Interpretation
Coronaviruses (CoV) are a large family of viruses that cause a variety
of diseases, from the common cold to more serious diseases such as the
Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory
Syndrome (SARS-CoV). Human beings can also be infected by inhalation of
droplets scattered from the respiratory tract of the sick individuals or
by contact with the surfaces contaminated with these aeroceles(7). Eighteen of our patients (45%) had a contact
with people whom had a history of the disease. Current evidence suggests
that the severity of disease among pregnant women after COVID-19
infection is similar to non-pregnant adult COVID-19 cases, and there is
no data showing that infection with COVID-19 during pregnancy has a
negative effect on the fetus. So far, there is no evidence that vertical
transmission from mother to baby during pregnancy (8).In our study, no vertical transition was detected as no Infant had
positive PCR test.
In 2002-2003, there was a high maternal mortality rate in the SARS-CoV-1
outbreak (9). However, there has not been a similar
situation in SARS-CoV-2 yet. However, more studies are needed on this
subject. Looking at the current studies, it seems difficult to make
clear comments. (10-12). In Turkey, as of June 2, the
overall mortality rate of the disease is 2.76 %, and there are no
published articles showing maternal mortality rates in pregnant women
with COVID-19 (6). Similarly, no maternal and fetal
death has been observed in our hospital too.
In terms of clinical findings in patients, the common symptoms at
baseline were cough, fever, and difficulty breathing, and the rate of
asymptomatic patients was 22 (13, 14). Similar to
current studies, laboratory tests were observed as low lymphocyte count,
increased CRP and D-dimer (15, 16).
The relatively high mortality of COVID-19 is making people feel anxious.
Most of the women had c-section in our study similar to the literature(17). The most common c-section indication was
maternal request. This was followed by difficulty breathing and anxiety.
Lung CT findings are important for the diagnosis of pneumonia in
pregnant women with COVID-19. In patients who had mild involvement in
CT, multiple patchy frosted glass areas are peripherally located rather
than parenchyma, and lesions increased as the disease progresses.
According to the study conducted by Li M et al., extensive pulmonary
consolidations are observed in cases of severe involvement, ”white
lungs” may appear on the radiogram, but pleural effusion is rare(18).
In treatment, hydroxychloroquine is usually used in combination with a
second-generation macrolide. There is not enough data to know if it has
a role in treatment, but it is widely used. It can also cause QT
prolongation and ventricular arrhythmias, which may pose a certain risk
for critical patients (19). Among the 40 patients we
studied, no cardiac side effects related to drug use were observed. In
addition, heparin has been suggested to be added into treatment by some
specialized consensus due to the risk of disseminated intravascular
coagulation and venous thromboembolism. Heparin treatment has been
related to well prognosis, mostly in severe COVID-19 cases with high
D-dimer concentrations (20). Lopinavir, another
treatment option, is a protease inhibitor used to treat HIV in
combination with ritonavir. In one of the randomized study with 199
patients by Bin Cao et al., 99 of these patients were evaluated in the
group receiving lopinavir-ritonavir and 100 in the standard care group.
According to this study, it was observed that there was no additional
benefit of lopinavir-ritonavir treatment beyond standard care in adult
patients diagnosed with heavy Covid-19 (21).Oseltamivir is an approved neuraminidase inhibitor for the treatment of
influenza. Since the epidemic in China occurred during the peak season
of influenza, oseltamivir was added to the treatment of patients. In
fact, this agent has no role in the treatment of COVID-19 after
influenza has been excluded (22). We applied LMWH and
hydroxychloroquine to pregnant women as standard treatment. We observed
one of our patients without treatment because she was asymptomatic and
laboratory values were normal. Initially, we added oseltamivir to the
treatment of 7 patients due to the seasonal period. We used
lopinavir/ritonavir treatment in patients who needed oxygen therapy and
had severe involvement findings on lung CT. We have created our
treatment algorithm according to the ”COVID-19 guide”, which is updated
regularly by our health ministry since the disease first appeared in our
country. Changes in treatments arise from this. (23).