Yıl: 2020 Cilt: 17 Sayı: 2 Sayfa Aralığı: 378 - 387 Metin Dili: Türkçe DOI: 10.38136/jgon.724118 İndeks Tarihi: 25-01-2021

COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi

Öz:
Koronavirüs hastalığı 2019 (COVID-19) tüm dünyayı etkisi altına almış olan bir pandemidir. İlk ortaya çıktığı 2019 yılı sonundan günümüze kadar çok hızlıbir yayılım göstermiş, ülkelerdeki sağlık sistemleri üzerinde ciddi bir yük oluşturmuştur. Öte yandan enfekte ettiği hastaların %15’ine yakınında pnömonitablosu yaratmış, %5’ine yakınında da mortal olarak seyretmiştir. Virüsün ana bulaş yolu enfekte solunum damlacıklarının göz, burun ve ağızdaki müközmembranlar ile temasıdır. Daha çok komorbit hastalığı mevcut olan ileri yaş hastalarda kötü prognoz göstermekle beraber genç hastalarda da ağır kliniktablolara yol açabilmekte ve daha önemlisi bu hastalar üzerinden risk grubundaki bireylere bulaş göstererek ciddi bir toplum sağlığı sorunu oluşturabilmektedir. Şu an için hastalığın aktif bir tedavisi ve aşısı mevcut değildir. Enfeksiyonla mücadelede en önemli adım bulaşı önlemek olarak görünmektedir. Hidroksiklorokin, azitromisin, oseltamivir, favipravir ve lopinavir/ritonavir gibi ilaçlar üzerinde hastalığın prognozu için olumlu olabilecekleri yönünde çalışmalarmevcuttur. Bilindiği üzere gebelik pek çok immünolojik adaptif değişikliği beraberinde getirmektedir ve gebe popülasyon enfeksiyon hastalıklarına karşıdaha duyarlıdır. Bu yüzden hastalığın gebe hastalardaki gidişatı, obstetrik komplikasyonlarla ilişkisi, güvenli tedavi yaklaşımları, prenatal takip ve intrapartum yönetim gibi konular üzerinde tartışmalar devam etmektedir. Virüsün gebelerde genel popülasyon ile benzer semptomlara yol açtığı düşünülmektedir.Çoğunlukla soğuk algınlığı ve grip benzeri bir klinik tablo mevcuttur. Buna karşın bazı çalışmalarda fetal distres ve preterm eylem riskini arttırabileceğigösterilmiştir. Yine bu vakalarda artmış sezaryen oranları dikkat çekmektedir. Vertikal geçiş ile ilgili net bilgi olmamakla beraber literatürde şüpheli vakalarmevcuttur. Sadece 30 hafta 3 günlük gebeliği olan bir vakada maternal ölüm bildirilmiştir. Gebe hastaların tedavisinde hidroksiklorokin ve lopinavir/ritonavirkombinasyonu tercih edilmektedir. Gebe popülasyonu korumak amacı ile prenatal takip sayısının ve muayene süresinin azaltılması önerilmektedir. Ayrıcahem sağlık personeli hem de muayene olan gebeler bulaş riskini azaltmak için gerekli kişisel önlemlerini almalıdır. Yine sağlık kuruluşları personelini vediğer hasta popülasyonu korumak amacı ile uygun yönetim şeması oluşturmalıdır.Şüpheli vakaların yönetimi multidisipliner bir ekip tarafından sağlanmalıdır. Doğum yapacak hastalarda maternal sağlığın yanında sağlık personelininde korunması hedeflenmeli, hastaneler bu hastaların doğumu için negatif basınçlı izole özel alanlar belirlemelidir. Kişisel koruyucu ekipman kullanımıkonusunda gerekli bilgilendirme yapılmalı, bu hastaların yönetiminde belirlenmiş olan kurallara titizlikle uyulmalıdır. Postpartum dönemde neonatal bulaşriski ile beraber emzirmenin önemi de göz önünde bulundurulmalı, gerekli önlemler alınarak anne-bebek bağlanması sağlanmalıdır. Bu derlemeyi yazmamızdaki amaç COVID-19 enfeksiyonu olan gebelerin sonuçlarını uluslararası literatür bazında gözden geçirmek ve bahsi geçen gebelerin obstetrik olarakyönetiminde klinisyenlere katkıda bulunmaktır.
Anahtar Kelime:

Follow up and Management of High Risk Pregnancies in COVID-19 Pandemic

Öz:
Coronavirus disease 2019 (COVID-19) is a pandemic that has influenced the whole world. It has spread rapidly since the first time it appeared in 2019 until today, creating a serious burden on the health systems in the countries. On the other hand, it has caused pneumonia in about 15% of the patients it infected with an approximate mortality rate of 5%. The main transmission route of the virus is the contact of infected respiratory droplets with the mucous membranes in the eyes, nose and mouth. Although it shows poor prognosis in older patients with more comorbid diseases, it can lead to severe clinical pictures in young patients and, more importantly, it can cause a serious public health problem by infecting individuals at risk through these patients. There is currently no effective treatment and vaccine for the disease. The most important step in the fight against infection seems to prevent transmission. There are studies in the literature reporting favorable outcomes with drugs like hydroxychloroquine, azithromycin, oseltamivir, favipravir and lopinavir / ritonavir. Pregnancy goes together with many immunological adaptive changes and pregnant population is more susceptible to infectious diseases. Therefore, discussions continue on issues such as the course of the disease in pregnant patients, its relation with obstetric complications, safe treatment approaches, prenatal follow-up and intrapartum management. The virus is thought to cause symptoms similar to the general population in pregnant women. Generally, flu-like clinical symptoms are observed. However, some studies have indicated increased risk for fetal distress and preterm labor in pregnancies complicated by COVID-19. Increased cesarean rates are also remarkable. Although there is no clear information about vertical transition, there are suspicious cases in the literature. Maternal death has been reported in only one case with a 30-week and 3-day pregnancy. Hydroxychloroquine and lopinavir / ritonavir combination is preferred in the treatment of pregnant patients. In order to protect the pregnant population, it is recommended to reduce the number of prenatal follow-up and the duration of the examination. In addition, both healthcare professionals and pregnant women who are examined should take the necessary personal precautions to reduce the risk of transmission. Again, health institutions should establish an appropriate management scheme to protect their staff and other patient populations. Management of suspicious cases should be ensured by a multidisciplinary team. In addition to maternal health, the protection of health personnel should be targeted in hospitals, and hospitals should designate isolated areas with negative pressure for the birth of these patients. Necessary information should be provided about the use of personal protective equipment, and the rules determined in the management of these patients should be followed carefully. In the postpartum period, the importance of breastfeeding should be taken into consideration along with the risk of neonatal transmission, and mother-baby attachment should be ensured by taking the necessary precautions. The purpose of this review is to review the results of pregnant women with COVID-19 infection on the basis of international literature and contribute to clinicians in the obstetric management of these pregnant women.
Anahtar Kelime:

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APA Tanacan A, EROL S, Yucel A (2020). COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. , 378 - 387. 10.38136/jgon.724118
Chicago Tanacan Atakan,EROL SEYIT AHMET,Yucel Aykan COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. (2020): 378 - 387. 10.38136/jgon.724118
MLA Tanacan Atakan,EROL SEYIT AHMET,Yucel Aykan COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. , 2020, ss.378 - 387. 10.38136/jgon.724118
AMA Tanacan A,EROL S,Yucel A COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. . 2020; 378 - 387. 10.38136/jgon.724118
Vancouver Tanacan A,EROL S,Yucel A COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. . 2020; 378 - 387. 10.38136/jgon.724118
IEEE Tanacan A,EROL S,Yucel A "COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi." , ss.378 - 387, 2020. 10.38136/jgon.724118
ISNAD Tanacan, Atakan vd. "COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi". (2020), 378-387. https://doi.org/10.38136/jgon.724118
APA Tanacan A, EROL S, Yucel A (2020). COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 17(2), 378 - 387. 10.38136/jgon.724118
Chicago Tanacan Atakan,EROL SEYIT AHMET,Yucel Aykan COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 17, no.2 (2020): 378 - 387. 10.38136/jgon.724118
MLA Tanacan Atakan,EROL SEYIT AHMET,Yucel Aykan COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, vol.17, no.2, 2020, ss.378 - 387. 10.38136/jgon.724118
AMA Tanacan A,EROL S,Yucel A COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2020; 17(2): 378 - 387. 10.38136/jgon.724118
Vancouver Tanacan A,EROL S,Yucel A COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2020; 17(2): 378 - 387. 10.38136/jgon.724118
IEEE Tanacan A,EROL S,Yucel A "COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi." Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi, 17, ss.378 - 387, 2020. 10.38136/jgon.724118
ISNAD Tanacan, Atakan vd. "COVID-19 Pandemisi Döneminde Riskli Gebe İzlemi ve Yönetimi". Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 17/2 (2020), 378-387. https://doi.org/10.38136/jgon.724118