doi:10.1016/j.ejogrb.2020.05.031. 8. Royal College of Obstetricians and Gynecologists Guideline: Coronavirus (COVID-19) Infection in pregnancy BMJ 2020;369:m1672. doi: 10.1136/bmj.m1672.
9. Gebelikte Coronavirüs Enfeksiyonu (COVID-19) Hakkında Görüş (3. Bilgilendirme, 03.04.2020). Maternal Fetal Tıp ve Perinatoloji Derneği. Available from: https://www.tmftp.org/files/Duyurular/3.bilgilendirme.pdf [Accessed 15 May 2022].
10. 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;222(5):415-26. doi: 10.1016/j.ajog.2020.02.017.
11 Farrell T, Reagu S, Mohan S, Elmidany R, Qaddoura F, Ahmed EE, Corbett G, Lindow S, Abuyaqoub SM, Alabdulla MA. The impact of the COVID-19 pandemic on the perinatal mental health of women. J Perinat Med 2020;48(9):971-96. doi: 10.1515/jpm-2020-0415.
12. Sahin D, Tanacan A, Erol SA, Anuk AT, Yetiskin FDY, Keskin HL, Ozcan N, Ozgu-Erdinc AS, Eyi EGY, Yucel A, Tayman C, Unlu S, Dinc B, Sari E, Surel AA, Moraloglu OT. Updated experience of a tertiary pandemic center on 533 pregnant women with COVID-19 infection: A prospective cohort study from Turkey. Int J Gynaecol Obstet 2021;152(3):328-34. doi: 10.1002/ijgo.13460.
13. Adhikari EH, Moreno W, Zofkie AC, MacDonald L, McIntire DD, Collins RRJ, Spong CY. Pregnancy outcomes among women with and without severe acute respiratory syndrome coronavirus 2 infection. JAMA Netw Open 2020;3(11):e2029256. doi: 10.1001/jamanetworkopen.2020.29256.
14. Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand 2020;99:823-9. https://doi.org/10.1111/aogs.13867.
15. Aabakke AJM, Krebs L, Petersen TG, Kjeldsen FS, Corn G, Wøjdemann K, et al. SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study. Acta Obstet Gynecol Scand 2021;100(11):2097-110. doi: 10.1111/aogs.14252.
16. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed 2020; 91(1): 157-60. doi: 10.23750/abm.v91i1.9397.
17. Connor P. More than nine-in-ten people worldwide live in countries with travel restrictions amid COVID-19. Pew Research Center 2020. Available from: https://www.pewresearch.org/fact-tank/2020/04/01/more-than-nine-in-ten-people-worldwide-live-in-countries-with-travel-restrictions-amid-covid-19// [Accessed 15 May 2022].
18. American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine, Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014;210(3):179-93. doi: 10.1016/j.ajog.2014.01.026.
19. Sutton D, Fuchs K, D'Alton M, Goffman D. Universal Screening for SARS-CoV-2 in Women Admitted for Delivery. N Engl J Med 2020; 382(22):2163-4. doi: 10.1056/NEJMc2009316.
20. Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 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 2020;2(2):100118. doi: 10.1016/j.ajogmf.2020.100118.
21. Dong L, Tian J, He S, Zhu C, Wang J, Liu C, Yang J. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA 2020;323(18):1846-8. doi:10.1001/jama.2020.462.
22. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong Q, Liao J, Yang H, Hou W, Zhang Y. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395(10226):809-15. doi: 10.1016/S0140-6736(20)30360-3