Pregnancy and coronavirus. What do we know about this?

• Ways to avoid stressful situations
• Arterial pressure
• Spasms
• Vegetative crisis

The sacrament of motherhood adorns any woman. However, a woman also experiences not very pleasant metamorphoses, such as panic and fright during pregnancy. During pregnancy, hormonal levels change, which affects the psychological state of the expectant mother.

Pregnant women often live in constant fear

Maternal instinct makes a woman constantly experience fear, because she worries all the time, and fear during pregnancy can affect the health of the unborn baby.

Is coronavirus dangerous for pregnant women?

Respiratory diseases in pregnant women are generally more severe and cause more complications. Doctors explain this by saying that during pregnancy the immune system weakens in order to protect the fetus from the risks of an accidental attack from the mother’s immune system. The downside of this mechanism: the body becomes more susceptible to colds and infectious diseases.

In general, the risk of contracting a coronavirus infection in pregnant women is the same as in everyone else. They are often asymptomatic, and if they have symptoms, they are mild or moderate. The most common clinical manifestations of the disease are fever, cough and myalgia (muscle aches). In addition, fatigue, diarrhea, shortness of breath, and sore throat are common. Overall, most pregnant women experience COVID-19 in the same way as others.

But the chances of getting seriously ill and dying from COVID-19 are still higher. An international study organized by scientists at the University of Oxford and conducted in 18 countries (including Russia) showed that the risk of severe complications is increased in both mother and child. And according to a comparative review of studies involving 10 thousand pregnant and 128 thousand non-pregnant women, the former have almost twice the risk of death. It is just over 11%.

Psychogenic shortness of breath - where does it come from?

Dyspnea is a disturbance in the frequency, rhythm and nature of breathing. There are pathological and nervous types.

With pathological shortness of breath, the cause lies in the disruption of the internal organs.

Psychogenic or nervous dyspnea develops primarily against the background of mental and nervous disorders:

• acute or chronic stress;
• psychogenic childhood - perhaps in childhood a person witnessed the occurrence of an attack of suffocation for various reasons. For example, a picture of drowning is accompanied by a convulsive swallowing of air by the drowning person, a characteristic facial expression;
• neurasthenia, neurosis, hysteria;
• depression;
• phobias, anxiety disorders;
• disorders of the autonomic nervous system – neurocirculatory dystonia;
• sleep disorders.

The symptom is difficulty breathing. It becomes superficial, with complicated short inhalations and long exhalations. His pace quickens, and even if a person manages to take a deep breath, it does not bring him much relief. This work of the lungs is called the breathing of a driven dog.

After uncontrolled accelerated respiratory movements there is a pause, and after it, convulsive breathing returns. All this causes anxiety and fear of approaching death in a person. A panic attack often occurs.

Distortion of the respiratory rhythm causes hyperventilation of the lungs and tension of the intercostal muscles. Because of this, false signs of angina pectoris and cardioneurosis develop. The patient is accompanied by weakness and malaise, excessive sweating, dizziness, cold extremities and convulsions.

Naturally, such symptoms suggest a heart disease, but it’s all about nervous tension.

Other signs of neurotic shortness of breath include:

• feeling of constriction in the chest;
• feeling of lack of air;
• control over the breathing process;
• feeling of a lump in the throat;
• attacks of neurotic cough - it becomes dry and annoying;
• nervous yawning;
• pain in the intercostal spaces;
• reflex movements to open the chest, which should help you take a breath - swinging your arms, straightening your shoulders, but they do not bring results;
• fear of death.

Nervous shortness of breath worsens a person’s mental state. It can cause depression, hypochondria, and mood disorders.

What kind of complications are we talking about?

In severe cases, problems can affect any aspect of pregnancy.

• Patients expecting a child are admitted to intensive care at least one and a half times more often than women of the same age who are not pregnant. And expectant mothers have to be connected to a ventilator even more often.
• Pregnant women are 50% more likely to experience premature birth and preeclampsia (high blood pressure and swelling).
• More than half of pregnant women with coronavirus give birth by caesarean section. Doctors often observe postpartum bleeding.

The highest risk of complications is observed in the following groups of women:

• with chronic lung diseases, including moderate and severe bronchial asthma;
• with diseases of the cardiovascular system and hypertension;
• with diabetes mellitus;
• with cancer;
• obese (body mass index > 30 kg/m2);
• with chronic kidney and liver diseases.

Spasms

During a fright, a woman’s body begins to actively produce adrenaline, which provokes vascular spasms, impairs the functioning of the mother’s circulatory system, which creates problems with blood circulation in the fetus. Fetoplacental insufficiency may develop, which may result in spontaneous abortion.

