新型冠状病毒肺炎孕妇在非定点医院的分娩期应对策略

Strateies for pregnant women with COVID-19 during childbirth in non-designated hospitals

目的:探讨妊娠期合并新型冠状病毒肺炎(COVID-19)患者在非定点医院分娩期应对方式。方法:回顾性分析2020年1月20日—3月16日在武汉大学人民医院(非定点医院)收治的7例妊娠合并COVID-19患者的临床资料,分析其实验室检测资料、影像学检查、产程、分娩期处置和妊娠结局。结果:7例患者均有武汉居住史,年龄(30.42±4.14)岁,平均孕周36周;肺部CT及新型冠状病毒(SARS-CoV-2)核酸、特异性IgM和IgG抗体检测符合轻型/普通型诊断。1例患者中期妊娠引产在普通产房分娩后3 d确诊,3例患者晚期妊娠急诊入院当天在缓冲区确诊后转入定点医院,3例患者晚期妊娠在隔离区域的单间分娩间分娩。在接诊和分娩过程中接触产妇所有医护人员执行三级防护并追踪体温变化。3例患者分娩中产力、产程、产时出血量均在正常范围内,产妇经皮氧饱和度均≥95%;胎心监护未发现异常;羊水情况:1例经产妇早产羊水Ⅰ度,余2例羊水清亮。阴道分娩的3例新生儿Apgar评分、脐动脉血气pH值在正常范围内,进行咽拭子SARS-CoV-2核酸检测均为阴性。结论:结合肺部CT、特异性IgM和IgG抗体检测可以实现快速筛查,从而提高防护效果。晚期妊娠的COVID-19轻型和普通型产妇分娩过程与正常分娩类似,无产力异常,不增加产程时限、出血量。新生儿结局良好。对于产科急诊产妇设立隔离区域的单间分娩间,在三级防护下可完成阴道分娩。在COVID-19感染孕产妇的分娩期应对处置中未发生医务人员感染。

Objective: To investigate the labor and delivery management for pregnant women with COVID-19 in non-designated hospital.Methods: Seven cases of pregnant women with COVID-19 at the obstetric department of Renmin Hospital of Wuhan University(Non-designated hospital) from Jan 20, to Mar 16, 2020 were included in this study, and their demographic characteristics, laboratory parameter, image examination, labor and delivery management, and obstetric outcomes were analyzed.Results: All the seven cases were the residents in Wuhan City, aged 30. 42±4. 14 years, and the average gestational age was 36 weeks. The results from CT scans of the lungs, SARS-CoV-2 nucleic acid test, and specific IgM and IgG antibody tests suggested mild/common COVID-19 pneumonia.One case was diagnosed after 3 days in general delivery room due to induced labor in the second trimester. Three cases of late pregnancies were referred from emergency department, and diagnosed as COVID-19 in the quarantine area of obstetric department, then transferred to the designated hospital.Three cases of late pregnancies were delivered at the single labor room in the quarantine area. All the healthcare workers were complied with the level 3 protective regulations and body temperature monitor during the labor and delivery treatments. The force of labor, delivery time, and blood loss were in the normal range for the three delivery cases. The transcutaneous oxygen saturation was over 95%,and fetal heart rate monitoring was normal. One case manifested as level 1 turbid amniotic fluid, the other two cases were normal. All the three cases adopted vaginal delivery with normal Apgar scoring and normal value of blood gas analysis in umbilical artery. All the newborns were negative for the SARS-CoV-2 nucleic acid test by throat swab.Conclusion: CT scans of the lungs combining with specific IgM and IgG tests can be used as fast screening method to improve the pandemic prevention.The labor and delivery management for late pregnancies with mild COVID-19 pneumonia are similar to those of normal delivery cases, as they are manifested as normal force of labor, delivery time and blood loss, and favorable perinatal outcomes for newborns. Vaginal delivery can be performed at single labor room in the quarantine area of obstetric department with level 3 protective regulations. No healthcare workers infection occurred during the labor and delivery management.