Jasmine Bazán
09/12/2021 6:01 AM
Clarín.com
Society
Updated 9/12/2021 6:01 AM
Initially,
pregnant women
were not considered a risk group against
Covid
and presented, in most cases, mild infections.
With the arrival of the
second wave
, the increased circulation of the virus and new strains, the situation changed.
This is demonstrated by experience and scientific studies.
According to the guide "Recommendation: Covid-19 vaccination in pregnant people in the Province of Buenos Aires", updated on August 23, due to the advance of the pandemic,
the coronavirus already constitutes
"the first cause of maternal death for the current year" within the Buenos Aires territory
.
The PBA Ministry of Health confirms the news.
They assure that "so far this year there are already 67 maternal deaths from Covid,
almost doubling the number of maternal deaths during the H1N1 flu pandemic
, which represents a high number."
Although the
immunization
campaigns
slowed the appearance of fatal cases, this would suggest that the rates will be higher than in other years.
Sources from the
Buenos Aires Ministry of Health
told
Clarín
that they still do not have the particular data, but "the higher mortality at the global level would suggest that there will be an impact on maternity as a logical consequence."
The impact of the virus on this population
will be known with certainty in 2022
, when the official statistics are processed and published.
And it will be reflected in the yearbook "Vital Statistics - Basic Information", in charge of the
Directorate of Health Statistics and Information
(DEIS), of the national Health portfolio.
A study on Covid-19 warns about the high risks during pregnancy for mothers and babies.
The risks of Covid: what was seen in the second wave
Roberto Casale is head of the Maternal and Child Department of the Professor Alejandro Posadas National Hospital, head of Maternity of the Trinidad Sanatorium, Ramos Mejía headquarters and director of Publications of the Society of Obstetrics and Gynecology of Buenos Aires (SOGIBA).
The expert details that it is
a global issue
.
Casale cites the study "Maternal and neonatal morbidity and mortality among pregnant women with and without Covid 19 infection", published in the prestigious American journal JAMA.
The analysis was carried out between March and October 2020, on 706 Covid patients and 1,424 pregnant women without the disease, in 43 institutions in 18 countries.
This showed that infected pregnant women had a
higher risk
of pre-eclampsia
(or high blood pressure during pregnancy),
severe infections
, hospitalizations in
intensive care units
and
mortality.
A pregnant woman is cared for in a medical center.
Photo: AFP.
In turn, it was shown that fever and shortness of breath lead to
"neonatal complications"
, such as prematurity and low weight.
And that "
13% of the babies of positive women also tested positive
."
Cesarean section - not breastfeeding - were associated with the risk of transmission.
The Posadas Hospital professional points out that, for ten years, maternal mortality rates have been declining, due to public policies that aim to prevent and treat pre-eclampsia, infections and postpartum hemorrhages.
To this, he clarifies, the approval at the end of 2020 of the Law of Voluntary Interruption of Pregnancy was added, which substantially reduces complications from abortion
(traditionally one of the leading causes of maternal mortality).
The coronavirus is likely to become one of the leading causes of maternal mortality in 2021.
"The Covid will undoubtedly raise the indicators of maternal death in the country
, as we saw in 2009 with the spread of Influenza A", complements the doctor.
And it indicates: "In Argentina we began to see this question between April and May of this year".
At first, it was not clear under what parameters to act.
For this reason, the creation of the "Guide for the management of pregnant people with severe illness due to Covid 19" was essential.
It was published by the
Ministry of Health
of the Province of Buenos Aires
, together with the Argentine Society of Intensive Care (SATI), the Argentine Federation of Gynecology and Obstetrics Societies (FASGO), the Society of Obstetrics and Gynecology of the Province of Buenos Aires (SOGBA), and the Society of Gynecology and Obstetrics of Buenos Aires (SOGIBA).
Vaccination: essential.
Photo: Nicolás Celaya.
"The most important thing was the inclusion of pregnant women in the vaccination plan,"
continues Casale.
The vaccination recommendation for pregnant people with risk factors or those with greater occupational exposure exists in the country since February of this year, later being extended to all pregnant people.
