Some questions related to Covid 19 for pregnant women
Article by Master, Doctor Dao Kim Phuong - Cardiologist and echocardiogram - Department of Examination - Vinmec Times City International Hospital
According to the US CDC, pregnant women with Covid-19 are at greater risk of severe illness than non-pregnant women. However, mortality did not differ between the two groups of pregnant and non-pregnant women.
1. Are pregnant women more susceptible to COVID-19 or at higher risk of complications from COVID-19?
Epidemic pregnancy and childbirth do not increase the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but appear to exacerbate the clinical course of COVID-19 compared with non-pregnant people of the same sex and age; however, most (>90%) of those infected recover.
2. Does COVID-19 increase the risk of pregnancy complications?
Yes, especially in those with pneumonia, there seems to be an increased frequency of preterm births (born before 37 weeks of gestation) and cesarean deliveries, possibly related to severe maternal illness. Most preterm births are prescribed by a doctor (i.e. scheduled labor or cesarean delivery).
3. Can pregnant women during the epidemic get vaccinated against SARS-CoV-2?
Yes, the first vaccines likely to be clinically available are viral mRNA-based and contain no infectious virus (SARS-CoV-2 or vector virus). Although pregnant women have been excluded from vaccine trials, we recommend that these vaccines not be abandoned solely because of pregnancy to those who are eligible and wish to use them. Counseling should be balanced based on available data on vaccine safety, risks to pregnant patients from SARS-CoV-2 infection, individual patient risk of infection, and serious comorbidities. .
4. Does SARS-CoV-2 cross the placenta?
There is no solid evidence that SARS-CoV-2 crosses the placenta and infects the fetus; however, some cases of tissue or placental membranes testing positive for SARS-CoV-2 and some possible cases of uterine infection have been reported. Some newborns may be due to a false-positive test result or an infection soon after birth. Reports of COVID-19 infection in infants generally describe mild illness.
5. How can prenatal care reduce the risk of contracting COVID-19?
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) support modification of traditional antenatal care protocols to limit person-to-person contact and thus help prevent spread of COVID-19. Modifications should be tailored for low-risk or high-risk pregnancies (eg, multiple pregnancy, hypertension, diabetes) and may include telehealth in cases of transmission proactive infection transmission, reducing face-to-face visits, visit time, and group testing (eg, anomalies, diabetes, infection screening) to minimize maternal exposure to others, Limit visitors when examining and testing, time of examination, assigned obstetric ultrasound, time and frequency of use of non-stress tests and physiological tests.
6. Should glucocorticoids be avoided in pregnant women with COVID-19?
No, pregnant women who meet the criteria for a glucocorticoid (also called a corticosteroid) mother to treat COVID-19 can receive the standard dose of dexamethasone. For those who also meet the criteria for antenatal corticosteroid use for fetal lung maturation, we recommend the usual doses of dexamethasone (four doses of 6 mg IV 12 hours apart) to induce fetal lung maturation and continued dexamethasone to complete maternal COVID-19 treatment (6 mg orally or intravenously daily for 10 days or until discharge, whichever is shorter) .
7. Is the SARS-CoV-2 vaccine safe for pregnant women and women planning a pregnancy?
Probably. Pregnant women were excluded from trials evaluating the COVID-19 vaccine, so safety and efficacy data are not available in this population. We recommend giving pregnant women the COVID-19 vaccine during a pandemic rather than delaying vaccination until after delivery, especially for those at higher risk of exposure or serious illness if infected. sick. Although pregnancy itself is associated with an increased risk of severe infection, some patients may choose to reasonably delay vaccination after weighing their individual risk for COVID-19 exposure. and disease severity based on very limited data on the safety and effectiveness of the COVID-19 vaccine during pregnancy.
Immunizations must be timed so that the patient does not receive the COVID-19 vaccine within 14 days of receiving another routinely used vaccine, such as Tdap (diphtheria, pertussis vaccine). , tetanus ) and influenza. However, a shorter interval between the COVID-19 mRNA vaccine and other vaccines is reasonable when prompt administration of another vaccine is important (e.g. tetanus vaccination during wound management). ) or if it would avoid unnecessary delays in COVID-19 vaccination.
Vaccination is not expected to affect fertility, and it is not necessary to delay pregnancy after vaccination.
8. Is a mother with COVID-19 an indication for a cesarean section?
No, COVID-19 is not a sign to change the birth route. Even if vertical transmission were confirmed as additional data were reported, this would not be an indication for cesarean delivery as it would increase the risk to the mother and is unlikely to improve neonatal outcomes.
9. Should planned induction of labor or cesarean section be postponed in asymptomatic women during the pandemic?
No, in asymptomatic women, induction of labor and caesarean section should not be postponed or postponed with appropriate medical indications. This includes 39-week cesarean deliveries or cesarean sections after patient counseling.
