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Covid 19 and Pregnancy

Pregnancy and childbirth generally do not increase the risk of contracting SARS-CoV-2 infection, but it appears to worsen the clinical course of COVID-19 compared to non-pregnant women of the same age; Most infected people (> 90%) recover in the prenatal period. Risk factors for severe disease include pregnancies over the age of 35, obesity, hypertension, and pre-existing diabetes. Maternal deaths have been reported, but not more than non-pregnant women of reproductive age with COVID-19.

Pregnant women should follow the same advice as non-pregnant people to avoid exposure to the virus: 

* Physical distance (at least two meters), 
* Two or 3 layer mask, 
* Avoiding crowded closed areas and crowds outside, 
* Washing or sterilizing hands frequently, 
* Disinfecting frequently touched surfaces,
* Avoiding close contact, especially with sick individuals.
* Those who come into contact with a confirmed or suspected COVID-19 case should be monitored. 

Clinical symptoms of COVID-19 in pregnant women are generally similar to those in non-pregnant individuals. Pregnant women should be monitored for the development of COVID-19 symptoms and signs, especially if they have had close contact with a confirmed case or contact persons. The most common complaints:

* Cough: 50,3% (51,3% in non-pregnant women)
* Headache: 42,7% (54,9% in non-pregnant women)
* Muscle aches: 36,7% (45,2% in non-pregnant women)
* Fever: 32,0% (39,3% in non-pregnant women)
* Sore throat: 28,4% (34,6% in non-pregnant women)
* Shortness of breath: 25,9% (24,8% in non-pregnant women)
* Loss of new taste or smell: 21,5% (24,8% in non-pregnant women).

What is done for the diagnosis of COVID-19 in pregnant women?
Covid-19 virus can be detected by reverse transcriptase polymerase chain reaction (RT-PCR) in swabs taken from nasal or oropharyngeal regions. In addition, ELISA or rapid antibody tests that detect IgM / IgG are also blood tests used in diagnosis. 

How often should pregnancy follow-ups be done? 
In pregnant women who did not have COVID-19 during the pandemic period, after the confirmation of pregnancy by ultrasonography and the routine examinations, the first 12 month screening performed at the 3th week and the detailed ultrasonography at the 20th week are important in pregnancy follow-up and should not be omitted. Routine pregnancy follow-ups; The existing risk situations of the pregnant woman should be within the periods determined by her doctor according to the accompanying diseases. 

Asymptomatic COVID-19 pregnant women need self-isolation during the disease period, risk assessment is made in terms of developing severe disease, and monitored for respiratory problems.

The clinical care of pregnant women with symptoms of COVID-19 depends on the severity of the disease, co-morbidities, pre-existing pregnancy problems, and the social status of the pregnant woman (for example, self-care and follow-up ability). Most pregnant patients (at least 19%) with known or suspected COVID-86 have mild illness that does not require hospitalization in the absence of obstetric problems (eg preterm labor). These patients should be closely monitored for progression to severe or critical illness, and pregnancy follow-up should be performed at least once within two weeks of the diagnosis of COVID-19. 

Delivery timing: Should be personalized according to the mother's condition, the presence of concurrent disorders, and the gestational age.

What is the frequency of infections in the unborn baby?
The extent of transmission to the baby in the womb in pregnant women with COVID-19 remains uncertain. Only a few possible cases of transmissions have been reported in the literature. 

What are the pregnancy and newborn results?
In a report published by the Center for Disease Control and Prevention, which includes more than 23000 COVID 19 pregnant women, the rate of entering the intensive care unit in cases of COVID 19 who are pregnant was reported as 10.5 per thousand. This rate was 3.9 per thousand people who were not pregnant. While the intubation rate was 1000 in 2.9 cases in the pregnant cases, it was 1.1 in the non-pregnant cases, the mortality rate was 1000 in 1.5 cases and 1.2 in the non-pregnant cases. 

Miscarriage risk: The frequency of miscarriage does not appear to be increased, but data on first and second trimester infections are limited.

Preterm birth and cesarean delivery rates: It is observed that the frequency of preterm birth and cesarean section increases in women infected with SARS-COV-2, especially those who develop pneumonia. (preterm birth rate: 10,2% versus 12,9%; cesarean rate: 34% versus 31,9)

Does it affect the unborn baby? 
Congenital anomalies (disability): no increased risk has been reported.

Stillbirth rates: While the rate of stillbirth among pregnant patients with COVID-19 hospitalized in the USA is about 3%, it is 19% in pregnant women with laboratory confirmed COVID-0.4 who do not require hospitalization. The total stillbirth rate in the USA is 0,6%.

More than 95% of newborns do well at birth and are often asymptomatic or have mild infection (ie no respiratory support is required). 

Does the presence of COVID-19 change the mode of delivery in pregnant women? 
No. 

Which anesthesia method is suitable for COVID-19 pregnant women during delivery?
Spinal and epidural anesthesia is preferred in patients with known or suspected COVID-19.

How should mother-baby contact be? 
The risk of a newborn baby contracting SARS-CoV-2 from its mother is low, and data show that there is no difference in the risk of neonatal SARS-CoV-2 infection, whether the newborn is cared for in a separate room or stays at home. However, mothers should wear a mask and practice hand hygiene during contact with their babies, and at other times it is desirable to maintain a physical distance of more than 2 meters between the mother and the newborn, or to place the newborn in an incubator if possible. 

Assoc. Dr. Derya Sivri Aydın
Atlas University
Obstetrics and Gynecology USA.