In this "war epidemic" to block the new crown of pneumonia, pregnant women and newborns are receiving special attention as special populations. Many obstetricians found during routine prenatal examinations that many pregnant women experienced varying levels of anxiety due to the outbreak. A few days ago, the "Expert Recommendations on New Coronavirus Infection in Pregnancy and Postpartum Period", co-written by well-known obstetrics and neonatal experts nationwide, was released, giving authoritative suggestions on related protection and treatment for pregnant women and newborns.
As one of the experts involved in the discussion, Pang Qiumei, director of the obstetrics department of the Maternal and Child Center of Beijing You'an Hospital, said: "Although the epidemic situation is severe, proper protection and proper treatment can escort the safety of mothers and infants. Do not be too anxious for pregnant women to avoid affecting themselves And the health of the child. "Director Pang Qiumei gave health recommendations for several focal issues that mothers care about.
1. Is it necessary to postpone the inspection?
The hospital is a key risk prevention and control area in the new crown pneumonia epidemic. Some departments recommend that non-emergency patients minimize the number of medical visits during the epidemic and reduce the risk of infection. Therefore, we can fully understand that some pregnant mothers are afraid to enter the hospital during this period.
So, is it necessary to postpone the inspection? Pang Qiumei believes that whether or not a pregnant woman can postpone a pregnancy check needs to be comprehensively judged based on the gestational week, the content of the checkup, the pregnancy risk rating, and the ability of the pregnant woman to manage herself. In general, if the intrauterine pregnancy is determined in the first and second trimester, there are no abnormalities such as vaginal bleeding and abdominal pain, and there are no specific tests (such as ultrasound orthodontic screening, Down's screening, diabetes screening, etc.), you can consult with the obstetrician Properly postpone inspections. However, for pregnant complications or complications, and pregnant women who are more than 28 weeks of late pregnancy, pregnant women who have sudden abnormalities during pregnancy, should undergo medical examinations.
For example, NT examinations from 11 to 14 weeks of pregnancy (one of the methods to assess whether the fetus may have Down syndrome), and screening for fetal malformations from 20 to 24 weeks of pregnancy are often only available by appointment, and it is recommended that the childbirth be performed regularly. Down's serology screening of week, glucose tolerance test from 24 to 28 weeks of pregnancy, ultrasound examination from 29 to 32 weeks of pregnancy, can be appropriately postponed after consultation with the doctor in charge within this time range; weekly pregnancy from 34 to 37 weeks For fetal heart monitoring, it is recommended to have a regular check-up. During this period, the mother and child are prone to comorbidities. Failure to check in time may affect the safety of the mother and child.
At the hospital, the pregnant women and accompanying persons must wear disposable medical masks and carry disposable hand sanitizer or disinfectant paper towels. After touching hospital items such as hospital door handles, curtains, etc., clean your hands with hand sanitizer in a timely manner. Do not touch your nose, mouth, and eyes before disinfecting your hands. At the same time, keep a distance of more than 1 meter with others as much as possible, and minimize the time spent in the hospital.
2. What symptoms need immediate medical attention?
Pregnant women should do self-monitoring at home, such as monitoring body temperature changes, weight changes, fetal movements, abdominal pain, vaginal bleeding, and signs of childbirth. Monitor blood pressure if necessary (especially those with underlying 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 must go to the hospital's obstetric department in time.
Among them, the abnormalities related to obstetric factors mainly refer to premature rupture of membranes, vaginal bleeding, contractions, and headache, abdominal pain, and abnormal fetal movement.
The abnormalities related to non-obstetric factors are mainly related to the epidemic situation, that is, pay attention to the suspicious symptoms of new coronary pneumonia. For example, within 14 days, there is a history of exposure in patients with epidemic areas or neo-coronary pneumonia, sublingual body temperature (measurement of underarm body temperature is not recommended, because underarm body temperature is greatly affected by sweating, clothing and other factors) exceeds 37.3 ℃, accompanied by cough and fatigue Such as clinical manifestations, you should seek medical treatment in a timely manner. If you have a history of exposure within 14 days from the epidemic area or neocoronary pneumonia, your temperature is normal, but you have symptoms such as shortness of breath, chest tightness, diarrhea, conjunctival inflammation, muscle soreness, etc., and you should see your doctor promptly. Pregnant women who have no contact history with epidemic areas or neo-coronary pneumonia, and whose body temperature exceeds 38 ° C, should also seek medical treatment in time for the sake of safety.
3. Is it safe to have a CT scan?
Pregnant women should see a doctor because of fever. The first consultation should go to the hospital for fever diagnosis, and then follow the doctor's order for the next check.
In the process of clinical diagnosis of new coronary pneumonia cases, chest radiographs with a small radiation dose have limited effects, and pulmonary CT has important reference value.
"Many people have concerns about having a CT scan of the lungs during pregnancy. This depends on the situation." According to the report, there are no reports of fetal malformation, growth restriction or miscarriage at the time of radiation exposure <50mGy . From the perspective of the gestational week, the radiation exposure from 8 to 15 weeks of pregnancy has the greatest impact on the central nervous system of the fetus. Some scholars have suggested that the minimum radiation threshold for mental retardation is 60-310 mGy.
