COVID-19 por SARS-CoV-2: la nueva emergencia de salud en la embarazada. Lo que médicos y obstetras necesitan saber
COVID-19 by SARS-CoV-2: the new health emergency in the pregnant. What doctors and obstetrics need to know
Resumen
La actual pandemia COVID-19, causada por SARS-CoV-2, se está propagando a un ritmo acelerado. Las embarazadas y sus fetos representan una población de alto riesgo debido a los cambios fisiológicos y mecánicos en el embarazo. Existe poca evidencia del compromiso materno fetal, y de transmisión vertical. El equipo de salud encargado de atender a la mujer durante su etapa prenatal, natal y postnatal debe estar al tanto de esta infección y su manejo. Se realizó una revisión sistemática de las publicaciones de mayor relevancia, de países que ya han presentado esta enfermedad y protocolos de organismos mundialmente facultados. Una de las principales fortalezas de la atención prenatal es su insistencia en la prevención y el diagnóstico oportuno. Las medidas de distanciamiento social, y/o cuarentena, hacen imperativo tomar decisiones sobre: cuándo y cómo realizar el control prenatal en tiempo de pandemia, y cómo es el manejo de la paciente embarazada COVID-19+, durante el tercer trimestre, trabajo de parto, parto, y puerperio; garantizando siempre, el bienestar materno fetal y del personal de salud. Se concluye que estamos ante un desafío único, que exigen un enfoque multidisciplinario. La evolución de este nuevo agente infeccioso es totalmente impredecible, falta mucho por conocer, las investigaciones futuras arrojarán luces sobre el comportamiento clínico del SARSCoV-2 en las diferentes etapas del embarazo, complicaciones, además de la posibilidad de transmisión vertical. Se recomienda la atención obstétrica y perinatal de pacientes gestantes en nuestro medio, de una manera consensuada, uniforme y basada en la evidencia científica actual.
The current COVID-19 pandemic, caused by SARS-CoV-2, is spreading at an accelerated rate. Pregnant women and their fetuses represent a high-risk population due to the physiological and mechanical changes in pregnancy. There is little evidence of fetal maternal engagement and vertical transmission. The health team responsible of caring woman during her prenatal, natal and postnatal stage should be aware of this infection and its management. A systematic review of the most relevant publications was made from countries that have already suffered from this disease and protocols from globally empowered agencies. One of the main strengths of prenatal care is its insistence on prevention and timely diagnosis. Social distancing measures, and/or quarantine, make it imperative to make decisions about: when and how to perform prenatal monitoring at pandemic time, and what the management of the pregnant patient COVID-19+ is like, during the third trimester, labor, delivery, and postpartum; always ensuring maternal fetal and health personnel well-being. It concludes that we are facing a unique challenge, which require a multidisciplinary approach. The evolution of this new infectious agent is totally unpredictable, there is much to learn, and future research will shed light on the clinical behavior of SARSCoV-2 at different stages of pregnancy, complications, in addition to the possibility of vertical transmission. Obstetric and perinatal care of pregnant patients in our environment is recommended, in a consensual, uniform manner based on current scientific evidence.
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ACOG. American College of Obstetricians and Gynecologists (2020) Advisory on Novel Coronavirus 2019 (COVID-19) including an algorithm to aid in assessment and management of pregnant patients with suspected or confirmed COVID-19. Disponible en: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019
Ai T., Zhenlu Y., Hongyan H., Zhan C., Chen Ch., Qian T., Ziyong S., Liming X. (2020). Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease (COVID-19) in China: A Report of 1014 Cases. Radiology. DOI: https://doi.org/10.1148/radiol.2020200823.
Aragón-Nogales R et al. (2020) Coronavirus 2019: la más reciente emergencia de salud 218 Rev Mex Pediatr; 86(6); 213-218 DOI: https://dx.doi.org/10.35366/91871
AVUM. Sociedad Venezolana de Ultrasonido en Medicina. (2020). Consenso COVID – 19 en gestantes. Disponible: https://www.flasog.org/static/COVID- 19/ consenso_ avum_ covid19 _ en_gestantes.pdf
Boelig, R., Saccone, G., Bellussi, F., Berghella, V. (2020) MFM Guidance for COVID-19, American Journal of Obstetrics & Gynecology MFM, doi: https://doi.org/10.1016/j.ajogmf.2020.100106.
Carlin, A. y Alfirevic, Z. (2008) Physiological changes of pregnancy and monitoring. Best Pract Res Clin Obstet Gynaecol; 22(5):801–823.
