What should pregnant mothers do in the face of the epidemic？
In this "war epidemic" to stop COVID-19, pregnant women and newborns, as a special group, are particularly concerned. Many obstetricians have found that many pregnant women have different levels of anxiety because of the epidemic. A few days ago, the "Expert Advice on novel coronavirus Infection during Pregnancy and Puerperium", written by well-known obstetricians and neonatal experts in China, was released, giving authoritative advice on the protection and treatment of pregnant women and newborns.
As one of the experts who participated in the discussion, Pang Qiumei, director of obstetrics department of Beijing You ‘an Hospital Maternal and Child Center, said: "Although the epidemic situation is grim, correct protection and proper treatment can protect the safety of mothers and infants. Pregnant women should not be too anxious, so as not to affect themselves and their children’s health." Director Pang Qiumei gave some health suggestions for several key issues that pregnant women are concerned about.
1. Is it necessary to postpone the check-up?
Hospitals are the key risk prevention and control areas in COVID-19 epidemic, and some departments suggest that non-emergency patients should try their best to reduce the number of medical visits and the risk of infection during the epidemic. Therefore, we can fully understand that some pregnant mothers are afraid to walk into the hospital during this period.
So, is it necessary to postpone the check-up? Pang Qiumei believes that whether pregnant women can postpone the prenatal examination needs to be comprehensively judged according to the gestational age, the content of the prenatal examination, the pregnancy risk rating and the self-management ability of pregnant women. Generally speaking, if the intrauterine pregnancy is confirmed in the first and second trimesters, and there are no abnormal conditions such as vaginal bleeding and abdominal pain, and there are no specific examinations (such as ultrasound exclusion, Down’s screening, diabetes screening, etc.), the time of prenatal examination can be appropriately postponed through consultation with obstetricians. However, for pregnant women with pregnancy complications or complications, as well as pregnant women in the third trimester of pregnancy over 28 weeks and pregnant women with sudden abnormal conditions during pregnancy, they should follow the doctor’s advice for prenatal examination.
For example, NT examination from 11 weeks to 14 weeks of pregnancy (one of the methods to evaluate whether the fetus may have Down syndrome) and fetal malformation screening from 20 weeks to 24 weeks of pregnancy are often only accepted by appointment, so it is recommended to have a prenatal examination on schedule; Down’s serological screening from 14th week to 20th week of pregnancy, glucose tolerance test from 24th week to 28th week of pregnancy, and ultrasound examination from 29th week to 32nd week of pregnancy can be postponed appropriately after consultation with the competent doctor. It is necessary to have fetal heart monitoring every week from the 34th week to the 37th week of pregnancy, so it is recommended to have regular prenatal check-ups. During this period, the mother and fetus are prone to complications, and untimely prenatal check-ups may affect the safety of the mother and fetus.
When going to the hospital for check-up, pregnant women and accompanying personnel should wear disposable medical masks and bring antibacterial hand gel or sterilized paper towels. After touching hospital items such as door handles and curtains, clean your hands with hand disinfectant in time, and don’t touch your nose, mouth and eyes before hand disinfection. At the same time, keep a distance of more than 1 meter from others as much as possible, and try to reduce the time spent in the hospital.
2. What symptoms do you need to see a doctor immediately?
Pregnant women should do a good job of self-monitoring at home, such as monitoring temperature changes, weight changes, fetal movement, abdominal pain, vaginal bleeding and signs of delivery, and monitoring blood pressure when necessary (especially those with basic diseases and abnormal blood pressure). Pang Qiumei specially reminded that in the process of self-monitoring of pregnant women at home, if there are abnormalities related to obstetric factors and abnormalities related to non-obstetric factors, they should go to the hospital for obstetric treatment in time.
Among them, the anomalies related to obstetric factors mainly refer to premature rupture of membranes, vaginal bleeding, uterine contraction, headache, abdominal pain, abnormal fetal movement and so on.
At present, the anomalies related to non-obstetric factors are mainly related to the epidemic situation, that is, pay attention to whether there are suspicious symptoms of COVID-19. For example, if you have a history of contact with patients in epidemic areas or COVID-19 within 14 days, your sublingual body temperature (it is not recommended to measure the underarm body temperature, because the underarm body temperature is greatly affected by sweating, dressing and other factors) exceeds 37.3℃, accompanied by clinical manifestations such as cough and fatigue, you should see a doctor in time. If you have a history of contact with patients in epidemic areas or COVID-19 within 14 days, and your body temperature is normal, but you have symptoms such as shortness of breath, chest tightness, diarrhea, conjunctival inflammation, and muscle soreness, you should also see a doctor in time. For the sake of safety, pregnant women who have no contact history with patients in epidemic areas or COVID-19, and whose body temperature exceeds 38℃, also need to see a doctor in time to investigate the cause.
3. Is it safe to do CT examination if it is suspected?
Pregnant women should go to the fever clinic of the hospital for the first visit because of fever, and then follow the doctor’s advice for the next examination.
In the process of clinical diagnosis of COVID-19’s case, the effect of chest X-ray examination with less radiation is limited, while lung CT has important reference value.
"Many people have concerns about lung CT examination during pregnancy, which depends on the situation." According to Pang Qiumei, according to literature reports, there are no reports of fetal malformation, growth restriction or abortion when the exposure dose is less than ＜50mGy. From the gestational age, the radiation exposure from the 8th to 15th week of pregnancy has the greatest impact on the fetal central nervous system. Some scholars suggest that the minimum radiation threshold for mental retardation is 60-310mGy.
