{"id":10583,"date":"2020-07-07T11:57:17","date_gmt":"2020-07-07T11:57:17","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=10583"},"modified":"2020-07-07T12:02:38","modified_gmt":"2020-07-07T12:02:38","slug":"prof-radu-vladareanu","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/prof-radu-vladareanu\/","title":{"rendered":"\u201cSocietatea de Obstetric\u0103 \u0219i Ginecologie din Rom\u00e2nia a\u00a0fost printre printer primele societ\u0103\u0163i care a emis \u00eenc\u0103 de la \u00eenceput o serie de recomand\u0103ri \u00een perioada pandemiei COVID-19\u201d"},"content":{"rendered":"
\"\"<\/a>
Prof. Dr. Radu\u00a0 Vl\u0103d\u0103reanu, Pre\u0219edintele Societ\u0103\u021bii de Obstetric\u0103 \u0219i Ginecologie din Rom\u00e2nia<\/em><\/figcaption><\/figure>\n

Cum s-a schimbat managementul na\u0219terii pacientei gravide \u00een actualul contex? <\/strong><\/p>\n

Schimbarea de management se refer\u0103 la cum abord\u0103m o gravid\u0103 care nu \u0219tim exact dac\u0103 este afectat\u0103 sau nu \u0219i pentru care \u00eenc\u0103 nu avem criterii de testare. A\u0219a cum \u0219ti\u0163i \u00een metodologia, pu\u0163in schimbat\u0103 dar nu din punct de vedere al gravidei, nu exist\u0103 screening pentru COVID-19 la gravidele asimptomatice dec\u00e2t dac\u0103 vin din izolare sau carantin\u0103. Nu este u\u0219or s\u0103 manageriezi un caz, fie c\u0103 e gravid\u0103, fie c\u0103 nu, pentru care nu \u0219tim exact statusul infec\u0163iei SARS-CoV-2 \u00een acel moment. Aceasta este o situa\u0163ia care va continua \u00een urm\u0103toarele luni, urm\u0103torul an \u0219i trebuie s\u0103 ne obi\u0219nuim cu acest lucru. Trebuie s\u0103 respect\u0103m indica\u0163iile legate de distan\u0163are, dar mai ales legate de echipamentul de protec\u0163ie \u0219i de protec\u0163ia echipamentului \u00een momentul \u00een care consult\u0103m, de dezinfec\u0163ia suprafe\u0163elor, aparaturii, camerelor. Sigur c\u0103 dac\u0103 avem gravid\u0103 confirmat\u0103 SARS-CoV-2 exist\u0103 o anumit\u0103 procedur\u0103 explicat\u0103 \u00een metodologia ministerului care a fost elaborat\u0103 \u00eempreun\u0103 cu comisia de neonatologie \u0219i o respect\u0103m \u00eentocmai.<\/em><\/p>\n

Evolu\u0163ia cazurilor la gravidele cu COVID-19 este u\u0219oar\u0103, dificil\u0103, ajung la terapie intensiv\u0103, necesit\u0103 ventila\u0163ie?<\/strong><\/p>\n

Asta constat\u0103m \u0219i asta au constatat \u0219i \u00een toat\u0103 lumea cei care au f\u0103cut ghiduri interna\u0163ionale \u0219i raport\u0103ri sau studii, de\u0219i teoretic gravidele au \u0219anse de a avea infec\u0163ii mai severe \u00een timpul sarcinii, \u00een practic\u0103, \u00een realitate nu s-au constat cazuri mai grave dec\u00e2t \u00een popula\u0163ia general\u0103 ci dimpotriv\u0103 mai u\u0219oare pentru gravide, \u0163in\u00e2nd cont c\u0103 ele sunt \u00een general persoane tinere; dup\u0103 cum se \u0219tie cazurile grave \u00een ceea ce prive\u0219te infec\u0163ia cu SARS-CoV-2 se reg\u0103sesc \u00een special la persoanele \u00een v\u00e2rst\u0103.<\/em><\/p>\n

Gravidele sunt \u00een marea lor majoritatea pe toate studiile existente,\u00a0 asimptomatice sau cu forme extrem de u\u0219oare merg\u00e2nd aceste 2 situa\u0163ii p\u00e2n\u0103 la 87-90% din cazuri de asimptiomatic sau forme extrem de u\u0219oare. Forme critice de boal\u0103 sau descris c\u00e2teva cazuri \u00een regiunile puternic afectate de genul New York, Lombardia, \u0219.a, dar nu \u00een Rom\u00e2nia.<\/em><\/p>\n

Exist\u0103 dovezi a infec\u0163iei intrauterine cauzate de transmiterea noului coronavirus la femeile care au dezvoltat sindromul respirator acut SARS-CoV-2 \u00een ultimul trimestru al sarcinii?<\/strong><\/p>\n

Ini\u0163ial lucrurile s-au spus destul de tran\u0219ant c\u0103 nu exist\u0103 transmitere vertical\u0103, de fapt aici ne interseaz\u0103 dac\u0103 infec\u0163ia mamei se transmite la f\u0103t mai mult dec\u00e2t dac\u0103 exist\u0103 infec\u0163ie \u00een lichidul amniotic. Datele de acum c\u00e2teva luni spuneau ferm nu, datele actuale \u00eens\u0103 spun c\u0103 este posibil acest lucru, dar necesit\u0103 studii mai aprofundate \u0219i mai multe cazuri care s\u0103 fie studiate. Toate ghidurile \u00eencep prin a spune ca \u00een prezent nu avem date de natur\u0103 s\u0103 tragem concluzii definitive. Acum sunt studii de gradul 3 sau 4, mai avem p\u00e2n\u0103 s\u0103 ajungem la concluzii validate \u0219tiin\u0163ific.\u00a0\u00a0\u00a0\u00a0<\/em><\/p>\n

