Gebelik ve Covid-19
Özet
Bu çalışma, gebelik döneminde COVID-19 enfeksiyonunun anne ve fetüs üzerindeki etkilerini, aşıların güvenliğini ve tedavi yöntemlerini incelemektedir. Gebelerin enfekte olma olasılığı genel popülasyondan fazla olmamakla birlikte, enfekte olanların çoğunluğu asemptomatik seyretmektedir. Semptomatik vakalarda en sık öksürük ve ateş görülürken, ağır hastalık genellikle üçüncü trimesterde ortaya çıkmaktadır. Siyahi veya Asyalı olmak, yüksek vücut kitle indeksi, kronik hastalıklar ve 35 yaş üstü olmak hastaneye yatış riskini artırmaktadır. Enfeksiyon, preterm doğum ve sezaryen oranlarında artışla ilişkilendirilmiş, ancak vertikal bulaşın nadir olduğu ve doğum şekli ile emzirmeden etkilenmediği saptanmıştır. Koronavirüs aşılarının (mRNA ve viral vektör) gebelikte kullanımı güvenli bulunmuş olup, anne sütü ve kordon kanı aracılığıyla yenidoğana pasif bağışıklık sağladığı gösterilmiştir. Tedavide oksijen desteği, hiperkoagülabilite nedeniyle düşük molekül ağırlıklı heparin ile tromboprofilaksi, solunum desteği gereken durumlarda kortikosteroidler ve belirli kriterleri karşılayan hastalarda tocilizumab kullanımı önerilmektedir. Ayrıca, solunum fonksiyonunu iyileştirmek için uygun dolgularla yüzüstü (prone) pozisyonu da düşünülmelidir.
This study examines the effects of COVID-19 infection during pregnancy on the mother and fetus, the safety of vaccines, and treatment methods. While pregnant women are not more likely to become infected than the general population, the majority of those infected remain asymptomatic. Cough and fever are the most common symptoms in symptomatic cases, while severe disease usually occurs in the third trimester. Being Black or Asian, a high body mass index, co-morbidities, and a maternal age over 35 increase the risk of hospitalization. The infection has been associated with increased rates of preterm birth and cesarean delivery; however, vertical transmission is rare and unaffected by the mode of delivery or breastfeeding. The use of coronavirus vaccines (mRNA and viral vector) during pregnancy has been found safe, and they have been shown to provide passive immunity to the newborn through breast milk and cord blood. In treatment, oxygen support, thromboprophylaxis with low-molecular-weight heparin due to hypercoagulability, corticosteroids when respiratory support is required, and the use of tocilizumab in patients meeting specific criteria are recommended. Additionally, the prone position with appropriate padding should be considered to improve respiratory function.
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