Coronavirus in Poland. What are pregnant women to do: see a doctor or postpone visits?

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Due to the state of epidemic threat in Poland, health care facilities operate according to changed rules. This also applies to gynecology and obstetrics clinics, although they look after pregnant women who require constant medical supervision. What should they do when the doors of many clinics are closed, some visits are canceled, and the entire research calendar is in question? We asked specialists.

1. If you have a routine checkup or visit in the coming days, contact your clinic or your doctor directly who will develop an action plan. Remember that it may be difficult to call medical facilities now, so you will likely have to wait longer than usual on the line. 
2. A routine visit may be postponed, carried out by telephone or videoconference. However, the medical team should decide on reducing the number of antenatal visits. Do not cancel your visit to the clinic without consultation. 

Pregnant woman and the coronavirus. What’s the risk?

So far, there is no evidence that pregnant women are more likely to be infected with the coronavirus than any other healthy person. It is known, however, that pregnancy in some women can affect the way they cope with serious viral infections. There is an increased risk of severe flu during pregnancy, but whether the same applies to SARS-CoV-2 remains to be investigated. It is also not known if the virus can be passed on to the baby through the placenta. Therefore, pregnant women are advised to exercise extreme caution, which includes, first of all, hand hygiene and limiting social contacts to the necessary minimum.

This means that pregnant women, as long as there is an epidemic threat, should avoid places where they may come into contact with clusters of people. Such places include health care facilities, which, moreover – in order to reduce the risk – they only introduce telephone or web registration and switch to telemedicine.

– We do not know what impact SARS-CoV-2 coronavirus could have on the fetus. Thus, if the patient does not have an absolute indication from the doctor in charge of the pregnancy to appear in person at the control visit in the coming weeks, then should opt for a medical consultation by phone or online – says the drug. med. Marta Mączka, specialist in obstetrics and gynecology, founder of the Woman and Mother Medical Center in Warsaw.

Coronavirus and the functioning of gynecology and obstetrics clinics

Each clinic works according to individually agreed rules, but taking into account the official recommendations of national consultants in the field of perinatology, obstetrics and gynecology. According to the information from the Ministry of Health, consultants recommend that:

1. cancel all planned gynecological procedures, except for emergencies, and in case of doubts, consult a specialist in obstetrics and gynecology by phone or directly before the procedure, 
2. cancel outpatient visits – except in emergencies and situations requiring direct contact with a doctor, 
3. in other cases, use remote advice (teleportation, teleconsultation), which aims to determine the further course of action (during such advice, you can get an e-prescription, e-test order, sick leave and set the date of the next visit).

In the latest recommendations we read:

Due to the state of epidemic threat, visits to obstetrics and gynecology wards are suspended, including the presence of accompanying persons during childbirth. Patients should be allowed to contact their loved ones using their own electronic devices.

According to the current guidelines, patients who report to the gynecology and obstetrics clinic should first make an appointment for a specific time – by phone or e-mail, and then come to the doctor no earlier than 15 minutes before the appointment.

– If it is necessary to visit a medical facility, it is most reasonable to do it yourself, without an accompanying person. Pay attention to observing the sanitary regime, i.e. washing and disinfecting hands, keeping a distance of at least 1,5 m from other people, and staying in this place as short as possible. It is also worth considering wearing a mask – explains Marta Mączka, a gynecologist.

Also read: Doctors appeal: do not come to the clinic

Is it easy to book an appointment?

We decided to see for ourselves how the clinic is now available. We called ten locations in various cities in Poland. In six of them we were able to ask about the possibility of being admitted to an ultrasound scan during pregnancy. In two of them it was necessary to stay on the line a bit longer – there were several people waiting in the line. In other clinics, the telephone did not answer. As for the facilities we managed to call, we received information that You can come for a follow-up ultrasound without any problems, you can also postpone the visit if you have any concerns. In one clinic it was stated that the gynecologist admits only four patients a day. Another said that only private visits are available at the moment. The ultrasound at the National Health Fund can be performed in June at the earliest.

When to go for research and when not?

What to do when a check-up ultrasound and other tests prescribed by a doctor are due? To this question, the drug. Marta Mączka replies:

– Which examinations and at what stage of pregnancy should be performed are strictly regulated by the ordinance of the Minister of Health. Each of these studies is important and has its own justification. All attempts to postpone diagnostic tests should be consulted with the attending physician. But let’s remember that we have had an epidemic threat in Poland for a week. If there is no medical indication to perform an ultrasound during pregnancy, please resign from doing it.

– The epidemiological situation, unfortunately constantly worsening, forces the revision of the procedures sanctioned in ministerial regulations during the period of the threat of global COVID-19 infection using common sense, obstetric knowledge, obstetric experience and forces an individual approach to each pregnant woman – emphasizes prof. Mariusz Zimmer, president of the Polish Society of Gynecologists and Obstetricians.

We appeal to doctors, who rightly rightly limit the number of patients admitted only to acute cases, for greater telephone / electronic availability for their own patients. In this situation, we must be more “remotely” available to patients.

Recommendations of prof. Mariusz Zimmer, president of the Polish Society of Gynecologists and Obstetricians

1. I suggest that launch information points in clinics, the so-called e-tips. A very good element of obstetric pregnancy management is the existence of “Pregnancy records”. Each pregnant woman has a document in which the previous visits and the most important information about the course of such pregnancy are entered. If it is impossible to continue the pregnancy with the current doctor, you can, with this document, go to another facility – register and, if necessary, undergo an examination. The examining doctor will have information about the current course of pregnancy with the above-mentioned. «Pregnancy cards».   
2. If the pregnancy is going well and three weeks have passed since the last visit, do not be afraid that there will be no examination in a week. After virtual contact with a midwife or doctor, you can and must postpone the visit – nothing should happen.  
3. Oczywiście if pregnancy is in danger or there are symptoms that threaten pregnancy, you should notify «your» doctor, and if you are not in contact with him, you can go to a working hospital. But remember, contact with such a place, gathering various cases, certainly increases the risk of infection. Let us decide on this step as a last resort.   
4. Such restrictions are related to the epidemiological danger of gynecological examinations. Vaginal discharge is a very dangerous infectious materialwhich may reach the lungs of the examiner or persons accompanying the examination in various forms, e.g. when removing the cover from the vaginal probe. So, in the current situation, let’s minimize the number of gynecological and ultrasound examinations using the vaginal method. If we do have to do it, we should pay great attention to the fact that the virus can spread. The audit standard certainly needs to be changed. The shortest possible test time. The patient must be prepared that it will be a short visit, with a short verbal explanation, and any details should be provided by e-mail.   
5. It is always important in medicine to put two parameters at stake: the BENEFITS of the study on the one, and the RISK of this study on the other. In the current epidemic situation the risk outweighs the benefits, so we can modify this procedure. Either do nothing at all, or, for example, do a glycemic profile in a few days. You definitely need to contact your doctor who should be able to modify routine procedures.   
6. We appeal to the responsibility of patients for their actions and decisions – I think that nobody wants to expose others to danger, which today is a very real threat to health and life.

Have a question about the coronavirus? Send them to the following address: [email protected]. You will find a daily updated list of answers HERE: Coronavirus – frequently asked questions and answers.

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