Open letter from gynecologists calls for actions to reduce

Open letter from gynecologists calls for actions to reduce
Open letter from gynecologists calls for actions to reduce

The Feminist Network of Gynecologists and Obstetricians released a public letter on Wednesday (7) in which it alerts the government and society to the high number of deaths of pregnant women by covid-19 in Brazil.

In the document, the entity lists a series of demands related to guarantees of testing, protection, absence from work, vaccination, educational campaigns and universal prenatal care, appropriate to the context of the pandemic.

According to the text, the scenario in 2021 remains dramatic. Data from the Ministry of Health itself report 102 cases of maternal death from Severe Acute Respiratory Syndrome (SARS) and 96 confirmed cases from Covid-19.

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“Newspaper headlines daily report tragic cases of young women who lose their lives during pregnancy or in the postpartum period, leaving a trail of desolation, grief and despair, not to mention a legion of orphans from COVID-19, many of whom premature babies, who are under the care of family members “, warns the letter.

The organization points out that “there were assistance failures in a significant proportion” and mentions disorganization in the prenatal care services, suspension of consultations and lack of structure in the care provided to women infected with the coronavirus.

“We found important problems in accessing adequate care for COVID-19, lack of diagnostic tests, lack of therapeutic supplies and specific ICU beds for the obstetric population”, reports the entity.

Last year, a study involving several institutions indicated that 8 out of 10 deaths of pregnant and postpartum women contaminated by covid occurred in Brazil.

Another survey evaluated cases of SARS in pregnancy and postpartum. The conclusion is that 40% of the patients who died did not get a place in the ICU and 6% were not even hospitalized.

It was also observed that there is a higher prevalence of deaths among black women, who live in peripheral areas, do not have access to the Family Health Program and live more than 100km from any referral hospital (7).

The repercussion of these studies was not enough for the public authorities to take action, in the perception of the Feminist Network of Gynecologists and Obstetricians.

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“Although the Ministry of Health published in September its Manual of Recommendations for Assistance to Pregnant Women and the Postpartum Facing the Pandemic of COVID-19 (9), there were no major changes in the structure, examinations and flow of care, and the deaths continued to happen “, states the entity’s text.

Vaccine

There is already a technical recommendation in Brazil for the administration of the vaccine in pregnant women with hypertension, obesity, cardiovascular disease, bronchial asthma, immunosuppressed, transplanted patients, chronic kidney diseases and autoimmune diseases.

The Feminist Network of Gynecologists and Obstetricians warns, however, that the slowness of the vaccination campaign means that a large volume of pregnant women and puerperal women with comorbidities continue to be exposed.

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Still according to the entity, it is necessary to expand this audience, “as it has been demonstrated many times, pregnancy and the puerperium are per se risk factors for complications and death by COVID-19, so that ALL pregnant women and puerperal women should be considered – and urgently – in the National Immunization Plan “.

Read below the list of urgent actions listed by the Feminist Network of Gynecologists and Obstetricians to reduce maternal mortality by covid-19 in Brazil.

1. Information, provision and access to contraceptive methods – unfortunately, many reproductive planning services interrupted care during the pandemic and it is impossible to reduce maternal mortality without ensuring adequate contraception and preventing unplanned pregnancies.

2. Specific campaigns involving information and clarification on the risks of COVID-19 in pregnancy and in the postpartum period, allowing women to make free and conscious decisions about the possibility of postponing pregnancy to another time when the pandemic is under control. In addition, alerting pregnant women to proper individual care: isolation (leave only for consultations and prenatal examinations or essential reasons), use N95 masks and alcohol gel.

3. Reinforcement and counseling of individual protection measures in prenatal consultations.

4. Ensuring that pregnant women are removed from their face-to-face work function across the country – currently it depends on each municipality, body or employer to accept the medical certificate.

5. Guarantee of access to quality prenatal care, without interruption of consultations, without “discharge” from prenatal care.

6. Minimum acceptable, fair and adequate income for pregnant women who do not have a formal job, allowing them to stay at home.

7. Free distribution of N95 masks for pregnant women.

8. Extensive testing at the entrance to maternity hospitals with rapid molecular tests.

9. “Tests, tests and more tests” for all pregnant women and postpartum women with symptoms or contacts of people with symptoms.

10. Guarantee of admission to the ICU in institutions that guarantee quality obstetric monitoring (seven days a week, 24 hours a day)

11. Immediate inclusion of pregnant women in the priority vaccine group (ALL pregnant women and not only those with comorbidities) and rapid vaccination of the population.

Edition: Vinícius Segalla

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