10. How to manage labor pain in women with COVID-19?
A neuroleptic is often preferred over other options for labor pain management because it provides good analgesia and thus reduces cardiopulmonary stress caused by pain and anxiety. In addition, it is available in the event that an emergency cesarean section is required, so that general anesthesia is not required. The Society of Obstetrics and Gynecology (SOAP) recommends considering the suspension of nitrous oxide for pain during labor in patients with confirmed or suspected COVID-19 because of insufficient data. regarding the cleaning, filtration, and aerosol generation of the nitrous oxide system, but it remains an option for patients who test negative for SARS-CoV-2.
11. Can an asymptomatic partner/supporter participate in labor and delivery?
Practical practice varies by institution. At a minimum, facilitators should be screened in accordance with hospital policy and those with any symptoms consistent with COVID-19, exposure to a confirmed case within 14 days, or testing positive for COVID-19 within 14 days is not allowed to attend labor and delivery. Most facilities acknowledge that a facilitator is important for many women in labor and allow a facilitator to stay with the woman in labor (which may not leave the room and then turn around). return). Additional facilitators may be allowed or may be part of the patient's labor and delivery via video.
12. How should a newborn baby be assessed?
13. Should mothers with COVID-19 be separated from their children?
Generally not because the risk of newborns contracting SARS-CoV-2 from their mothers is low and the data show no difference in the risk of neonatal SARS-CoV-2 infection whether infants are cared for in in her own room or in her mother's room. However, mothers should wear masks and practice hand hygiene when interacting with babies. At other times, there should be a distance > 1.85m between mother and infant or place the infant in an incubator if possible.
14. How long should mother-baby precautions at home continue after a recent infection?
Mothers with suspected or previously confirmed symptoms of COVID-19 are not considered a potential risk of transmitting the virus to their infants if they have met the criteria for discontinuing isolation and other measures. precautions:
● At least 10 days have passed since their symptoms first appeared (up to 20 days if they are critically ill or severely immunocompromised).
● At least 24 hours have passed since the last fever without fever-reducing medication.
● Their other symptoms have improved.
For asymptomatic mothers identified only by obstetric screening tests, at least 10 days have passed since the test was positive.
15. Can breast milk transmit SARS-CoV-2?
There is a general consensus that breastfeeding should be encouraged because of its many benefits for mothers and babies. It is not yet known whether SARS-CoV-2 can be transmitted through breast milk because very few breast milk samples have been tested. In a World Health Organization (WHO) study, breast milk samples from 43 mothers were negative for SARS-CoV-2 by PCR (RT-PCR) and samples from three mothers showed positive results. positive, but specific testing to determine viability and infectivity was not performed.
16. What precautions should mothers with confirmed or suspected COVID-19 take while breastfeeding?
Droplet transmission from an infected mother to her baby can occur through close breastfeeding contact. Mothers can take precautions to prevent this by practicing hand and breast hygiene and using a mask. In a study from New York City that tested and followed 82 infants out of 116 mothers who tested positive for SARS-CoV-2, none of the infants tested positive for SARS-CoV. -2 postpartum, although most are housed in the same room as their mothers and are breastfed. Newborns were kept in a closed cage upon entry, and mothers wore surgical masks when caring for infants and followed regular breast and hand washing protocols.
Alternatively, infants may be fed expressed breast milk by a healthy caregiver following hygiene precautions until the mother has recovered or is proven to be free of infection. Mothers should wash their hands and wear a mask strictly before and during milking.
17. Can pregnant and postpartum women with COVID-19 take NSAIDs and acetaminophen?
Yes, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can be used to treat fever and relieve pain during pregnancy and after delivery. Before delivery, the lowest effective dose of an NSAID is used, ideally less than 48 hours, with the potential for gestational age-related toxicity (eg, oligohydramnios, premature closure of the ductus arteriosus). Low-dose aspirin is safe to prevent preeclampsia during pregnancy. In patients with abnormal liver enzymes secondary to COVID-19, the use of acetaminophen is potentially hepatotoxic; however, doses less than 2 grams per day may be safe in the absence of severe liver disease or decompensation.
18. Is the SARS-CoV-2 vaccine safe for breastfeeding women?
Probably. Breast-feeding women were excluded from trials evaluating the COVID-19 vaccine, so safety and efficacy data are not available in this population. We recommend getting the COVID-19 vaccine for women who are breastfeeding rather than delaying vaccination until after breastfeeding, especially for those at higher risk of exposure or severe illness if: infected. Some women may reasonably decide to postpone vaccination after weighing the risk of COVID-19 exposure and severity of the disease against the very limited data available on vaccine safety and effectiveness. - Apply for COVID-19 during lactation.
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Reference source: update.com