Lancet: Maternal Management Advice for Suspected SARS-CoV-2 Infection
Original Zhang Xiangjun/Liu Dan SIFIC Infection Evidence-Based Information
On 3 March 2020, in the journal Lancet Infectious Diseases, the team of the department of obstetrics and gynecology at the University Hospital of Lausanne, Switzerland, published a management recommendation on pregnant women suspected of SARS-CoV-2 infection.
Management advice for pregnant women with suspected SARS-CoV-2 infection
Search: Vinson Chen
Translation: Zhang Xiangjun/Liu Dan
Coronaviruses that cause severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) can lead to severe adverse pregnancy outcomes such as miscarriage, premature birth, intrauterine developmental inviolation of the fetus and maternal mortality. The new coronavirus (COVID-19), or Severe Acute Respiratory Syndrome coronavirus type 2 (SARS-COV-2), found in 2019, has no evidence of vertical transmission between mother and child, with the exception of individual cases that may be due to perinatal transmission.
The effects of SARS-COV-2 on pregnancy are uncertain, and although there is no evidence that infection with SARS-COV-2 can have serious adverse consequences for mothers and newborns, this possibility cannot be ruled out. Experience from the Zika virus shows that when new pathogens emerge, health care providers should be prepared for the worst." Therefore, there is an urgent need for management recommendations for pregnant women at risk of SARS-CoV-2 infection.
We recommend that pregnant women who have been to a country with sars-COV-2 outbreaks in the past 14 days or who have been in close contact with a patient diagnosed with SARS-COV-2 should be tested for SARS-COV-2 nucleic acid, even if they do not show clinical symptoms. Pregnant women with SARS-COV-2 infection in the laboratory with no clinical symptoms should self-monitor at home for at least 14 days. Due to the risk of fetal intrauterine retardation, both pregnant women and pregnant women recovering from mild illness should undergo a bimonthly fetal ultrasound and assessment. Pregnant women with COVID-19 pneumonia should be treated and cared for by a multidisciplinary team at the tertiary care centre. When the patient meets the criteria for rapid sequential organ failure assessment, he/she should be transferred to an intensive care unit for treatment.
For pregnant women who have been diagnosed with SARS-COV-2, the delivery time should be based on the number of weeks of pregnancy, mother, fetus and delivery. Where possible, the vaginal delivery method should be chosen as far as possible, and when given the condition, the delivery by means of an instrument should be made to avoid exhaustion of maternal energy. For patients who have been infected, avoid unnecessary surgical complications. In the event of infectious shock, acute organ failure or fetal distress, a caesarean section should be performed urgently (or legal termination of pregnancy before the fetus survives).
For SARS-CoV-2-positive mothers, newborns should be quarantined for at least 14 days or until the virus is removed, during which time direct breastfeeding is not recommended.
The above recommendations should apply to local health care facilities and be revised in the interest of any further updates regarding SARS-CoV-2 and COVID-19.
Original 张向君/廖丹 SIFIC感染循证资讯 1 week ago
📷2020年3月3日，在Lancet Infectious Diseases杂志上，瑞士洛桑大学附属医院妇产科学研究团队发表了一篇关于疑似SARS-CoV-2感染孕妇的管理建议。针对疑似SARS-CoV-2感染孕妇的管理建议检索：陈文森翻译整理：张向君/廖丹引起严重急性呼吸综合征（SARS）和中东呼吸综合征（MERS）的冠状病毒，会导致严重的不良妊娠结局，如流产、早产、胎儿宫内发育迟缓和孕产妇死亡。2019年发现的新型冠状病毒（COVID-19），即严重急性呼吸综合症冠状病毒2型（SARS-COV-2），目前尚无证据表明其在母婴之间存在垂直传播，除了个别病例可能是由于围产期导致的交叉传播。SARS-COV-2对妊娠的影响尚不确定，虽然无证据表明感染SARS-COV-2后会对母亲和新生儿产生严重的不良后果，但仍不能排除这种可能性。来自寨卡病毒的经验表明，当出现新的病原体时，医疗保健机构应做好应对最坏情况的准备。因此，迫切需要出台针对存在SARS-CoV-2感染风险的孕妇的管理建议。我们建议在过去14天内曾经去过发生SARS-COV-2疫情的国家或与确诊SARS-COV-2的患者有过密切接触的孕妇，均应进行SARS-COV-2核酸检测，即使其未出现临床症状。实验室确诊为SARS-COV-2感染但无临床症状的孕妇应在家中自我监测至少14天。由于存在引起胎儿宫内发育迟缓的风险，这类孕妇和从轻症疾病中康复的孕妇都应接受每两个月一次的胎儿超声波检查和评估。患有COVID-19肺炎的孕妇应由三级护理中心的多学科小组进行治疗和护理。当患者达到快速序贯器官功能衰竭评估标准时，应被转移到重症监护室进行治疗。对于确诊SARS-COV-2的孕妇，其分娩时间应根据怀孕周数、母亲、胎儿和分娩情况而定。在可能的情况下，应尽量选择经阴道的分娩方式，有条件时借助仪器分娩以避免产妇精力耗竭。对于已经感染的患者，应尽量避免不必要的手术并发症。若孕妇出现感染性休克，急性器官衰竭或胎儿窘迫时，应紧急行剖宫产术（或在胎儿尚存活前合法终止妊娠）。对于SARS-CoV-2阳性的母亲，其新生儿应至少隔离14天或直到病毒清除时方可解除隔离，在此期间不建议直接母乳喂养。以上建议应适用于本地的医疗保健机构，并根据有关SARS-CoV-2和COVID-19的任何进一步更新而进行修订。