Adrenaline is actively produced during childbirth, because childbirth is also stressful for the female body. Adrenaline promotes labor by helping to contract smooth muscles. This means that fear during pregnancy, during which adrenaline is produced, will also provoke labor. The result of this may be premature birth, which in the early stages of pregnancy can lead to the loss of the child.

How can this affect the child? Can his mother infect him with the virus in the womb?

Apparently, the virus can be transmitted to a child in the womb.

In March 2021, doctors described a case in which a pregnant woman with suspected COVID-19 was taken by ambulance to Skåne University Hospital in Malmö, Sweden. She suffered from sudden severe abdominal pain. Doctors also noticed the baby's heart rate was abnormally low, which could be a sign that the baby was not getting enough oxygen. Doctors performed an emergency caesarean section. Tests of the child's blood and throat swabs showed that both mother and child were infected with coronavirus. The baby also developed antibodies against the virus and had no serious symptoms after delivery.

In another case, described in a scientific article in the journal Viruses, the child and his mother were much less fortunate. A healthy 27-year-old woman had a mild infection at 21 weeks' gestation. At the 23rd week, after recovery, an ultrasound showed that the fetus began to grow more slowly and blood flow in the umbilical artery slowed down. Another two weeks later, the premature baby was born by Caesarean section and died in the intensive care unit a day and a half later. Before infection, the patient's pregnancy was normal.

However, so far such tragic cases are rare, while millions of women fall ill with coronavirus. In general, according to a systematic review of studies that together included 100 thousand pregnant women, transmission of the virus from mother to fetus was recorded in 5.3% of cases (if the mother was sick herself). Almost every tenth child born to an infected mother was also COVID-positive.

What is the real risk of consequences for the child?

• Newborns born to infected women are nearly three times more likely to have serious medical complications such as neonatal intensive care unit (NICU) admission, mostly due to preterm birth.
• In 26–30% of cases, doctors register distress syndrome (breathing disorder) in the newborn.
• In 25% of cases - low birth weight.
• In 1.4% of cases - asphyxia (suffocation) of newborns (1.4%).
• In only 0.35–2.2% of cases, children of infected mothers die as a result of or after childbirth.

Respiratory neurosis

There are many types of neuroses, each of which is distinguished by a specific group of symptoms. One of them is respiratory neurosis, which is characterized primarily by neurogenic breathing disorder.

The concept was introduced into use in 1871 by the American scientist Da Costa. It has several related names: “respiratory neurosis”, “neurorespiratory syndrome”, “respiratory dystonia”. But the term most often used is “hyperventilation syndrome” (HVS) . It accounts for approximately 10% of cases. Among the patients there are both children and adults. It is worth noting that women suffer from this disease several times more often than men.

The causes of the syndrome are divided into mental, organic, and mixed. Of course, the majority (about 60%) is due to psychogenic factors.

5% of cases include organic etiology. These include disorders of the structure of the central nervous system: encephalopathy, hydrocephalus, inflammation of the meninges, as well as diseases such as diabetes, hypertension, chronic bronchitis. Sometimes the reason is taking certain medications.

During the course of the disease, there are 3 groups of signs:

• respiratory;
• psycho-emotional;
• muscular.

Group I has several forms of manifestations:

1. Empty breathing is a feeling of lack of air, its pace quickens.
2. It seems that air is forced into the lungs, and there is a lump in the throat. Accessory muscles are involved in the respiratory act.
3. A premonition of breathing stopping appears, and the person is forced to control its process by consciously inhaling.
4. Yawning, moaning, sighing.

Group II symptoms include nervous tension and concern about one’s condition. The patient cannot relax. He develops phobias, in particular, a fear of open areas and places with large crowds of people.

Symptomatic group III includes muscle hypertonicity, various tactile sensations in the form of tingling, burning, and “goosebumps.”

This triad of symptoms is a typical, leading manifestation of the disease.

The disease is characterized by a chronic course, in which exacerbations occur.

An exacerbation of hyperventilation syndrome is called a hyperventilation crisis. This is a condition in which the manifestations of the disease intensify. Characterized by an increased sense of fear. The patient is suffocating, hysterical, and feels “near death.” At the same time, he is accompanied by chills, dizziness, nausea, and becomes covered in sticky cold sweat.

A crisis is caused by a negative psychological environment. A unique way to relieve an attack is to breathe into a bag. In this case, carbon dioxide is concentrated in it, which the neurotic inhales. Gas balance is restored, breathing is leveled out. This is the first aid in this situation.

As for children, they are also characterized by such a pathology as respiratory neurosis, which is also caused by stress, phobias and anxiety disorders. But it is worth noting that the main role in their occurrence is played by an unfavorable situation in the family, and this applies not only to rude and inadequate attitude towards the child, but also to the relationship between parents. Constant quarrels and conflicts in the family, aggression can provoke the development of psychogenic shortness of breath in children.