Au fost descrise c\u00e2teva cazuri c\u00e2nd s-au g\u0103sit anticorpi de tip IGM adic\u0103 anticorpi care nu au cum s\u0103 treac\u0103 prin placent\u0103 la nou n\u0103scut \u00een primele 12 ore de la na\u0219tere, ceea ce \u00eenseamn\u0103 c\u0103 acel nou n\u0103scut a primit SARS-CoV-2 \u0219i probabil, fiind sub 12 ore, \u00eenseamn\u0103 c\u0103 ei au fost infecta\u0163i de la mam\u0103.<\/em><\/p>\n

Cel mai mare studiu f\u0103cut pe gravide \u00een Marea Britanie a fost publicat \u00een 12 mai pe cazurile din 1 martie \u2013 14 aprilie, \u0219i ne arat\u0103 c\u0103 doar una din 10 gravide primesc \u00eengrijire \u00een ATI, 5 au fost decese \u00een r\u00e2ndul minorit\u0103\u0163ilor, s-a constat c\u0103 minorit\u0103\u0163ile sunt cele mai expuse, 60 % din aceste gravide au n\u0103scut, \u0219i 6 nou n\u0103scu\u0163i au fost testa\u0163i pozitiv. Este o cifr\u0103 mic\u0103 dar care ne arat\u0103 c\u0103 putem avea o discu\u0163ie legat\u0103 de transmiterea vertical\u0103.<\/em><\/p>\n

\u00a0Au fost descrise dou\u0103 cazuri \u0219i de c\u0103tre medicii chinezi \u00een lunile martie, aprilie. Sunt foarte rare aceste situa\u0163ii, marea majoritate a nou n\u0103scu\u0163ilor infecta\u0163i cum a fost \u0219i la Timi\u0219oara au provenit de la infec\u0163ia cu siguran\u0163\u0103 dup\u0103 na\u0219tere.<\/em><\/p>\n

Au femeile gravide diagnosticate cu COVID-19 risc crescut de complica\u0163ii \u00een sarcin\u0103?<\/strong><\/p>\n

Femeile gravide diagnosticate cu SARS-CoV-2 nu au risc crescut de complica\u0163ii, nu fac forme grave, nu\u00a0 fac afectare pulmonar\u0103 sau respiratorie sever\u0103 \u00een marea lor majoritate. Exist\u0103 \u00eens\u0103 \u0219i cazuri de excep\u0163ie, este posibil s\u0103 aib\u0103 complica\u0163ii \u0219i au fost descrise c\u00e2teva cazuri \u00een zonele grav afectate c\u00e2nd femeile au stat \u00een com\u0103 \u0219i au putut vedea copilul abia dup\u0103 multe luni de la na\u0219tere.<\/em><\/p>\n

Cum arat\u0103 situa\u0163ia \u00een spital, dup\u0103 aceste dou\u0103 luni de pandemie? <\/strong><\/p>\n

Per global situa\u0163ia este una bun\u0103. Ne-am bazat pe un triaj foarte bun, am reu\u0219it s\u0103 stabilim circuitele astfel \u00eenc\u00e2t s\u0103 evit\u0103m infec\u0163ia cu SARS-CoV-2 \u00een maternitate cu orice fel. De altfel Societatea de Obstetric\u0103 \u0219i Ginecologie din Rom\u00e2nia a emis \u00eenc\u0103 de la \u00eenceput o serie de recomand\u0103ri, din c\u00e2te am urm\u0103rit eu istoric fiind printre primele societ\u0103\u0163i, care a f\u0103cut acest lucru, recomand\u0103ri care au fost implementate foarte repede. Au urmat apoi recomand\u0103rile comune ale Comisiilor de Obstetric\u0103 Ginecologie \u0219i Neonatologie ale Ministerului \u0219i acum lucrurile s-au p\u0103strat la fel, \u00een prezent cel mai mult cont\u00e2nd circuitele, igiena \u0219i dezinfec\u0163ia echipamentelor.<\/em><\/p>\n

\n","protected":false},"excerpt":{"rendered":"

Cum s-a schimbat managementul na\u0219terii pacientei gravide \u00een actualul contex? Schimbarea de management se refer\u0103 la cum abord\u0103m o gravid\u0103 care nu \u0219tim exact dac\u0103 este afectat\u0103 sau nu \u0219i […]<\/p>\n","protected":false},"author":4,"featured_media":10584,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[276],"tags":[],"class_list":["post-10583","post","type-post","status-publish","format-standard","has-post-thumbnail","category-interviu"],"yoast_head":"\n\u201cSocietatea de Obstetric\u0103 \u0219i Ginecologie din Rom\u00e2nia a\u00a0fost printre printer primele societ\u0103\u0163i care a emis \u00eenc\u0103 de la \u00eenceput o serie de recomand\u0103ri \u00een perioada pandemiei COVID-19\u201d - Jurmed - Medici<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/prof-radu-vladareanu\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u201cSocietatea de Obstetric\u0103 \u0219i Ginecologie din Rom\u00e2nia a\u00a0fost printre printer primele societ\u0103\u0163i care a emis \u00eenc\u0103 de la \u00eenceput o serie de recomand\u0103ri \u00een perioada pandemiei COVID-19\u201d - Jurmed - Medici\" \/>\n<meta property=\"og:description\" content=\"Cum s-a schimbat managementul na\u0219terii pacientei gravide \u00een actualul contex? 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