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

Mevcut derlemenin amacı, gebelik sırasında maternal Coronavirus Disease 2019 (COVID-19) enfeksiyonunun anne sağlığı üzerine etkilerinin belirlenmesi ve neonatal sonuçlar üzerine etkisinin analiz edilmesidir. 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 İngilizce 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. Maternal COVID-19 enfeksiyonu vakalarının %50’sinde asemptomatik seyretmiştir. Klinik semptomlar %39 ile öksürük, %34 ateş, %24 koku kaybı, %16 dispne şeklindedir. Maternal enfeksiyonda hastaların %13’ünde hastanede yatış gerekliliği belirlenmiştir. 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. COVID-19 enfeksiyonu ile komplike gebe hastalarda, maternal ve neonatal sonuçlarda kötüleşme saptanmadı. Anneden bebeğe vertikal geçiş gösterilmemekle beraber %2 yenidoğan PCR ile pozitiflik oranı bildirilmiştir. Hastaneye kabulde tüm gebelerin taranması önem taşıyabilir.

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

The purpose of this review is to determine the effects of maternal Coronavirus Disease 2019 (COVID-19) infection during pregnancy on maternal health and evaluating its effect on neonatal outcomes.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 were '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 were 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. Maternal COVID-19 infection was asymptomatic in 50% of the cases. Clinical symptoms were 39% cough, 34% fever, 24% loss of smell, and 16% dyspnea. The requirement for hospitalization was determined in 13% of the patients in maternal infection. Lung involvement was 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 neonates, there were no neonatal deaths due to COVID-19. Maternal and neonatal outcomes were similar to controls in pregnant patients complicated by COVID-19 infection. Although vertical transmission was not shown, a neonatal positivity rate of 2% has been reported. Screening of all pregnant women at hospital admission may be crucial.

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