The coronavirus continues to be the theme No1 in Ukraine and the world: The number of Ukrainian infected this week exceeded 10 thousand, and the rate of spread of the epidemic in the country is not reduced. Although most of the patients are undergoing a disease without complications, certain categories of people are more vulnerable. What threat does a virus cause for women who are preparing to become mothers and how to reduce the risks of getting pregnant? Read in the new article "Stopcrust".
Flash COVID-19 for the first time in the modern history so brightly questioned the collective responsibility of people for the fate of vulnerable populations — those who, with great probability, will get serious complications or die if the rest of people who do not belong to the "risk group" will not adhere to preventive measures. Restrictions, changes in domestic habits, social life and doing business.
We are all well aware that, to high risk groups of complications and deaths from COVID-19 include older adults and patients with severe comorbidities: lesions of the cardiovascular system, lungs, immune system, oncological diseases, diabetes, liver cirrhosis, obesity, and others. But there is an impression that there is another vulnerable category: Pregnant women.
Therefore, we set a goal to show the main risks for such women during a pandemic, and give them recommendations on how to reduce the risks. These recommendations are based on data from other countries ' health services and English-speaking publications. Unfortunately, specific recommendations for pregnant women of the Ministry of Health of Ukraine have not yet to to develop.
During pregnancy, the woman's body undergoes certain changes that make it more vulnerable. The most important are two factors.
First, the woman's immune system becomes less aggressive. This is necessary in order to reduce the risk of the immune attack on the fetus and give the baby the opportunity to be born alive and healthily.
Secondly, in the third trimester of pregnancy (after 28 weeks), the uterus, which now already occupies a significant part of the abdominal cavity of a pregnant woman, restricts the movement of aperture and complicates breathing. The price paid for this woman, in particular, in later stages of pregnancy, is associated with severe course of in her bacterial and viral pneumonia.
Considering these circumstances, it is not surprising that in many countries pregnant women belong to groups of increased risk of coronavir infection. In particular, the following three categories are distinguished:
1. Women in the third trimester of pregnancy (after 28 weeks of pregnancy).
2. Women, regardless of the term of pregnancy, have serious comorbidities.
3. Women, regardless of the term of pregnancy, work in the workplace, associated with a high risk of infection with coronasomes.
At the same time, there are good news for pregnant women. Firstly, there is no evidence that pregnant women have a greater risk of getting coraride than the other categories of people. Therefore, if a pregnant woman and her loved ones will adhere to general preventive recommendations (below), the risk of occurrence of the disease will be the same as in all others.
Secondly, the course of coronared disease in a pregnant woman in 1-2 trimester of pregnancy is not significantly different from the course of this disease in any other person. A pregnant woman can also move the disease in an easy form or even not to experience any symptoms.
Thirdly, there is no evidence that the infection of a pregnant woman increases the risk of abortion in 1-2 trimester of pregnancy.
Fourthly, evidence of vertical infection of the fetus during pregnancy is limited and the risk of transmitting the virus through the placenta is estimated as extremely small. Even if infection with the fetus occurs, there is no evidence of a substantial threat to the child or the emergence of teratogenic effect on the fetus.
The biggest problem arises when the coronavirus is struck by a woman in the third trimester (after 28 weeks of pregnancy). If the expectant mother develops a severe form of pneumonia and respiratory failure, physicians are often forced to cause premature birth to release the lungs and the body as a whole from overload (this is stated, for example, in the video from New York Maternity Hospital).
https://www.youtube.com/watch?v=nd7X2TufBlI
Such a tactic in the occurrence of respiratory failure in the children's care should be chosen by Ukrainian doctors for protocols treatment, approved by the Order of the Ministry of Health of Ukraine 28.03.2020 R. №722.
If you consider the existing statistics, then due to the difficult course of the disease, caesarean section had to make 91% of women, who through the coronavirus disease were prescribed indications for premature birth. Sadly, even under such conditions, not all women survive.
Preventive measures to prevent from infecting coronasis should be directed primarily to pregnant women in the third trimester of pregnancy-it is necessary to exclude all contacts that can lead to the infection COVID-19.
Problems also occur when pregnant women, regardless of the term of pregnancy, get sick on severe comorbidities such as heart and lung disease. These women also need to exclude all contacts that promote from infecting coronause, and conduct treatment of concomitant chronic diseases in order to keep them in a state of compensation. The woman should stay home and, if possible, work remotely.
As for pregnant women up to 28 weeks of pregnancy without comorbidities, they should adhere to general guidelines that reduce the risk of disease. But at the same time it should be taken into account that there are certain professions associated with an increased risk of getting sick for coronavirus: medical workers, merchants in shops and some other categories of personnel.
