During COVID-19 epidemic at the pregnant women having planned examinations and procedures it is necessary to collect in a routine order detailed data on recent trips, on an occupation, on potentially dangerous contacts and stay in regions with the high level of an infection and also about existence of clinical signs of a disease.
At arrival of pregnant women with risk factors, they have to be placed in the isolation center for further assessment of a state. At suspicion of COVID-19 at pregnant women as the main instrument of detection of a disease in zones of epidemic can be considered capture of a smear and noso-and stomatopharynxes and also a computer tomography. For carrying out this research it is required to receive the informed consent of the patient and to impose a lead apron on area of a pregnant uterus when carrying out KT.
Treatment of COVID-19 during pregnancy
With COVID-19 the versatile team of specialists has to be engaged in maintaining pregnant women. Women with suspicion on COVID-19 or with the confirmed infection have to come to special hospitals in which there are insulators and means of protection at first. Patients with suspicion of an infection are isolated from people around for the period of treatment, patients with the confirmed disease are placed in boxes with negative pressure. The patient in a critical state with the confirmed infection has to be located to the box with negative pressure in intensive care unit. In specialized hospitals it is necessary to prepare the allocated operating room with negative pressure and the isolated office for newborns. During the work with patients with the confirmed COVID-19 or on existence of this disease on medical staff individual protection equipment has to be suspicious.
Pregnant women with slight clinical symptoms at first can not be located in a hospital and it is possible to consider stay them on the mode of house isolation if it is possible in terms of logistics and if at the same time it is possible to continue to watch a condition of the patient. For the lack of boxes with the negative pressure of the patient have to be located in separate single chambers, and after confirmation of COVID-19 can be placed in the general chamber together with other infected. For transportation of patients with the confirmed infection or suspicion the medical staff has to put on SIZ it and together with the patient to observe a distance not less than 1-2 meters from any other person without SIZ.
At suspicion of an infection carry out maintenance of water and electrolytic balance; treatment of symptoms (febrifugal and proivodiareyny drugs). Strict observation of indicators of the vital functions and a saturation of hemoglobin is obligatory; carrying out analysis of gas structure of an arterial blood; repeated visualization of a thorax (according to indications); regular general blood test, hepatic tests and analyses on function of kidneys, coagulative tests. Carry out monitoring of a condition of a fruit.
If there is a confirmed infection and not a severe disease, approach to maintenance of water and electrolytic balance, treatment of symptoms and observation same, as for patients with suspicion of an infection. If antiviral therapy is considered, it has to is carried out after detailed consultations with virologists and pregnant women it is necessary to inform in detail on possible side effects of antiviral therapy for mother and on risks of an arrest of development of a fruit. It is necessary to check existence of a bacterial infection and at detection of consecutive bacterial infection to appoint timely the corresponding antibiotics. Continue monitoring of a condition of a fruit.
In the presence of the confirmed infection and a serious or critical state the risk of maternal and perinatal mortality therefore aggressive therapy, including the supporting measures (hydration, an oxygenotherapy, physical therapy of a thorax) is necessary is high. The patient has to be in the box with negative pressure in ORIT under observation of versatile medical crew. Preferable situation — lying on the left side. At the suspect or the confirmed consecutive bacterial infection it is necessary immediately (but after consultation with microbiologists!) to begin treatment with antibiotics in combination with antiviral drugs. Control of arterial blood pressure and maintenance of a water balance: patients without septic shock need to carry out conservative infusional therapy. It is necessary to give oxygen for maintenance of level of a saturation of ≥95%. If necessary use IVL. Continue monitoring of a condition of a fruit. The question of premature delivery on medical indications is considered by versatile medical team in an individual order.