WHAT IS THE NEW CORONAVIRUS?
The coronavirus (covid-19) is a large family of viruses that can infect both animals and humans.
In humans, they usually cause respiratory infections of varying severity, ranging from the common cold to severe respiratory failure.
Two strains of the coronavirus that bother the scientific community due to their complications, are the SARS coronavirus that causes severe acute respiratory syndrome and the MERS coronavirus that causes the Middle East respiratory syndrome.
SARS-CoV-2 coronavirus is a recently discovered strain that is isolated from humans for the first time and the infection it causes is classified as COVID-19.
TRANSMISSION
Based on the available epidemiological data, it appears that the COVID-19 coronavirus is most likely to be transmitted:
- from person to person through droplets excreted from a person who is carrying the virus, through coughing or sneezing (from a distance less than 2 meters for at least 15 minutes)
- through the hands when in contact with potentially contaminated surfaces or objects.
The incubation time of the disease is estimated between 2 and 14 days with an average incubation time of 5 days.
It is not certain how long the virus that causes COVID-19 survives on surfaces, but it appears to behave like the rest of the coronaviruses. Studies indicate that coronaviruses can remain on surfaces for a few hours or even several days. Total survival time is usually affected by environmental conditions (eg surface type, temperature or ambient humidity).
SYMPTOMS
According to the bibliography and the analysis of the data so far, the infection is mainly manifested (~ 80%) with mild symptoms, while it is recorded that about 16% have a severe infection and 6% of the patients with the disease are in critical condition. .
Most cases of severe infection have been reported in the elderly and in patients with chronic underlying diseases (hypertension, diabetes, asthma, HIV, chronic heart disease, chronic liver disease, chronic lung disease, chronic kidney disease, haematological disorders, immunosuppression, etc.).
It can be manifested with:
- fever
- cough
- pharyngitis
- arthralgias
- myalgias
- headache
- fatigue
- diarrhea and vomiting (rare)
- shortness of breath
DIAGNOSIS
The Covid-19 infection is confirmed in the laboratory in samples from the lower respiratory tract (nasopharyngeal secretions or a combination of nasopharyngeal and oropharyngeal smear samples, and in the most severe cases a chest X-ray or chest CT scan.
If there is a clinical indication, pregnancy is not a contraindication to performing an axial or chest x-ray.
TREATMENT - VACCINATION
There is no specific treatment for the disease.
Treatment is based on the severity of the pregnant woman's condition.
At the same time, close monitoring is required for any worsening of the symptoms as well as the well-being of the fetus, while at the same time all the usual obstetric instructions are followed.
At this stage there are several proposed regimens, however at present, there is insufficient evidence from randomized clinical trials in humans using a control group to support both their safe administration and their efficacy.
There is currently no vaccine available for COVID-19.
Finally, pregnant women should systematically apply all the proposed personal and respiratory hygiene measures, such as hand hygiene and avoid contact with patients with respiratory infections.
PREGNANCY MONITORING
Pregnant women with possible or confirmed COVID-19 infections should be examined at the reference hospital.
In cases of COVID-19 infection with mild symptoms that do not require hospitalization, it is recommended that the pregnant woman stay at home in isolation, provided that her symptoms can be monitored for an early detection of signs of clinical deterioration and immediate medical evaluation.
Pregnant women with a possible infection or confirmed infection who are asymptomatic or recovering from a mild illness are recommended to be monitored every 2-4 weeks with an ultrasound to evaluate the fetus.
Pregnant women who had some type of contact with a case or have a mild or asymptomatic COVID-19 infection are advised to postpone their scheduled visit or ultrasound examination for 14 days.
Simultaneously including the above, all the usual obstetric instructions and practices are to be followed, as well as the established guidelines depending on the medical history of each pregnant woman
ΔΙΑΧΕΙΡΗΣΗ ΤΟΚΕΤΟΥ
Η λοίμωξη COVID-19 δεν αποτελεί από μόνη της ένδειξη για τοκετό παρά μόνο στην περίπτωση που απαιτείται παρέμβαση για βελτίωση της οξυγόνωσης της εγκύου.
