Doctors warn of risk of increased premature births during pandemic

Doctors warn of risk of increased premature births during pandemic
Doctors warn of risk of increased premature births during pandemic

Considered one of the countries where there were more deaths of pregnant and postpartum women by Covid-19 in the world, Brazil also faces the risk of an increase in premature births during the pandemic, according to medical experts. Obstetricians at the forefront of combating the pandemic warn of the dangers of infection during pregnancy and report the crisis scenario they face in maternity hospitals in Minas Gerais.

The data from the Ministry of Health, which is being updated, still does not show a significant variation in the percentage of babies that were born earlier than expected in 2020, in relation to previous years, and, in Minas, the rate has remained at around 11% for years. The director of the Association of Gynecologists and Obstetricians of Minas Gerais (Sogimig), Inessa Bonomi, who works at the hospital Júlia Kubitschek (HJK), however, points out that the cases of premature infants among those infected with the coronavirus have been more common.

“Once the pregnant woman has Covid-19, she has a 17% to 20% chance of having a premature birth more than pregnant women without the disease, this is what we are seeing in practice, and a 30% chance greater hospitalization. The chance that she needs an ICU and mechanical ventilation also increases ”, details the doctor. HJK is the reference for serious cases of pregnant women with Covid-19 in Belo Horizonte.

At Sofia Feldman hospital, one of the three largest maternity hospitals in the country, the eight beds reserved for pregnant women with confirmation or suspicion of Covid-19 had never been full in 2020, according to the hospital’s technical director, obstetrician João Batista Lima. This year, according to him, the team even expanded the offer in two beds to accommodate more patients, and the transfers of pregnant women with Covid-19 in serious condition to HJK increased at an unprecedented pace in March.

“In 2020, 20 patients were transferred throughout the year. So far this year, there have been ten. The challenge is that, even if we do not care for critically ill patients, they end up arriving and staying here. We had a patient who was in intensive care at the hospital for more than 24 hours, who has no intensive care doctors, just a consultant. We had to prepare the team to treat critically ill patients ”, he details.

Causes

A report by the Center for Disease Control and Prevention (CDC) shows that women with Covid-19 were 25% more likely to have a premature birth than pregnant women without the disease. A review of studies published in the Canadian Journal of Medicine this month also maintains that the diagnosis of the disease is related to the increase in early births, taking into account more than 400,000 pregnant women.

One of the hypotheses to explain the phenomenon, says the technical director of Sofia Feldman, is that Covid-19 causes changes in the placenta. On the other hand, in many cases, delivery is anticipated by the doctors themselves to save the health of the mother who needs intensive care, recalls the obstetrician.

The World Health Organization (WHO) considers as a risk group for Covid-19 only pregnant women who have some comorbidity, but highlights that there are signs that pregnant women in general need to develop severe symptoms tend to need more intensive care than women. women who are not expecting a baby.

Records of death of pregnant women scale in 2021

In the first three months of 2021, Minas recorded almost the same number of deaths of pregnant women by Covid as last year. Since last January, the State Department of Health has received 25 death confirmations, while in the year 2020, there were 26. The government does not inform, however, if all deaths registered in 2021 occurred even this year or if they were only registered now

In July 2020, a study published in the North American period “International Journal of Gynecology” showed that 77% of the deaths of pregnant women or puerperal women in the world had occurred in Brazil, and affected black women almost twice as much in relation to the total. Before the pandemic, the country already had a maternal mortality rate considered high by global health agencies: for every 100,000 mothers, 60 die in childbirth in Brazil, according to the United Nations (UN).

The technical director of the Sofia Feldman hospital, João Batista Lima, notes that the increase in Covid-19 cases among pregnant women follows the trend of the rest of the population. “As Covid-19 is affecting the younger population and it is in this population that pregnant women tend to be, the disease affects them more now”, she highlights. Even at this time of discharge, however, pregnant women should continue to do prenatal care, recalls doctor Inessa Bonomi, from the hospital Júlia Kubitschek (HJK).

Pregnant and baby die 11 days after hospitalization

At the end of March, another pregnant woman died in the State, in Viçosa, in the Zona da Mata. Kely Rodrigues, 30, had been pregnant for seven months and had no known comorbidities. She and her partner, businessman Raniel Arruda, 37, had symptoms, which were in principle mild. The first doctor they consulted recommended that they return home and did not diagnose them with Covid-19, says Raniel. In the second consultation, with another professional, Kely did a quick test that showed negative results and confirmation of the disease only arrived days later, when her condition had worsened and she was admitted to the São Sebastião Hospital, in Viçosa.

The hospital, according to a note on the institution’s social networks, tried unsuccessfully to find an ICU vacancy for Kely in other locations in the municipality. Kely received support in an intensive care bed, but died less than two hours after being transferred to an official ICU bed at the institution, 11 days after her admission. The baby also died.

“We matched a lot, we were very affectionate with each other, it was a kiss to sleep and to wake up. Our daughter already had all the affection too, I talked to her, she moved. It was an indescribable thing. Our life was on track, a work of God himself, a very good thing that was happening. I thought we were going to be together forever, ”says Raniel.

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