Coronavirus disease 2019 (COVID-19) pandemic and pregnancy
Coronavirus disease 2019 (COVID-19) pandemic and pregnancy
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DOI：
10.1016/j.ajog.2020.03.021
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发表时间：
2020-06-01
影响因子：
9.8
通讯作者：
Su, Lin Lin
中科院分区：
文献类型：
--
作者：
Dashraath, Pradip;Wong, Jing Lin Jeslyn;Su, Lin Lin
当前由严重急性呼吸系统综合征冠状病毒2型（SARS-CoV-2）引起的冠状病毒病2019 （COVID-19）肺炎大流行正在全球加速传播，基本繁殖数（R0）为2-2.5，表明一名指示患者将感染2-3人。这是一种严重的突发公共卫生事件，在卫生保健提供者没有充分准备控制感染的脆弱人群和社区中尤其致命。截至2020年3月16日，全球新冠肺炎确诊病例超过18万例，相关死亡病例超过7000例。已从无症状个体中分离出SARS-CoV-2病毒，受感染患者在症状停止2周后仍具有传染性。高发病率和社会经济影响迫使各大洲采取严厉措施，包括在全国范围内封锁和关闭边境。在传染病暴发期间，孕妇及其胎儿是高危人群。迄今为止，文献中已报告了55名感染COVID-19的孕妇和46名新生儿的结局，没有明确的垂直传播证据。妊娠期的生理和机械变化通常会增加对感染的易感性，特别是当心肺系统受到影响时，并促使妊娠期呼吸衰竭的快速进展。此外，怀孕倾向于t -辅助性2 （Th2）系统的优势，保护胎儿，使母亲容易受到病毒感染，而病毒感染更有效地由Th1系统控制。这些独特的挑战要求对受SARS-CoV-2影响的妊娠采取综合方法。在这里，我们回顾了COVID-19在妊娠期的研究，汇集了各种因素，包括病理生理学和易感性的理解，实时逆转录聚合酶链反应（RT-PCR）检测的诊断挑战，治疗争议，宫内传播和母胎并发症。我们讨论了抗病毒治疗和疫苗开发的最新选择，包括氯喹在COVID-19管理中的新用途。胎儿监测，鉴于倾向于生长限制和特殊考虑在劳动和分娩，是解决。此外，我们在继续提供基本服务的同时，注重保障一线产科护理提供者的安全。我们的临床服务模式是围绕工作场所隔离、负责任的社交距离、遏制医疗保健提供者交叉感染、明智使用个人防护装备和远程医疗等原则建立的。我们的目标是分享一个框架，供在大流行期间管理孕妇的三级产科单位采用，同时以维护患者和医疗保健提供者的安全为核心。
The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2-2.5, indicating that 2-3 persons will be infected from an index patient. A serious public health emergency, it is particularly deadly in vulnerable populations and communities in which healthcare providers are insufficiently prepared to manage the infection. As of March 16, 2020, there are more than 180,000 confirmed cases of COVID-19 worldwide, with more than 7000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious 2 weeks after cessation of symptoms. The substantial morbidity and socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns and border closures.Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks. To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure in the gravida. Furthermore, the pregnancy bias toward T-helper 2 (Th2) system dominance, which protects the fetus, leaves the mother vulnerable to viral infections, which are more effectively contained by the Th1 system. These unique challenges mandate an integrated approach to pregnancies affected by SARS-CoV-2.Here we present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcription polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission, and maternal-fetal complications. We discuss the latest options in antiviral therapy and vaccine development, including the novel use of chloroquine in the management of COVID-19. Fetal surveillance, in view of the predisposition to growth restriction and special considerations during labor and delivery, is addressed. In addition, we focus on keeping frontline obstetric care providers safe while continuing to provide essential services. Our clinical service model is built around the principles of workplace segregation, responsible social distancing, containment of cross-infection to healthcare providers, judicious use of personal protective equipment, and telemedicine. Our aim is to share a framework that can be adopted by tertiary maternity units managing pregnant women in the flux of a pandemic while maintaining the safety of the patient and healthcare provider at its core.