When pregnant women receive chest CT or CT pulmonary angiography (exposure radiation dose is 0.1-10mGy), the radiation dose received by the fetus is 0.01-0.66mGy, which is much lower than the teratogenic dose and is a safe dose. Therefore, for pregnant women who are suspected of being infected with neo-coronary pneumonia virus or in the acute phase of infection, they can use CT for lung examination while protecting the abdomen, such as wearing lead clothing. Even if pregnant women do not have abdominal protection in the second and third trimesters, they will not affect the fetus.
4. Can breastfeeding be diagnosed?
Can a pregnant woman continue to be pregnant if she is diagnosed with the new coronavirus? Will the virus be transmitted to the fetus?
In this regard, Pang Qiumei said that the possibility of vertical transmission of maternal-fetal transmission of the new coronavirus cannot be ruled out, but there is not enough evidence to confirm vertical transmission of maternal-fetal, and there is also no evidence to show whether the virus itself is harmful to the embryo. However, according to previous clinical experience, if a pregnant woman is infected with the virus in the first trimester, a persistent high fever above 38.5 ° C is harmful to the embryo tissue.
Therefore, after a pregnant woman is diagnosed with the new coronavirus, she should undergo a multidisciplinary consultation, comprehensively including the gestational week and the severity of the disease, to decide whether to continue the pregnancy. In addition, according to current experience, most antiviral drugs are relatively safe to use during pregnancy, and doctors will take them carefully according to the situation of the pregnant woman and the fetus.
Do I need to isolate my newborn if I have a postpartum confirmed infection? This is a concern for many women. The answer is beyond doubt. "Maternal infection needs to be isolated from the newborn for further evaluation. In other words, the mother and newborn cannot be in the same room." Pang Qiumei said.
Women who are suspected or have been diagnosed with the new coronavirus are quarantined for at least 14 days after their baby is born. During this period, breastfeeding is not recommended. It is recommended to squeeze milk regularly to ensure lactation, and then to breastfeed until eliminated or cured.
5. What about anxiety or depression during isolation?
The risk of anxiety and depression is higher in pregnant women than in the general population, and this risk may increase once infected or suspected to be infected with the new coronavirus.
Pay special attention to the mental health of pregnant women during self-isolation or long-term reduction. Pang Qiumei suggested that when a doctor or family member finds out a pregnant woman's emotional, psychological, or behavioral abnormalities, "the person's anxiety, depression, sleep status, suicidal ideation, and source of anxiety should be assessed in a timely manner, and a psychiatrist should be promptly provided for psychological intervention."
For pregnant women, the following measures can be taken to alleviate the psychological pressure during the epidemic: understand the epidemic situation and related protection knowledge from regular channels, reduce panic, worry and anxiety caused by frequent refreshing of information; and more with relatives, friends, colleagues, etc. Communicate by telephone or internet, comfort each other, encourage each other, and get psychological support; try to maintain normal life and work under scientific protection, ensure nutrition and exercise, and maintain normal emotions. You can divert attention by listening to music, painting, and reading; Pregnant mothers who are in the period of isolation should accept their negative emotions and the environment of isolation; when self-psychological adjustment is difficult, they can seek professional help and psychological intervention through channels such as the consultation hotline.
(Author: Beijing You'an Hospital)
Medical guidelines
The Beijing Municipal Commission of Health and Health recently released the "List of 77 Midwifery Midwifery Institutions Available for Fever in Beijing", including the first consultation places and contact details of fever pregnant women in various hospitals. For the detailed list, please refer to the official website of the Beijing Municipal Commission of Health. Some hospitals are listed here for maternal reference.
1. Union Hospital
2. Beijing Hospital
3.Tongren Hospital
4. Peking University First Hospital
5.Beijing Jiangong Hospital
6. Friendship Hospital
7, Xuanwu Hospital
8.Beijing Weeping Willow 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. First Medical Center of PLA General Hospital
18.Rocket Army Medical Center
19. Strategic Medical Support Center (formerly the 306 Hospital of the PLA)
20.Ditan Hospital
21. 731 Hospital of China Aerospace Science and Industry Corporation
22.You An Hospital
23. Beijing Electric Power Hospital
24. Beijing Aerospace General Hospital
25.Tiantan Hospital (New Hospital District)
26. Beijing Shijingshan Hospital
27. Shougang Hospital of Peking University
28. Chaoyang Hospital (Western Hospital)
29. Yuquan Hospital, Tsinghua University
30.Beijing Sijiqing Hospital
31. Haidian Hospital
32. Beijing Shangdi Hospital
33. Peking University Third Hospital
34. Aerospace Central Hospital
35.Beijing Shijitan Hospital
36. Beijing Wangfu Integrated Hospital of Traditional Chinese and Western Medicine
37. Beijing Jishuitan Hospital (Huilongguan Hospital District)
38. Beijing Tsinghua Chang Gung Hospital