COVID 19 salgınının prenatal bakım kliniklerindeki etkisi; Geç teşhis?

Amaç: Corona Virüs Hastalığı 19 (COVID-19) pandemisinin sağlık sistemi ve doğum öncesi bakım üniteleri üzerinde de etkisi vardır. Amacımız, COVID-19 salgını sırasında doğum öncesi bakımın kesintiye uğradığı noktaları ve bu kesintinin nedenlerini belirlemek ve bu konuda neler yapılabileceğini tartışmaktır. Yöntemler: Bu çalışma, ülkemizde COVID-19 enfeksiyonu tespit edildikten sonraki ilk 6 ay içinde perinatoloji polikliniğimize başvuran ve daha erken tanı konabilecek olmasına rağmen geç tanı alan olguları derleyen retrospektif kesitsel bir çalışmadır. Bulgular: Çalışmaya 22 geç tanı almış vaka dahil edildi. Olguların prenatal takiplerini kaçırma nedenleri sorgulandığında 9'u (%40,9) hastane ortamında enfeksiyon kapmaktan korkarken, 8'i (%36,3) şehirlerarası seyahat kısıtlamaları nedeniyle gereken prosedürleri takip edemedi, 4 (18,1) tanesi prenatal takip döneminde temaslı listesindeydi ve 1'i (%4,5) doktoru enfekte olduğu için takibini kaçırdı. Sonuç: Genel olarak, COVID-19 salgınının yüz yüze ziyaret hacimlerini önemli ölçüde azalttığı gösterilmiştir. Salgın sırasında doğum öncesi bakım tesislerinin de muhtemelen seyahat kısıtlamaları, enfeksiyon korkusu ve kontamine sağlık personeli nedeniyle yetersiz kullanıldığı tespit edildi. Sonuç olarak, anne sağlığı programlarını iyileştirmeye yönelik çabalar önerilmektedir. COVID-19 salgını sırasında hamile kadınların bakımı hakkında farkındalık yaratmak için çeşitli bilgi, eğitim ve iletişim materyalleri oluşturulabilir.

Anahtar Kelimeler:

COVID-19, poliklinik ziyaretleri, doğum öncesi bakım

The Impact of the COVID-19 Pandemic in Prenatal Care Clinics; Late Diagnosis?

Objective: Coronavirus Disease 2019 (COVID-19) pandemic has an effect on the healthcare system and prenatal care units as well. Our goal is to identify the points where antenatal care was interrupted during the COVID-19 pandemic, as well as the reasons for disruption, and to discuss possible measures in this regard. Methods: This study is a retrospective cross-sectional study which compiles cases who presented to our perinatology clinic for a period of 6 months after the COVID-19 infection was first detected in our country and were diagnosed late, despite the fact that they could have been diagnosed earlier based on their condition. Results: The study included 22 cases of delayed diagnosis. When the reasons for missing the antenatal follow-ups of the cases were examined, nine of them (40.9%) were afraid of being infected in the hospital environment, eight of them (36.3%) could not follow the procedures due to long-distance travel restrictions, four of them (18.1) were on the contact list during the antenatal follow-up period, and one of them (4.5%) escaped the follow-up to because their doctor was infected. Conclusion: COVID-19 outbreak has been found to drastically minimize the number of face-to-face visits. Prenatal care facilities were also found to be underutilized during the pandemic, possibly due to travel limitations, fear of infection, and contaminated healthcare staff. As a result, efforts to improve maternal health programs are suggested. A variety of information, education, and communication materials can be created to raise awareness about the care of pregnant women during COVID-19 pandemic.

Keywords:

COVID-19, outpatient visits, prenatal care,

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Abosse Z, Woldie M, Ololo S. (2010). Factors influencing antenatal care service utilization in hadiya zone. Ethiop J Health Sci, 20 (2):75–82. doi: 10.4314/ejhs.v20i2.69432.
Borrelli E, Grosso D, Vella G, Sacconi R, Querques L, Zucchiatti I, Prascina F, Bandello F, Querques G. (2020). Impact of COVID-19 on outpatient visits and intravitreal treatments in a referral retina unit: let's be ready for a plausible "rebound effect". Graefes Arch Clin Exp Ophthalmol, 258(12):2655-2660. doi: 10.1007/s00417-020-04858-7
Chimankar D, Sahoo H. (2011).Factors influencing the utilization of mater nal health care services in Uttarakhand. Stud Ethno-Med, 5:209–216. doi: 10.1080/09735070.2011.11886411
Coronavirus and pregnancy–preserving maternal health across the European Region. (2020). https://www.euro.who.int/en/ health-topics/Life-stages/maternal-and-newborn-health/news/news/ 2020/6/coronavirus-and-pregnancy-preserving-maternal-health- across-the-european-region.
Fagbamigbe AF, Idemudia ES. (2015). Assessment of quality of antenatal care services in Nigeria: evidence from a population-based survey. Reprod Health Med Care Serv Rev, 12(1):88. doi: 10.1186/s12978-015-0081-0
Gitonga E. (2017). Determinants of focused antenatal care uptake among women in Tharaka Nithi County, Kenya. Adv Public Health, 3685401.24. doi: 10.1155/2017/3685401
Graatsma E, Jacod B, Van Egmond L, Mulder E, Visser G. (2009). Fetal electrocardiography: feasibility of long-term fetal heart rate recordings. BJOG,116:334–8. doi: 10.1111/j.1471-0528.2008.01951.x.
Grassl N, Nees J, Schramm K, Spratte J, Sohn C, Schott TC, et al. (2018). A web-based survey assessing the attitudes of health care professionals in Germany toward the use of telemedicine in pregnancy monitoring: cross-sectional study. JMIR mHealth and uHealth, 6:e10063. doi: 10.2196/10063
ICF, EPHI. (2019). Ethiopia Mini Demographic and Health Survey 2019: Key Indicators. Rockville, Maryland, USA: EPHI and ICF,13.
Kahyaoglu Sut H, Kucukkaya B. (2020). Anxiety, depression, and related factors in pregnant women during the COVID-19 pandemic in Turkey: A web-based cross-sectional study. Perspect Psychiatr Care, 10.1111/ppc.12627. doi: 10.1111/ppc.12627 Epub ahead of print.
Kasaven LS, Saso S, Barcroft J, Yazbek J, Joash K, Stalder C, Ben Nagi J, Smith JR, Lees C, Bourne T, Jones BP. (2020). Implications for the future of Obstetrics and Gynaecology following the COVID-19 pandemic: a commentary. BJOG, 127(11):1318-1323. doi: 10.1111/1471-0528.16431
Knight M. (2019).The findings of the MBRRACE-UK confidential enquiry into maternal deaths and morbidity. Obstetrics, Gynaecology & Reproductive Medicine, 29(1):21-23. doi: 10.1016/j.ogrm.2018.12.003
Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, Giesbrecht G. (2020). Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord, 277:5-13. doi: 10.1016/j.jad.2020.07.126
Linton NM, Kobayashi T, Yang Y, Hayashi K, Akhmetzhanov AR, Jung SM, Yuan B, Kinoshita R, Nishiura H. (2020). Incubation period and other epidemiological characteristics of 2019 novel coronavirus infections with right truncation: a statistical analysis of publicly available case data. J Clin Med, 9(02):E538. doi: 10.3390/jcm9020538
MARCH. (2020). COVID-19 research |. https://www.marchnetwork.org/research.
Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. (2020). The impact of the COVID-19 pandemic on outpatient visits: a rebound emerges. To the Point (blog). Commonwealth Fund. https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits.
National Collaborating Centre for Women's and Children's Health (UK). (2008). Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG
Nebeb GT, Salgedo W, Alemayehu Y. (2015). Antenatal care utilization in Debre Tabor, North West Ethiopia. Gynecol Obstet, 5:2161–2932. doi: 10.4172/2161-0932.1000339
Royal College of Obstetricians and Gynaecologists (RCOG). (2020). Coronavirus (COVID-19) Infection in Pregnancy. https://www.rcog.org.uk/coronavirus-pregnancy.
Saccone G, Florio A, Aiello F, Venturella R, Chiara De Angelis M, Locci M, et al. (2020). Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol, 223(2): 293–295. doi: 10.1016/j.ajog.2020.05.003
Tadesse E. (2020). Antenatal Care Service Utilization of Pregnant Women Attending Antenatal Care in Public Hospitals During the COVID-19 Pandemic Period. Int J Womens Health, 12:1181-1188. doi: 10.2147/IJWH.S287534
Tucker KL, Sheppard JP, Stevens R, Bosworth HB, Bove A, Bray EP, et al. (2017). Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Med,14:e1002389. doi: 10.1371/journal.pmed.1002389
Tuladhar H, Dhakal N. (2011). Impact of antenatal care on maternal and perinatal utcome: a study at Nepal Medical College Teaching Hospital. Nepal J Obstet Gynaecol, 6(2):37–43. doi:10.3126/ njog.v6i2.6755.
Varol G, Tokuç B. (2020). Halk Sağlığı Boyutuyla Türkiye’de Covid-19 Pandemisinin Değerlendirmesi. Namık Kemal Tıp Dergisi, 8(3): 579-594. doi:10.37696/nkmj.776032
WHO (2020). World Health Organization (WHO). Rolling updates on coronavirus disease (COVID-19), https://www.who.int/emergencies/diseases/novelcoronavirus-2019/eventsas-they-happen
Wu Z, McGoogan JM. (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323: 1239– 1242. doi:10.1001/jama.2020.2648