El Gobierno de la Ciudad de Buenos Aires elaboró un protocolo específico para afrontar y prevenir el coronavirus en mujeres embarazadas y recién nacidos. El objetivo de éste, el cual está dirigido a los 33 hospitales públicos del territorio porteño y el Centro Asistencial Cecilia Grierson, es dar orientación a los equipos de salud en el marco de la pandemia.
“La idea es que todas las maternidades continúen funcionando con normalidad, tomando los recaudos necesarios para el cuidado del equipo de salud en el uso de los elementos de protección”, aclara el subsecretario de Planificación Sanitaria y Gestión en Red de la Ciudad, Daniel Ferrante.
A su vez, apunta que “todos los controles de embarazo se realizan en los Centros de Salud con turno previo, y es importante que en este momento, teniendo en cuenta las recomendaciones básicas, las embarazadas continúen en contacto con los profesionales para los diferentes consultas y controles necesarios”.
Protocolo de la Ciudad para mujeres embarazadas y recién nacidos
Embarazadas asintomáticas que vuelven de zonas con transmisión
● Aislamiento domiciliario durante 14 días.
● Consulta temprana ante la aparición de síntomas.
● Posponer los controles obstétricos programados, la realización de ecografías y exámenes de laboratorio de control hasta finalizar el período de aislamiento.
Atención de embarazadas que se consideren caso sospechoso o confirmado
● Ante la presencia de síntomas de enfermedad se recomienda la comunicación telefónica inmediata con el 107 o dirigirse a la guardia del hospital o maternidad dando aviso de la situación antes de la entrada al centro de salud.
● Colocarse el barbijo quirúrgico al llegar al servicio de salud.
● Se internará a toda embarazada con sospecha de Covid 19 en una habitación que cumpla las recomendaciones de bioseguridad, definidas según las sugerencias nacionales.
● Luego se tomarán muestras para un diagnóstico de laboratorio.
● La condición de mujer gestante no debe evitar ni retrasar la realización de exámenes radiográficos si estuvieran indicados. Se utilizará protección para disminuir la exposición fetal.
● Las indicaciones de tratamiento con drogas antiretrovirales son las mismas que para pacientes no embarazadas.
● En los casos confirmados, se mantendrá a la mujer internada en aislamiento hasta cumplir con los requisitos de alta, definidos en las recomendaciones nacionales (tercer día sin fiebre y 2 pruebas negativas, separadas por 24 horas).
Nacimiento
● Idealmente se recomienda el parto natural (si no presenta sepsis o síndrome de dificultad respiratorio).
● La evidencia actual no indica la necesidad de cesárea. Sin embargo, se necesita mayor información para definir la posibilidad de transmisión materno infantil en el momento del parto.
● En el momento del nacimiento se deben realizar monitoreo fetal intra-parto y monitoreo cardiovascular materno.
Lactancia
● Se sugiere continuar con la lactancia materna.
● Tampoco amamantar en forma directa, sino extraer y que la leche sea administrada por otra persona.
● Extracción de leche materna: se debe proveer bomba de extracción de leche con estricta adherencia a las normas de esterilización. La bomba no podrá ser compartida con otra paciente y la extracción se realizará en la habitación donde se hace el aislamiento.
Atención del recién nacido de madre confirmada con coronavirus
● Baño/limpieza precoz del recién nacido.
● Monitoreo respiratorio estricto.
● Internación por separado de madre y recién nacido.
● Aislamiento respiratorio y de contacto de la madre hasta que presente dos pruebas negativas, separadas por 24 horas.
Recién nacidos sintomáticos
La información disponible sobre recién nacidos con COVID-19 diagnosticados hasta el momento demuestra que los mismos presentan síntomas leves a moderados de la enfermedad:
● El recién nacido con síntomas respiratorios debe ser evaluado con o PCR para COVID-19 en muestras de secreciones nasofaríngeas, RX TORAX o Hemograma, Hepatograma, reactantes de fase aguda.
● La internación del caso sospechoso y confirmado se realizará en aislamiento respiratorio y de contacto estricto.
● Alta recién nacido: se puede dar egreso con mejoría clínica y dos pruebas negativas tomadas con 24 horas de diferencia.
● La circulación del recién nacido dentro del ámbito hospitalario debe ser siempre en incubadora de transporte.
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