Carvajal, A. y Márquez, D. (2020). Nuevo coronavirus (SARS-CoV-2) y embarazo. Rev Obstet Ginecol Venez; 80 (1): 53 - 63.
CDC. Centro para el Control y la Prevención de Enfermedades. (2020). Guidance on Coronavirus in Pregnant and Breastfeeding women https://www.contemporaryobgyn.net/article/cdc¬guidance¬coronaviruspregnant-breastfeeding¬women
CDC. Control and Prevention. Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (2019-nCoV). https://www.cdc.gov/coronavirus/2019‐COVID/hcp/guidance‐home-care.html
CDC. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
Chen, D., Yang, H., Cao, Y., Cheng, W., Duan, T., Fan, C., Belfort, M. A. (2020). Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID‐19) infection. International Journal of Gynecology & Obstetrics. DOI: https://doi.org/10.1002/ijgo.13146
Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W. (2020) Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 395: 809–15. DOI: https://doi .org/10.1016/S0140-6736(20)30360-3.
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y. (2020) Epidemiological and clinical characteristics of 9 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet; 395:507-513.
Chen, S., Huang, B., Luo, D. (2020) Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases. Zhonghua Bing Li Xue Za Zhi 49 (0): E005-E05. doi: 10.3760 / cma.j.cn112151-20200225-00138
Chinese expert consensus on the perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (First edition). (2020). Ann Transl Med. 2020 DOI: http://dx.doi.org/10.21037/atm.2020.02.20.
Cui, J., Li, F., Shi, Z. (2019). Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019; 17(3): 181-192.
Dashraath, P. y Wong, J. (2020). Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/ j.ajog.2020.03.021.
Del Río, C. y Malani, P. (2020) Nuevo coronavirus: información importante para los médicos. JAMA; doi: 10.1001 / jama.2020.1490
E- ¬lactancia. (2020). COVID¬19 Materna. Enfermedad materna por Coronavirus 19 y Lactancia Materna ¿Son compatibles? Disponible: http://www.e¬lactancia.org/breastfeeding /maternal-coronavirus ¬2019¬ncovinfection/product/
Fan, C., Lei, D., Fang, C., Li, C., Wang, M., Liu, Y., Wang, S. (2020). Perinatal Transmission of COVID-19 Associated SARS‐CoV‐2: Should We Worry? Clinical Infectious Diseases. DOI: https://doi.org/10.1093/cid/ciaa226
Favre, G., Pomar, L., Musso, D., Baud, D. (2020). 2019-nCoV epidemic: what about pregnancies? Lancet; doi: 10.1016/S0140- 6736(20)30311-1.
Fuk-Woo, J., Yuan, S., Kok, K., Kai-Wang, T., Chu, H., Yang, J. (2020). A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The Lancet; 395(10223): 514-523.
Guan, W., Zheng-yi, N., Yu, H., Wen-hua, L., Chun-quan, O., Jian-xing, H., Lei, L., Shan, H., Lei, Ch., Bin, Du., Lan-juan, L. (2020). Clinical Characteristics of Coronavirus Disease in China New England Journal of Medicine; doi: 10.1056/NEJMoa2002032
Heshui, S., Xiaoyu, H., Yukun, C., Osamah, A., Chuansheng, Z. (2020). Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. 2020. The Lancet Infectious Diseases; 20 (4) 4, 425-434
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y. (2020). Clinical features of patients infected with 2019novel coronavirus in Wuhan, China. The lancet, 395(10223): 497¬506.
International Committee on Taxonomy of Viruses (ICTV). [Internet]. [Access 5 April of 2020] Available in: https://talk.ictvonline.org/ taxonomy/.
ISUOG. International Society of Ultrasound in Obstetrics & Gynecology. (2020). Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals. Ultrasound in Obstetrics & Gynecology. https://doi.org/10.1002/uog.22013
Jiao, J. (2020). Under the epidemic situation of COVID‐19, should special attention to pregnant women be given? Journal of Medical Virology; https://doi.org/10.1002/jmv.25771
Jin, Y., Cai, L., Cheng, Z., Cheng, H., Deng, T., Fan, Y. (2020). A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020; 7(1): 4. DOI: https://doi. org/10.1186/s40779-020-0233-6.
