COVID-19 Enfeksiyonu ve Gebelik Üzerindeki Etkileri

Çin’de aralık ayında görülen ve pandemi olarak ilan edilen COVID-19 enfeksiyonu ile ilgili her geçen gün morbidite ve mortalite oranları yükselmektedir. Salgın ile beraber gebelik süreciyle ilgili kaygılar da artmaktadır. COVID-19 pnömonisi geçiren gebeler ile genel popülasyonun klinik belirtileri benzerdir. Gebelerin solunum patojenlerine ve şiddetli pnömoniye karşı daha hassas olması ve yapılan çalışmalarda vaka sayılarının azlığı sebebi ile sürecin daha kontrollü sürdürülmesi gerekmektedir. Dünya sağlık örgütü tarafından önerilen Enfeksiyonu Önleme ve Kontrol (IPC) basamaklarının gebelerde olduğu gibi düşük, fetal kayıp, postpartum dönemdeki kadınlar ve bebek bakımını üstlenen kişiler tarafından da uygulanması gerektiği vurgulanmıştır. Yapılan çalışmalarda yeterli kanıtlar olmamakla beraber hastalığın anneden bebeğe geçişinin dikey bulaşla olduğu belirtilmiştir. Enfeksiyon veya şüphesi olan gebelerin doğumdan sonra en az 14 gün boyunca bebeği ile yakın temasının kesilmesi ve emzirilmemesi önerilmektedir. Doğum şekli için tıbbi bir endikasyon yoksa vajinal yolla yapılabileceği belirtilmektedir. Gebeler enfeksiyon sürecinde perinatoloji, yenidoğan ve yoğun bakım uzmanlarından oluşan multidisipliner bir yaklaşımla ele alınmalıdır. Ayrıca bu süreçte gebelere psikososyal desteğin sağlanması da çok önemlidir.

Anahtar Kelimeler:

Koronavirüs, pandemi, gebelik

COVID-19 Infectıon and Its Effects on Pregnancy

Morbidity and mortality rates are increasing day by day in relation to the COVID-19 infection seen in China in December and announced as a pandemic. Concerns about the pregnancy process increase with the epidemic. The clinical manifestations of the general population are similar to those of pregnant women who have had COVID-19 pneumonia. Because the pregnant women are more sensitive to respiratory pathogens and severe pneumonia, the process should be maintained in a more controlled manner due to the low number of cases. It was emphasized that the IPC measures proposed by the world health organization should be implemented by pregnant women, as well as those in abortus, fetal loss, postpartum period, and those who take care of the baby. Although there is not enough evidence in the studies conducted, it was stated that the transition of the disease from mother to baby is by vertical transmission. It is recommended that pregnant women with infection or suspicion should not be kept in close contact with their baby for at least 14 days after birth and not breastfeeding. It is stated that if there is no medical indication for delivery, it can be done vaginally. Pregnant women should be handled with a multidisciplinary approach consisting of obstetric, perinatal, newborn and intensive care specialists during the infection process. Also, providing psychosocial support to pregnant women is very important in this process.

Keywords:

Coronavirus, pandemic, pregnancy,

PDF

___

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. The Lancet. 2020;395(10223):497-506.
2. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China Novel Coronavirus, I., Research, T.(2020) A Novel Coronavirus from Patients with Pneumonia in China, N Engl J Med. 2019.
3. Novel CPERE. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua liu xing bing xue za zhi= Zhonghua liuxingbingxue zazhi. 2020;41(2):145.
4. Dhama K, Sharun K, Tiwari R, Sircar S, Bhat S, Malik YS, et al. Coronavirus Disease 2019–COVID-19. 2020.
5. Organization WH. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Geneva, Switzerland. 2005.
6. Chan JF-W, To KK-W, Tse H, Jin D-Y, Yuen K-Y. Interspecies transmission and emergence of novel viruses: lessons from bats and birds. Trends in microbiology. 2013;21(10):544-55.
7. Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis. Journal of medical virology. 2020.
8. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020:200463.
9. Peeri NC, Shrestha N, Rahman MS, Zaki R, Tan Z, Bibi S, et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? International Journal of Epidemiology. 2020.
10. McIntosh K, Hirsch MS, Bloom A. Coronavirus disease 2019 (COVID-19).
11. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020.
12. 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(10223):497-506.
13. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. Jama. 2020.
14. Boldog P, Tekeli T, Vizi Z, Dénes A, Bartha FA, Röst G. Risk assessment of novel coronavirus COVID-19 outbreaks outside China. Journal of Clinical Medicine. 2020;9(2):571.
15. Xu H, Huang S, Liu S, Deng J, Jiao B, Ai L, et al. Evaluation of the clinical characteristics of suspected or confirmed cases of COVID-19 during home care with isolation: A new retrospective analysis based on O2O. Available at SSRN 3548746. 2020.
16. Lan L, Xu D, Ye G, Xia C, Wang S, Li Y, et al. Positive RT-PCR Test Results in Patients Recovered From COVID-19. JAMA. 2020.
17. Li X, Hu C, Su F, Dai J. Hypokalemia and Clinical Implications in Patients with Coronavirus Disease 2019 (COVID-19). medRxiv. 2020.
18. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). StatPearls. Treasure Island (FL): StatPearls Publishing StatPearls Publishing LLC. 2020.
19. Gottfredsson M. The Spanish flu in Iceland 1918. Lessons in medicine and history. Laeknabladid. 2008;94(11):737-45.
20. 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. American journal of obstetrics and gynecology. 2004;191(1):292-7.
21. Schoeman D, Fielding BC. Coronavirus envelope protein: current knowledge. Virology journal. 2019;16(1):69.
22. Zhang Y. Novel 2019 coronavirus genome. Virological.[Accessed 21 Jan 2020].
23. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, 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.
24. Zhelezov D, Kossey T, Zarzhitskaya N. Features of myometrium remodeling after surgical inteventions on the uterus. Journal of Education, Health and Sport. 2020;10(1):142-9.
25. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of 2019 novel coronavirus infection in China. MedRxiv. 2020.
26. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020.
27. Qiao J. What are the risks of COVID-19 infection in pregnant women? The Lancet. 2020;395(10226):760-2.
28. ACOG. Outpatient Assessment and Management for Pregnant Women With Suspected or Confirmed Novel CCoronaries (COVID-19) 2020.