Pregnant woman infected with SARS-COV-2 – diagnosis and treatment
DOI:
https://doi.org/10.12775/JEHS.2022.12.09.024Keywords
SARS-CoV-2, COVID-19, pregnancy, pandemyAbstract
Introduction: COVID-19 is an infection caused by the new SARS-CoV-2 virus. In pregnant women with COVID-19, compared to non-pregnant women, there is an increased risk of a severe course of the infection. Pregnant women are more often hospitalized in the Intensive Care Unit and require mechanical ventilation. In the course of COVID-19 infection, pregnant women have a greater risk of miscarriage, premature birth or having a baby with low birth weight, compared to their healthy pregnancy peers.
The aim of the study: To present, based on the available literature, the principles of management of a pregnant woman infected with SARS-CoV-2 virus.
State of knowledge: The evidence of infection is the detection of the virus in the clinical specimen confirmed by PCR. Chest computer tomography can be useful in diagnosis, especially when the PCR test result is negative. Particular attention should be paid to pharmacological treatment, which should be both effective and safe for the fetus. Certain antiviral and anti-inflammatory drugs as well as anticoagulants drugs are used in COVID-19 therapy. Oxygen and fluid therapy is also important. The condition of the fetus should be monitored regularly. It is recommended to measure the fetal heart rate, perform cardiotocography, pregnancy ultrasound and assess the volume of amniotic fluid. The decision about the time and method of delivery should be made individually on the basis of obstetric indications and the maternal-fetal condition.
Summary: The therapy of a pregnant patient infected with SARS-CoV-2 should be adjusted individually depending on the woman's health condition. In therapeutic interventions, the welfare of both the mother and the fetus should be taken into account.
References
Allotey, J., Fernandez, S., Bonet, M., Stallings, E., Yap, M., Kew, T., Zhou, D., Coomar, D., Sheikh, J., Lawson, H., Ansari, K., Attarde, S., Littmoden, M., Banjoko, A., Barry, K., Akande, O., Sambamoorthi, D., van Wely, M., van Leeuwen, E., Kostova, E., Kunst, H., Khalil, A., Tiberi, S., Brizuela, V., Broutet, N., Kara, E., Kim, C.R., Thorson, A., Escuriet, R., Gottlieb, S., Tong, V.T., Ellington, S., Oladapo, O.T., Mofenson, L., Zamora, J., Thangaratinam, S. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis, BMJ. 2020;370;m3320.
Tang, P., Wang, J. and Song, Y., Characteristics and pregnancy outcomes of patients with severe pneumonia complicating pregnancy: a retrospective study of 12 cases and a literature review’, BMC Pregnancy and Childbirth. 2018;18(1):434.
Royal College of Obstetricians and Gynaecologists a, 2021, Coronavirus (COVID-19) infection in pregnancy. www.rcog.org.uk/globalassets/documents/guidelines/2021-08-25-coronavirus-covid-19-infection-in-pregnancy-v14.pdf [Data dostępu: 25.08.2021].
Yanes-Lane, M. Winters, N., Fregonese, F., Bastos, M., Perlman-Arrow, S., Campbell, J.R., Menzies, D., Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis, PLOS ONE. 2020; 15(11) :e0241536.
European Society of Human Reproduction and Embryology. 2020, Assisted reproduction and COVID-19: A statement from ESHRE for phase 1- Guidance on fertility services during pandemic. https://www.eshre.eu/Europe/Position-statements/COVID19 [Data dostępu: 02.04.2020].
Favre, G., Pomar, L., Qi, X., Nielsen-Saines, K., Musso, D., Baud, D., Guidelines for pregnant women with suspected SARS-CoV-2 infection, The Lancet Infectious Diseases. 2020; 20(6) :652-653.
The American College of Obstetricians and Gynecologists, 2020, Novel Coronavirus 2019 (COVID-19), Practice Advisory. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019 [Data dostępu: 08.07.2020].
World Health Organization, 2020, Coronavirus Disease (COVID-19). https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19?fbclid=IwAR1OXcQiD2iskhQnLIkylShv49Ha8I-qtOuSsqlKpcdQz7Sa4gjbv0WU074 [Data dostępu: 12.10.2020].
Centers for Disease Control and Prevention a, 2020, Collection and Submission of Postmortem Specimens from Deceased Persons with Confirmed or Suspected COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html?fbclid=IwAR2hRtILu_DOhGk3JNx3isJoLTNETxh5YbqgHJUhpY-F2nQXeCrdhp82nTs [Data dostępu: 02.12.2020].
Poon, L.C., Yang, H., Dumont, S., Lee, J.C.S., Copel, J.A., Danneels, L., Wright, A., Costa, F.D.S., Leung, T.Y., Zhang, Y., Chen, D., Prefumo, F., ISUOG Interim Guidance on coronavirus disease 2019 (COVID‐19) during pregnancy and puerperium: information for healthcare professionals – an update, Ultrasound in Obstetrics & Gynecology. 2020; 55(6):848-862.
Fang, Y., Zhang, H., Xie, J., Lin, M., Ying, L., Pang, P., Ji, W., Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR, Radiology. 2020; 296(2):E115-E117.