In this case, head is advised to assess the risks If this risk is high (for example, a medical worker who has direct contact with patients), then a woman may continue to work at this workplace only with her consent. Sometimes there are cases when a woman because of social or psychological factors even insists on continuing work.
Alternative positions for a pregnant woman-a medical worker may include telephone consultations, control and administrative positions.
Under the first section, we serve general recommendations for all pregnant women and their family members. The second section contains recommendations for women with high-risk factors (third trimester pregnancy or severe comorbidities). And for accomplishments in the third chapter — recommendations on the employment of pregnant women.
What general preventive measures should be used by a pregnant woman and her family members with whom she resides together:
1. Wash your hands for at least 20 seconds.
2. In public places do not touch the hands of the nose, eyes, mucous membranes of the mouth unwashed hands.
3. Use wipes when anyone from a family coughing or sneezes. After using a napkin throw away, and wash your hands.
4. Avoid contact with people who have any symptoms of acute respiratory disease (fever, cough, runny nose, etc.).
5. Not to use public transport without any urgent need.
6. Work from home as much as possible.
7. Avoid crowds and groups of people, in particular, in public places, bars, restaurants, centers of culture and leisure, in other places.
8. Avoid meetings with friends and relatives who live separately. Use the video communication tools to contact them.
9. Members of the family of pregnant women with whom she lives together have the same as strictly adhere to the mentioned preventive measures. If the work of family members living with frequent public contacts, they should be attentive and follow additional measures: taking a shower and changing clothes after returning home, often wash your hands and wash clothes.
10. Family members living with pregnant women have separate responsibility. After all, if one of them is sick on a coronant infection, avoiding further consistent infection of a pregnant woman will be very difficult. It is important not to forget about it!
What to do when a sick family member with whom a pregnant woman lives in the same room.
If a pregnant woman is ill with a coronavirus infection, some of the relatives with whom they reside will have to adhere to strict precautions. In particular, this is important when a pregnant woman has high risks and enters into a vulnerable group (third trimester pregnancy, presence of severe comorbidities). Precautionary measures include the following:
1. If possible, a pregnant woman should be transferred to another room or place of residence, where she can completely avoid contact with the patient.
2. If this is not possible, it is necessary to limit the contacts of a pregnant woman to the patient as well as to the premises and objects of common use.
3. Keep the distance at least 2 meters.
4. A variety of towels and washing agents. Towels are to be dry. If the towel became moist, replace it. Even better — to have disposable paper towels.
5. Family members must wash their hands after each contact with a patient with a coronavirus infection, as well as before cooking and eating, a visit to the toilet.
6. A relative, but not a pregnant woman, takes care of a sick family member.
7. You can not sleep in the same bed with a patient on a coronavirus family member.
8. A variety of bathrooms and toilets are available if there are more than one. If one — after each time disinfect in the toilet surface. It is advisable that in this case the patient who visited the toilet, was treated by a disinfectant with all surfaces, which she touched while using the toilet. If you have to use the bathroom together, the pregnant woman has the first use of the bath, and the patient is the last one.
9. Do not assemble together in the kitchen. The patient should eat in the room where he is constantly staying.
10. Ventilate and disinfect all premises regularly. Pay special attention to items that family members often touch (e.g., door handles, toilet bowls, etc.).
11. Before washing, do not shake clothes or clothing, so as not to distribute dust with coronadies indoors. Try to wash all dirty things from the patient with a coronavirus infection at a temperature of 60-90 degrees in the washing machine to avoid contact with other whiteness.
12. Dishes after washing, clothes and underwear after washing it is necessary to dry well. If possible, it is better to wash the dishes in the dishwasher.
13. Do not have illusions that wearing masks in the family is able to protect a pregnant woman from a coronait infection, if one of the family members is already sick. It is better to pay attention to the recommendations set out above in paragraphs 1-12.
Employment advice for pregnant women (unfortunately, these recommendations in Ukraine are of advisory nature and are not enshrined in the norms of legislation):
1. Try to work from home. If the work requires communication, use the distance communication tools.
2. If the term of pregnancy does not exceed 28 weeks, you do not have severe comorbidities, and the work is related to frequent contacts with people in public places (for example, shop vendors, healthcare workers), you should review the working conditions in order to radically reduce the risk of infection. This revision is the responsibility of not only the employee, but first of all — management of the company in which she is pregnant. If a woman on a 1-2-trimester pregnancy without severe concomitant diseases agreed to work in the workplace, which is connected with frequent contacts in public places, it should be provided with reliable means of individual protection, and interactive procedures with clients should minimize the risk of infection. Alternative positions for a pregnant female medical worker may include telephone consultations, control and administrative positions.
3. If gestation is longer than 28 weeks (third trimester) or you have serious comorbidities regardless of pregnancy, then your professional contacts should exclude direct interactions with potentially sick patients or customers. It is best to work from home and comply with all means of social distancing.