The vaccine benefits newborns secondarily
, since it reduces the chances of perinatal problems.
In addition, the transfer of antibodies through the placenta and breast milk is documented.
International recommendations
Precisely, Carissa Etienne - director of the Pan American Health Organization - urged to give
priority in vaccination to lactating or pregnant people
from the first trimester.
Etienne stressed that the Covid could "erase 20 years of hard-won achievements" to reduce the mortality of the pregnant population in Latin America and the Caribbean.
Dr. Carissa Etienne, director of the Pan American Health Organization, during a press conference (March 2020).
Photo: Saul Loeb / AFP.
PAHO estimates that
more than 270,000 pregnant women have become ill with coronavirus in the region
and more than 2,600 have lost their lives.
The state of the art (due to various resources, supplies, and results of health policies) varies from country to country.
Mexico, Argentina, and Brazil account for half of the deaths in the Americas.
Decreased controls
"There are publications from other Latin American countries that already speak of Covid as
an indirect cause of the increase in maternal mortality
."
The speaker is Analía Blanco, a gynecologist and obstetrician at the Hospital de Clínicas.
The doctor emphasizes that, according to the World Health Organization,
between 80% and 90% of maternal mortality cases are preventable and avoidable.
In this context, it is essential that pregnant women can access the health system.
A pregnant woman receives the vaccine in Paraguay.
Complications in access to health occur throughout the region.
Photo Nathalia Aguilar / EFE.
"
Maternal mortality acts as a reliable indicator to measure social inequalities
, the level of development of a population, the quality and access to health services. Poverty, the inexistence or distance to medical centers, the lack of information or Sex education, among other things, directly affect the statistics, "summarizes the specialist.
Dr. Blanco confirms that the health emergency associated with the pandemic violated people's right to access sexual and reproductive health.
"Prenatal controls were affected, as well as birth control, because many of the contraceptive services were not available or because
women did not have the means to pay for contraception,
" he adds.
Contraceptives are a right, although not everyone has access to them.
Photo: Shutterstock.
The obstetrician has received patients in her private office, who had been treated in a public hospital all their lives, but they stopped finding appointments.
This option is not viable for a large part of the citizenry.
"
The hours of primary health centers were closed or restricted
, such as the Community Health and Action Centers -CeSAC- in the Capital or the salitas in the Province," he reflects.
It also highlights that
the available health personnel was reduced
, due to licenses or because many had to turn to coronavirus care.
"I believe that, indeed, when maternal mortality rates are published, an increase will be seen, as in the rest of the region: due to the pandemic, the socioeconomic situation and the decrease in access to health," he concludes.
Latest official data
The last governmental part is from 2019 (the data for this year would be published soon, respecting the usual times).
Then
188 maternal deaths
were quantified
.
25 deaths had been for
"pregnancies terminated in abortion"
;
18 for "medical abortion, other abortion, unspecified abortion and unsuccessful attempted abortion";
and one for "miscarriage".
It is worth clarifying that the registered percentage of deaths for this reason corresponds to
the cases that reach the health system.
And that, as connoisseurs of the subject have pointed out, many times deaths are caused by infections or hemorrhages, which is why they are not always included in the previous categories.
Only next year will the incidence of Covid on maternal mortality be known .. Photo Shutterstock.
The document "Maternal and child health in figures (2019)" - prepared by the Argentine Society of Pediatrics with the support of Unicef - established that, worldwide, complications from
"dangerous abortions"
represented 13% of maternal deaths.
In Argentina, 1 in 7.
Another cause of death is "ectopic pregnancy, hydatidiform mole, and dead or retained fetus."
The remaining mortality is divided into two large groups
: "direct obstetric causes"
(such as hypertensive disorders, edema, proteinuria in pregnancy, childbirth and the puerperium) and
"indirect obstetric causes"
(such as disorders in the circulatory, respiratory and digestive systems).
How
Covid 19
will be located
in terms of maternal death factor in Argentina during 2021 remains an unknown.
But it is emerging - following the examples of Mexico and Colombia - to lead the list.
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