Such children are characterized by anxiety and lability (instability) of mood. They experience outbursts of anger over trifles, general nervousness, refusal to communicate with friends, and sleep disturbances.

Parents should be more vigilant and sensitive in raising their children.

Can pregnant women get vaccinated?

Vaccination for pregnant women is only partially approved in Russia. But there is growing evidence that vaccination is safe for mother and child.

Several thousand women around the world are now known to have been vaccinated during pregnancy. The registry of the American Center for Disease Control contains observational data on 827 patients. The frequency of pregnancy complications in them did not differ from the frequency of complications in unvaccinated people. Therefore, some major foreign national associations have recommended vaccination for pregnant women who are at high risk of developing severe COVID-19.

The updated instructions for the Russian Sputnik V vaccine recently included a new instruction: it should be used during pregnancy “only in cases where the expected benefit to the mother outweighs the potential risk to the fetus.” Evidence that the vaccine is safe during pregnancy comes only from animal studies.

Vaccination is not recommended for nursing mothers due to the fact that “the risk to newborns/infants who are breastfed cannot be excluded,” the instructions say.

Frequency of attacks during pregnancy

According to medical statistics, for many women the frequency of attacks during pregnancy remains the same or decreases. The period of gestation does not in any way affect the appearance of new signs of epilepsy or the worsening of the mother's condition. An increase in attacks is observed in up to 30% of cases in the first or third trimester of pregnancy, in which the body is more susceptible to changes.

It is impossible to predict changes in the frequency of attacks based on the patient's medical history. The duration of the pathology and the increased frequency of attacks during a previous pregnancy also do not affect the woman’s condition at the moment. The situation can change at any moment. Some patients have catamenial epilepsy. With this diagnosis, women experience attacks or become more frequent during certain phases of the menstrual cycle. Even with this form of the disease, it is impossible to predict an increase in epileptic seizures during pregnancy.

The following factors influence the frequency of seizures:

• nervous tension or emotional changes;
• impaired water-salt metabolism;
• disrupted hormonal levels or changes in hormonal levels;
• decrease in the level of antiepileptic drugs in the blood.

The expectant mother is advised to monitor the quality of her sleep and compliance with the prescribed course of treatment. If you experience frequent drowsiness or insomnia, you should definitely consult your doctor. Adjusting treatment on your own is strictly prohibited. Throughout pregnancy, the patient is required to visit an epileptologist who will monitor the condition and monitor changes. Only in this case can the occurrence of complications and the risk of congenital anomalies of the fetus be prevented.

40th week of pregnancy: how is the baby developing?

40 weeks – full-term pregnancy. The weight of a child born at this period ranges from 2,600 g to 4,400 g, and his body length is 48-53 cm. These indicators are very arbitrary, since at 40 weeks miniature babies weighing 2,600 g and real heroes are born, whose body weight approaches 5,000 g. The body length of newborns can also vary from 45 to 55 cm.

Most women give birth at 40 weeks. At this stage, the baby is completely ready for birth; it meets all the parameters of a full-term baby. Before birth, the baby presses its arms and legs closely to the body, bends its head as much as possible and presses against the exit of the uterus. This position makes it possible to pass the birth canal with the narrowest part of the skull. During labor, with each contraction, the child gradually moves downward; he does not move in a straight line, but makes helical-translational movements, as if screwing into the mother’s birth canal. As the newborn moves forward and his head descends completely, the cervix opens completely. This is followed by pushing, that is, contractions of the uterus that move the baby along the birth canal. The baby's head gradually appears, followed by his body. Childbirth is a complex mechanism that is aimed not only at the safe passage of the birth canal by the child, protecting him from accidental injuries due to increased pressure, but also at preventing ruptures of the woman’s soft tissues.

In what cases is it recommended to abstain from intimacy:

• Placenta previa
• The presence of sexually transmitted diseases in the active phase in one or both parents (syphilis, gonorrhea, trichomoniasis, chlamydial infection, etc.). If HIV infection is detected in the expectant father, the pregnant woman is advised to refrain from unprotected sexual intercourse during pregnancy.
• Acute inflammatory process of the genital organs in one or both partners (before and during sanitation it is recommended to refuse sex).
• Symptoms indicating a threat of miscarriage: bleeding from the genital tract, pain in the lower abdomen, increased uterine tone, etc.

• A history of recurrent miscarriage or premature birth.

• If the pregnancy is multiple, sexual rest is recommended after 28 weeks to avoid premature birth.
• Leakage of amniotic fluid. If you suspect a water leak, you should immediately consult a doctor.