Kelvin, K., Owen, T., Cyril, Ch., Kwok-Hung, Ch., Jacky, M. (2020). Consistent Detection of 2019 Novel Coronavirus in Saliva. Clin Infect Dis; doi: 10.1093/cid/ciaa149
Leung, N., Chu, D., Shiu, E. (2020). Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med; DOI: https://doi.org/10.1038/s41591-020-0843-2
Liang, H. y Acharya, G. (2020). Novel corona virus disease (COVID‐19) in pregnancy: What clinical recommendations to follow? Acta Obstetricia et Gynecologica Scandinavica; 99 (4), 439-442.
Liu, D., Li, L., Wu, X., Zheng, D., Wang, J., Yang, L., y Zheng, C. (2020). Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID‐19) Pneumonia: A Preliminary Analysis. American Journal of Roentgenology, DOI: https://doi.org/10.2214/ajr.20.2307
Liu, H., Liu, F., Li, J., Zhang, T., Wang, D. y Lan, W. (2020). Clinical and CT imaging features of the COVID-‐19 pneumonia: Focus on pregnant women and children. Journal of Infection, DOI: https://doi.org/10.1016/j.jinf.2020.0 3.007
Lu, H. (2020) Drug treatment options for the 2019-new coronavirus (2019- nCoV). Biosci Trends; doi: 10.5582/bst.2020.01020.
Matt, A., Eric, Y., Lindy, K. (2020). Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA; doi:10.1001/jama.2020.4326
MPPPS. Ministerio del Poder Popular Para La Salud de Venezuela. (2020). COVID 19. Definiciones Epidemiológicas. Actualización 9 de Abril 2020.
MPPPS. Ministerio del Poder Popular para la Salud. Venezuela/ UNICEF, OPS, OMS, UNFPA (2014). Protocolos de atención. Cuidados prenatales y atención obstétrica. https://www.paho.org/venezuela/
MPPS/OPS/UNFPA. Ministerio del Poder Popular para la Salud / Organización Panamericana para la Salud/ Fondo de Población de las Naciones Unidas. (2020). COVID¬19, embarazo y lactancia: Dirigido a proveedores de salud. Venezuela
Mullins, E., Evans, D., Viner, R. M., O'Brien, P., & Morris, E. (2020). Coronavirus in pregnancy and delivery: rapid review. Ultrasound in Obstetrics & Gynecology, https://doi.org/10.1002/uog.22014
OMS (2016) Recomendaciones de la OMS sobre atención prenatal para una experiencia positiva del embarazo. Disponible: https://apps.who.int/iris/bitstream/handle/10665/250802/WHO-RHR
OMS. (2020). Reportes epidemiológicos y guías interinas para profesionales de salud. https://www.who.int/emergencies/diseases/novel-coronavirus-2019
OMS. Declaración sobre la segunda reunión del Comité de Emergencias del Reglamento Sanitario Internacional (2005) acerca del brote del nuevo coronavirus (2019-nCoV) Disponible en: https:// www.who.int/es/news-room/detail/30-01-2020-statement-onthe-second-meeting-of-the-international-health-regulations- (2005)-emergency-committee-regarding-the-outbreak-of-novelcoronavirus-(2019-nCOv).
OMS. World Health Organization (2020). Modes of transmission of virus causing
OMS. World Health Organization. (2020). Infection Prevention and control during health care when novel coronavirus (nCoV) infection is suspected Interim guidance.
OPS. Organización Panamericana de la Salud (2020). Sobre COVID-19: https://www.paho.org/ hq/index.php? option=com_content&view=article&id= 15696: coronavirus-disease-COVID-19&Itemid=4206〈=es
Organización Panamericana de la Salud / Organización Mundial de la Salud. (2020). Actualización Epidemiológica: Nuevo coronavirus (COVID¬19). Washington, D.C.: OPS/OMS; 2020. • www.paho.org • © OPS/OMS.
Peng, Ph., Ho, P. y Hota, S. (2020). Outbreak of a new coronavirus: what anaesthetists should know. British Journal of Anaesthesia;. doi: 10.1016/j.bja.2020.02.008
PUBLICACIONES GUBERNAMENTALES DEL REINO UNIDO (2020). COVID-19. https://www.hps.scot.nhs.uk/ recursos web / Information on COVID-19, including guidance on the assessment and management of suspected UK cases.
Qiao, J. (2020). What are the risks of COVID-19 infection in pregnant women? Lancet. 395 (10226):760-762.