When pregnant women receive chest CT or CT pulmonary angiography (exposure dose is 0.1-10 mgy), the radiation dose received by the fetus is 0.01-0.66 mgy, which is far lower than the teratogenic dose and is a safe dose. Therefore, for pregnant women suspected of COVID-19 virus infection or acute infection, CT can be used for lung examination under the condition of protecting the abdomen, such as wearing lead clothes. Even if pregnant women in the second and third trimester do not have abdominal protection, it has no effect on the fetus.
4. Can I breastfeed after diagnosis?
Can a pregnant woman continue her pregnancy if she is diagnosed with novel coronavirus? Will the virus be transmitted to the fetus?
In this regard, Pang Qiumei said that the possibility of vertical transmission between mother and fetus in novel coronavirus cannot be ruled out at present, but there is not enough evidence to prove vertical transmission between mother and fetus, and there is also no evidence to show whether the virus itself is harmful to embryos. However, according to past clinical experience, if pregnant women are infected by virus in the first trimester, persistent high fever above 38.5℃ will be harmful to embryonic tissue.
Therefore, after a pregnant woman is diagnosed with novel coronavirus, a multidisciplinary consultation should be conducted to decide whether to continue the pregnancy, including the gestational age and the severity of the disease. In addition, according to the existing experience, most antiviral drugs are relatively safe during pregnancy, and doctors will use them carefully according to the situation of pregnant women and fetuses.
If it is a postpartum infection, do you need to be isolated from the newborn? This is a concern of many parturients. There is no doubt about the answer. "If a pregnant woman is diagnosed with infection, she needs to be isolated from her newborn for further evaluation. In other words, the mother and the newborn cannot be in the same room. " Pang Qiumei said.
Pregnant women suspected or diagnosed to be infected with novel coronavirus should be quarantined for at least 14 days after the baby is born, during which breastfeeding is not recommended. It is recommended to milk regularly to ensure lactation, and then breast-feed until it is excluded or cured.
5. What about anxiety or depression during isolation?
The risk of anxiety and depression of pregnant women is higher than that of ordinary people, and this risk may increase once they are infected or suspected of being infected with novel coronavirus.
During the period of self-isolation of pregnant women or when going out for a long time, we should pay special attention to their mental health. Pang Qiumei suggested that when doctors or family members find that the mood, psychological status or behavior of pregnant women are abnormal, "they should promptly assess the anxiety, depression, sleep status, suicidal thoughts and sources of anxiety of the parties concerned, and promptly ask a psychiatrist for psychological intervention."
For pregnant and lying-in women, the following measures can be taken to alleviate the psychological pressure during the epidemic period: learn about the epidemic situation and related protection knowledge from formal channels, and reduce the panic, worry and anxiety caused by frequent refreshing of information; Communicate with relatives, friends, colleagues, etc. by telephone or internet to comfort and encourage each other and get psychological support; Try to maintain normal life and work under scientific protection, ensure nutrition and exercise, so as to maintain normal mood, and you can divert your attention by listening to music, painting and reading; Pregnant mothers in isolation should accept their own bad emotions and accept the isolation environment; When self-psychological adjustment is difficult, we can seek professional help and carry out psychological intervention through consultation hotline and other channels. (Author Liu Hui, Beijing You ‘an Hospital)
Guidelines for medical treatment
The Beijing Municipal Health and Health Commission recently released the List of 77 midwifery institutions in Beijing that can accept pregnant women with fever, including the first consultation places and contact information of pregnant women with fever in various hospitals. For details, please refer to official website of the Beijing Municipal Health and Health Commission. Some hospitals are listed here for pregnant women’s reference.
1. Union Medical College Hospital
2. Beijing Hospital
3. Tongren Hospital
4. Peking University First Hospital
5. Beijing Jiangong Hospital
6. Friendship Hospital
7. xuanwu hospital
8. Beijing Chuiyangliu Hospital
9. Beijing United Family Hospital
10. Aviation General Hospital
11. China-Japan Friendship Hospital
12. anzhen hospital
13. Chaoyang Hospital
14. Emergency General Hospital (formerly Coal General Hospital)
15. Civil Aviation General Hospital
16. beijing huaxin hospital
17. The First Medical Center of PLA General Hospital
18. Rocket Army Medical Characteristic Center
19. Special Medical Center of Strategic Support Forces (formerly the 306th Hospital of the People’s Liberation Army)
20. ditan hospital
21. China Aerospace Science and Industry Group 731 Hospital
22. You ‘an Hospital
23. Beijing Electric Power Hospital
24. Beijing Aerospace General Hospital
25. Tiantan Hospital (new campus)
26. Beijing Shijingshan Hospital
27. Peking University Shougang Hospital
28. Chaoyang Hospital (West Hospital)
29. yuquan hospital, Tsinghua University
30. Beijing Sijiqing Hospital
31. Haidian Hospital
32. Beijing Shangdi Hospital
33. Peking University Third Hospital
34. Space Center Hospital
35. Beijing Millennium Monument Hospital
36. Beijing Wangfu Hospital of Integrated Traditional Chinese and Western Medicine
37. beijing jishuitan hospital (Huilongguan Campus)
38. Tsinghua Chang Gung Memorial Hospital.