Οι έγκυες με επιβεβαιωμένη λοίμωξη θα πρέπει να αντιμετωπίζονται αποκλειστικά στα καθορισμένα νοσοκομεία αναφοράς και εάν είναι εφικτό, με διαθέσιμη υποδομή για αρνητική πίεση σε αίθουσα τοκετού, θάλαμο νοσηλείας και μονάδα νοσηλείας νεογνού.
Η απόφαση για το χρόνο και το είδος τοκετού, εξατομικεύεται ανάλογα με την κλινική κατάσταση της εγκύου, την ηλικία κύησης και την κατάσταση του εμβρύου.
QUESTIONS
1. Is there a high risk of serious illness in pregnant women?
n pregnancy due to changes that occur in the cardiorespiratory and immune systems there is an increased risk of complications.
According to the bibliography, pregnant women affected by other serious respiratory infections (H1N1 Influenza, SARS - CoV and MERS) have a higher chance of developing a more serious disease as well as a higher mortality rate.
With regard to the SARS-CoV-2 coronavirus and the COVID - 19 infection and its effects on pregnancy, the data are extremely limited and currently cover only the third trimester of pregnancy.
A pregnancy is not a factor of increased susceptibility to infection with the new virus.
In order to get a complete picture of the effect of the virus on the whole pregnancy, both pregnant women and fetuses need more data on the virus behavior, a larger number of patients, information on all trimesters of pregnancy as well as more data on women and the fetus after childbirth
2. Is the coronavirus transmitted to the baby through breastfeeding?
It seems that the virus is not transmitted through breastfeeding. Milk samples have been tested from sick mothers and the virus has not been detected. But the main danger due to the immediate and close contact remains high. A very good alternative is the breast pump. But before and after its usage the mother must respect all the general protection rules.
3. Is the newborn allowed to stay in the same room with the mother after giving birth? (ROOMING - IN)
From the first hours of birth, the importance of breastfeeding and contact of the mother with her newborn is well known. However in sick mothers the risk of transmitting the virus in the newborn due to close contact is large. For this reason it is also acceptable that babies should for 14 days not come into contact with the positive SARS-CoV-2 mothers, something that was implemented in China. The final decision must be made jointly in consultation with the mother and individualized according to the severity of the disease. There is also the recommendation that the newborns of sick mothers be treated as likely cases and be treated in isolation.
4. Can sick pregnant women transmit the infection to the fetus?
At this stage there is no scientific evidence for intrauterine transmission of SARS-CoV-2 to the fetus by the patient's mother. At the same time they have been examining amniotic fluid samples from diseased mothers and the virus has not been detected. Despite the limited bibliographic references, vertical transmission has not been found even in new-born infants even from other members of the coronavirus family. The data so far of SARS-CoV-2 during pregnancy are limited and require analysis of more cases for proper impact assessment.
If you have any first symptoms, or if you suspect that you or a family member may have come in contact with a person infected with Covid-19 during your stay at home, you can monitor your health. with the help of the following manual.
http://www.patt.gov.gr/site/attachments/entipo.pdf
The above information is fully harmonized with the instructions of the World Health Organization (WHO), the National Organization of Public Health (EODY) and the guidelines of the Hellenic Obstetrics and Gynecology Society (EMGE) and the Hellenic Society of Obstetrics and Gynecology. Given the limited data on the behavior of the new coronavirus and the infection it causes, at this stage the following information is subject to change when more data are available.
FOR MORE INFORMATION
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
https://eody.gov.gr/neos-koronaios-covid-19/
https://eody.gov.gr/erotiseis-kai-apantiseis-gia-to-neo-koronoio-covid-19/
https://hsog.gr/?page_id=4274
https://www.hsoge.gr/wpcontent/uploads