Rasmussen, S., Smulian, J., Lednicky, J., Wen, T., y Jamieson, D. (2020). Coronavirus Disease 2019 (COVID-‐19) and Pregnancy: What obstetricians need to know. American Journal of Obstetrics and Gynecology; https://doi.org/10.1016/j.ajog.2020. 02.017
Royal College of Obstetrician and Gynecologists (RCOG). (2020) Coronavirus (COVID-19) Infection in Pregnancy. Information for healthcare professionals. Version 1: Published Monday 9 March, 2020. Disponible en internet: https://www.rcog.org.uk/globalassets/ documents/guidelines/ coronavirus-COVID-19-virus-infection-in- pregnancy-2020-03-09.pdf
Ruan, Q., Yang, K., Wang, W. (2020). Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med; DOI: https://doi.org/10.1007/s00134-020-05991
Schwartz, D. (2020) An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Disponible en https://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2020-0901-SA
Schwartz, D. (2020). An Analysis of 38 Pregnant Women with COVID‐19, Their Newborn Infants, and Maternal‐Fetal Transmission of SARS‐CoV‐2: Maternal Coronavirus Infections and Pregnancy Outcomes. Archives of Pathology & Laboratory Medicine; DOI: https://doi.org/10.5858/arpa.2020‐0901‐sa
Schwartz, D. y Graham, A. (2020). Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses;12(2):194
Secretaría de Salud Gobierno Mexicano. Subsecretaría de Prevención y Promoción de la Salud. Dirección General de Epidemiología.Nuevo Coronavirus en el mundo (COVID-19). Lineamiento estandarizado para la Vigilancia Epidemiológica y por Laboratorio de Enfermedad por 2019-NCOV. Disponible: https://www.gob.mx/cms
Sociedad Española de Ginecología y Obstetricia S.E.G.O. (2020). Recomendaciones para la prevención de la infección y el control de la enfermedad por coronavirus 2019 (COVID-19) en la paciente obstétrica. Rev Iberoam Fert Rep Hum;, http://www.revistafertilidad.org/rif-noticias/recomendaciones-para-la-prevencion-de-la-infeccion-y-el-control-de-la-enfermedad-por-coronavirus-2019--COVID-19-en-la-paciente-obstetrica.
Shen, Z., Xiao, Y., Kang, L. (2020). Genomic diversity of SARS-CoV2 in coronavirus disease 2019 patients. Clin Infect Dis; DOI: 10.1093 / cid / ciaa203.
SMFM. Sociedad de Medicina Materno Fetal (2020). Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. Disponible: https://s3.amazonaws.com/ cdn.smfm.org/ media/2267/COVID19-_updated_3-17-20_PDF.pdf
Sociedad Chilena De Infectología (2020). Recomendaciones manejo clínico de infección respiratoria por nuevo coronavirus 2019 (2019 n‐COVID) Comité de Infecciones Emergentes -Comité Consultivo de IAAS. Disponible: http://www.sochinf.cl/portal/
SOGV. Sociedad de Obstetricia y Ginecología de Venezuela (2020). Protocolo de la atención de la Embarazada ante la Pandemia por COVID 19. http://www.sogvzla.org.ve/
Song, Z., Xu, Y., Bao, L., Zhang, L., Yu, P., Qu, Y. (2020). From SARS to MERS, thrusting coronaviruses into the spotlight. Viruses; 2019; 11(1): 59.
Su, S., Wong, G., Shi, W., Liu, J., Lai, A., Zhou, J. (2016). Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol; 24(6): 490-502.
Tan, E. y Tan, E. (2013). Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol;27(6):791-802
UNICEF. United Nations Children’s Fund. (2020). Coronavirus disease (COVID¬19): What parents should know. Disponible en: https://www.unicef.org/stories/novel¬coronavirus-outbreak¬what¬parents¬shouldknow
Wang, X., Zhou, Z., Zhang, J. (2020). Case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clinical Infectious Diseases; doi: 10.1093 / cid / ciaa200
WHO Infection Prevention and Control During Health Care When Novel Coronavirus (nCoV) Infection Is Suspected: Interim Guidance. WHO website. Disponible: https://www.who.int/publicationsdetail/infection-prevention-and-control-during-health-care-whennovel-coronavirus-(ncov)-infection-is-suspected-20200125.
Zhang, J., Wang, Y., Chen, L. (2003). Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome. Zhonghua Fu Chan Ke Za Zhi; 38: 516-20.
Zhou, P., Yang, X., Wang, X., Hu, B., Zhang, L., Zhang, W. (2020). A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. DOI: https:// doi.org/10.1038/s41586-020-2012-7.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J. (2020).A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. DOI: 10.1056/NEJMoa2001017.
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