Centers for Disease Control and Prevention b, 2020, Interim Guidelines for Collecting and Handling of Clinical Specimens for COVID-19 Testing. https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html?fbclid=IwAR0w6b-arxKpmB42hA0PxM_mnHZXpeubp-9tjQ91TjX1NC3zmRHRPCHayFM [Data dostępu: 26.02.2021].
Paul, N.S., Roberts, H., Butany, J., Chung, T., Gold, W., Mehta, S., Konen, E., Rao, A., Provost, Y., Hong, H.H., Zelovitsky, L., Weisbrod, G.L., Radiologic Pattern of Disease in Patients with Severe Acute Respiratory Syndrome: The Toronto Experience, RadioGraphics. 2004; 24(2):553-563.
Hao, W. and Li, M., Clinical diagnostic value of CT imaging in COVID-19 with multiple negative RT-PCR testing, Travel Medicine and Infectious Disease. 2020; 34:101627.
Damilakis, J., Perisinakis, K., Prassopoulos, P., Dimovasili, E., Varveris, H., Gourtsoyiannis, N., Conceptus radiation dose and risk from chest screen-film radiography, European Radiology. 2003; 13(2):406-412.
Chen H., Guo J., Wang C., Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226):809-815. Erratum in: The Lancet. 395(10229):1038.
Yang, W., Sirajuddin, A., Zhang, X., Liu, G., Teng, Z., Zhao, S., Lu, M., The role of imaging in 2019 novel coronavirus pneumonia (COVID-19), European Radiology. 2020; 30(9):4874-4882.
Chen, L., Li, Q., Zheng, D., Jiang, H., Wei, Y., Zou, L., Feng, L., Xiong, G., Sun, G., Wang, H., Zhao, Y., Qiao, J., Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China, New England Journal of Medicine. 2020; 382(25):e100,
Polskie Towarzystwo Ginekologów i Położników, 2020, Zalecenie Sekcji Ultrasonografii PTGIP w zakresie badań USG w sytuacji epidemiologicznej-COVID-19. https://www.ptgin.pl/zalecenie-sekcji-ultrasonografii-ptgip-w-zakresie-badan-usg-w-sytuacji-epidemiologicznej-covid-19 [Data dostępu: 21.03.2020).
Ministerstwo Zdrowia, 2020, Stanowisko konsultanta krajowego w dziedzinie anestezjologii intensywnej terapii w sprawie postępowania terapeutycznego u chorych z zakażeniem koronawirusem SARS-CoV-2. https://ftp.nfz-lodz.pl/Inne/zaproszenia/RO_stanowisko_COVID_19.pdf [Data dostępu: 28.02.2020].
Wujtewicz, M., Dylczyk-Sommer, A., Aszkiełowicz, A., Zdanowski, S., Piwowarczyk, S., Owczuk, R., COVID-19 – what should anaethesiologists and intensivists know about it?, Anaesthesiology Intensive Therapy. 2020; 52(1):34-41.
Ray, B. and Trikha, A., Prone position ventilation in pregnancy: Concerns and evidence, Journal of Obstetric Anaesthesia and Critical Care. 2018; 8(1).
McIntosh, J.J., Corticosteroid Guidance for Pregnancy during COVID-19 Pandemic, American Journal of Perinatology. 2020; 37(8):809-812.
The RECOVERY Collaborative Group, Dexamethasone in Hospitalized Patients with Covid-19, New England Journal of Medicine.2021; 384(8):693-704.
Cheng, X., Wang, G., Lee, K., Yang, X., Dexamethasone Use During Pregnancy: Potential Adverse Effects on Embryonic Skeletogenesis, Current Pharmaceutical Design. 2014; 20(34) :5430-5437.
Saad, A.F., Chappell, L., Saade, G.R., Pacheco, L.D., Corticosteroids in the Management of Pregnant Patients With Coronavirus Disease (COVID-19), Obstetrics & Gynecology. 2020; 136(4):823-826
Royal College of Obstetricians and Gynecologists b, 2022, COVID-19 infection in pregnancy. https://www.rcog.org.uk/media/xsubnsma/2022-03-07-coronavirus-covid-19-infection-in-pregnancy-v15.pdf [Data dostępu: 05.08.2022].
Naqvi, M., Zakowski, P., Glucksman, L., Smithson, S., Burwick, R.M., Tocilizumab and Remdesivir in a Pregnant Patient With Coronavirus Disease 2019 (COVID-19), Obstetrics & Gynecology. 2020; 136(5) :1025-1029.
Igbinosa, I., Miller, S., Bianco, K., Nelson, J., Kappagoda, S., Blackburn, B.G., Grant, P., Subramanian, A., Lyell, D.J., El-Sayed, Y.Y., Aziz, N., Use of remdesivir for pregnant patients with severe novel coronavirus disease 2019, American Journal of Obstetrics and Gynecology. 2020; 223(5):768-770.
Ryan, G.A., Purandare, N.C., McAuliffe, F.M., Hod, M., Purandare, C.N., Clinical update on COVID ‐19 in pregnancy: A review article, Journal of Obstetrics and Gynaecology Research. 2020; 46(8) :1235-1245.
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