Considerable spread of a new koronavirusny infection resulted in need of the solution of questions of maintaining the patients having in addition to a koronavirusny infection also other states demanding medical care. In this article we will sort questions of obstetric tactics at the pregnant women who caught COVID-19.
In general, one may say, that obstetric tactics at a koronavirusny infection is defined by three aspects: duration of gestation, condition of a fruit and condition of mother.
If infection with a coronavirus arose at the very beginning of pregnancy, the condition of the woman is regarded as moderately severe or heavy, and duration of gestation does not exceed 12 weeks, then after recovery of the woman it is possible to consider a question of need of abortion. It is connected with the fact that the viral infection leads to growth of perinatal complications, and it can be connected both with the infection, and with side effects of medicines which were applied to treatment. If the woman refuses abortion, then a number of additional researches for identification of possible anomalies of a fruit can be will at appointed.
At later terms of a gestation it is necessary to be guided in general by the size of a pregnant uterus. For example, at duration of gestation up to 20 weeks the pregnant uterus slightly influences warm emission and respiratory function therefore it is possible not to hurry with expeditious delivery. At term 20–23 weeks expeditious delivery aims at preservation of life of mother, and at later terms (more than 24 weeks) the purpose of Cesarean section is rescue of life both mother, and a fruit.
At the same time it must be kept in mind that delivery which is carried out to a heat of infectious process raises number of complications and increases maternal lethality. At the same time complications can be connected as with a koronavirusny infection (weighting of a current, progressing of respiratory insufficiency), and to have obstetric character (death of a fruit, obstetric bleeding, it is purulent - septic complications and so on). At the same time the emergency Cesarean section is shown when progressing a hypoxia in the conditions of carrying out artificial ventilation of the lungs, development of respiratory insufficiency, a fluid lungs, septic shock. In these situations the emergency expeditious delivery is carried out according to vital indications.
Besides, development of the situation when in the middle of infectious process at the woman spontaneous patrimonial activity develops is possible. In this case it is recommended to conduct childbirth in natural patrimonial ways. Regional techniques which to a lesser extent influence respiratory function are applied to anesthesia of the woman. If necessary various methods of extraction of a fruit (obstetric nippers or vacuum extraction) can be used.
At emergence of indications for expeditious delivery, it is carried out by the standard principles. Besides, indications to expeditious delivery can arise at an aggravation of symptoms of mother.
When choosing a method of anesthesia in such situations it is necessary to proceed from a condition of the woman. At a stable condition of the patient, lack of the expressed respiratory insufficiency, a stable condition of a hemodynamics and a hemostasis carrying out regional anesthesia on condition of respiratory support is possible. In case of serious condition of the woman method of the choice is the general anesthesia with artificial ventilation of the lungs.
Regardless of duration of gestation preventive events concerning a possible intra-or postoperative bleeding are held. It is necessary to have in availability necessary infusion solutions, components and blood preparations, drugs for correction of a hemostasis.
After completion of treatment, at making decision on a possible extract of the pregnant woman or the woman in childbirth from a hospital, it is necessary to be guided by a number of criteria:
- Normal body temperature at the woman within three and more days;
- Lack of clinical symptoms of defeat of a respiratory organs;
- Normalization of laboratory indicators;
- Lack of obstetric complications of pregnancy or puerperal period.
All above-mentioned criteria are approximate and depend on a concrete clinical situation.
If to speak about the forecast for pregnant women at a koronavirusny infection, then it depends on duration of gestation, existence of risk factors (smoking) and the accompanying pathology at the woman (a diabetes mellitus, obesity, chronic respiratory pathology, HIV infection and so on), severity of a koronavirusny infection, possible obstetric or not obstetric complications, timeliness of the request for medical care and timeliness of the beginning of therapy.