On January 28, the Department of Obstetrics and Gynecology and the Department of Neonatology jointly issued the Guiding Opinions on the Management of Newborn Women during the Coronavirus Infection. Tencent Medical Code has been authorized to publish this guidance; the following is the detailed content. Since December 2019, there have been many cases of pneumonia caused by coronavirus infection in different cities of china, USA, Canada and almost in whole globe. A small number of patients have symptoms such as nasal congestion, runny nose, and diarrhea. In some cases, there is no obvious fever. The total number of peripheral blood leukocytes in the early stage of the disease was normal or decreased, and the lymphocyte count decreased. Chest CT showed imaging features of pneumonia.
Pregnant women are in a special state of immune tolerance, which is a susceptible group of the virus, and there have been confirmed cases of infection of pregnant women’s throughout in the world. The diagnosis and treatment of infected pregnant women should take into account the situation of both mother and child. The common clinical problems and treatment suggestions are summarized below.
1.Which medical institutions can accept pregnant women with fever or suspected infection?
Medical institutions of obstetrics and neonatal departments, or designated medical institutions designated by the health committees at all levels.
2. Which pregnant women need to visit the fever clinic?
The fever and suspected cases in pregnant women are first pre-diagnosed and sorted, the body temperature is measured and directed by a special staff to the designated fever clinic.
3. What are the judgment criteria for suspected cases?
Any one of the following epidemiological history is in line with any two of the following clinical manifestations.
Epidemiology history:Travel history or residence history in different with continuous transmission of local cases within 14 days before onset:
Patients who had contact with fever or respiratory symptoms from Wuhan City or other areas where local cases continue to spread within 14 days before the onset:
There is clustered disease, or epidemiological association with new coronavirus infection.
Clinical manifestations:Chest CT imaging features (early showing multiple small patch shadows and interstitial changes, with obvious extrapulmonary bands, and then developing multiple ground glass shadows and infiltration shadows of the lungs. In severe cases, pulmonary consolidation may occur, and pleural effusions are rare).
In the early stage of onset, the total number of white blood cells is normal or decreased, or the lymphocyte count is reduced. The typical blood cell count changes may not appear in the early stage of infection in pregnant women.
We can not rule out. According to the existing clinical cases, patients with pneumonia infected with new coronavirus may be infected with pathogens such as influenza A virus, influenza B virus, and Mycoplasma pneumoniae.
Whether the radiological examination causes abnormal fetal development depends on the gestational age and the radiation dose of the fetus in the radiological examination technique. In theory, the fetal radiation dose of chest CT does not reach the teratogenic threshold, which is relatively safe. For safety reasons, it is recommended that pregnant women undergo chest CT examination with informed consent and take abdominal protection measures.
The drug has been listed as the preferred medication plan for HIV during pregnancy. Based on animal studies and limited human reports, the drug does not seem to increase the risk of adverse pregnancy outcomes. Medical personnel should fully inform pregnant women and their families about the benefits of pregnant women who use the drug and the potential risks of the fetus, weigh the pros and cons, and choose the medication when the potential benefits are greater than the potential risks of the fetus.
Should obstetrics be routinely checked during the epidemic?
Pregnant women are a susceptible group of new coronaviruses. During the epidemic, routine prenatal examinations should be carried out, and changes in fetal movement should be closely monitored. Those with complications or complications during pregnancy should appropriately increase the number of birth examinations.
Judging according to the specific conditions of obstetrics, grasping the indications for termination of pregnancy.
Severe cases: Respiratory distress (respiratory frequency ≥30 breaths / min); or resting, finger oxygen saturation ≤93%; or arterial blood oxygen partial pressure (PaO2) / oxygen concentration (FiO2) ≤300mmHg.
Critical cases:Respiratory failure requiring mechanical ventilation; or shock; or combined with other organ failure requires intensive care unit (ICU) monitoring treatment.
Suspected cases and confirmed cases that are not cured are not recommended for breastfeeding.
Lopinavir / ritonavir can be secreted with the milk of rats, and it is unclear whether human breast milk contains the drug. Therefore, breastfeeding is not recommended specially while taking any rich quantity medicine.
Breastfeeding should pay attention to the cleanliness of hands and breasts. Pregnant women suffer from physical exertion, blood loss, and a lot of water loss during the childbirth process, and the body's environmental disturbance causes the resistance to decline, becoming a susceptible group after delivery.
Patients with asymptomatic infections may experience clinical symptoms during this period. For example, postpartum fever after puerperal infection, breast swelling, mastitis and other obstetric conditions should be ruled out. Be alert to the possibility of respiratory infections, such as pneumonia, tuberculosis, and viral influenza.
At present, some cases have been found to have fever within 6 to 48 hours, suspected of being a coronavirus infection. Therefore, it is recommended that in addition to routine respiratory virus screening, lung CT examination can be improved. Suspected cases need to be further diagnosed by pathogenic examination.
After discharge, the fever patient is referred to the fever clinic, and the obstetrics and gynecology consultation is also required to rule out the obstetrics.
1. Will pregnant mothers infected with new coronavirus be transmitted to fetuses or newborns?
No cases of neonatal infection have been found so far, but it is still unclear whether the new coronavirus is transmitted vertically through the placenta or through breastfeeding after birth. Therefore, for mothers who are diagnosed with new coronavirus infection, the newborn is immediately isolated according to the virus infection process Observe for 2 weeks without breastfeeding.
2. Which newborns need to be screened for new coronavirus infections?
The possible ways of neonatal coronavirus infection are: vertical mother-to-child transmission, close contact transmission and droplet transmission (between family members, family visitors), and acquired infections in hospitals, so those who meet any of the following items need to be investigated:
Those diagnosed with maternal or highly suspected infection, Family members in close contact with pregnant women are diagnosed or highly suspected of being infected;
There are confirmed and highly suspected infections in the family caregivers after the newborn is born.
3. How should newborn babies born for the mothers those who diagnosed or suspected to be infected be isolated?
After the mother delivery is done, a newborn doctor should conduct a timely health assessment of the born baby. Newborns who are generally in good condition should be taken home immediately and isolated at home.
4. When the mother is diagnosed or suspected to be infected with a newborn, what symptoms appear during home isolation and need to be consulted in time?
The incubation period of the new coronavirus in adults is 1 to 14 days, and it is recommended that newborns be isolated for at least 14 days. The clinical manifestations of neonates, especially premature babies, lack specificity, such as fever, cough, dyspnea, poor mental response, poor milk intake, repeated vomiting and other symptoms, and should be treated promptly.
5. What should mothers pay attention to when the mother is diagnosed or suspected to be infected?
At present, it is uncertain whether the newborn will be infected or become a source of infection. Prevention and control measures should be taken during home isolation: single room isolation, minimal caregivers, regular window openings in the room, caregivers to wash hands frequently, and good care of the newborn Disinfection (high temperature or 75% alcohol) etc.
Observe closely the changes of the newborn's body temperature, milking, breathing, jaundice, etc.