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Gravidez e Coronavírus

A Covid-19 mudou de forma inédita nossas vidas, relações pessoais e profissionais, exigindo de nós uma ampliação da capacidade de adaptação e reinvenção. Continuando o trabalho da Luz de oferecer uma assistência gentil, respeitosa e segura para as mulheres, seus bebês e suas famílias, nós, equipe da Luz, respondemos algumas perguntas importantes sobre gravidez e o novo Coronavírus:

Quais são os riscos da Covid-19 para grávida e bebê?

Pelo conhecimento acumulado até o momento, sabe-se que  mulheres grávidas e no pós-parto que contraem a doença têm maior chance de desenvolver quadros graves, com maior frequência de internação em UTI e necessidade de ventilação mecânica¹, quando se compara com a população em geral.

Dados mundiais não apontam para um aumento de risco de morte pela Covid-19 associado à gravidez. Importantes publicações brasileiras², no entanto, revelam uma maior mortalidade materna por essa causa no nosso país, muito provavelmente relacionada à dificuldade de acesso ao pré-natal adequado e à assistência qualificada de maior complexidade (internação em UTI e ventilação mecânica, por exemplo), permeada por recortes de iniquidade de raça/cor e classe social.

Além disso, como em outras doenças infecciosas que podem ser contraídas na gestação, a Covid-19 aumenta o risco de nascimento prematuro, ocorrência de restrição de crescimento fetal intra-uterino, além de sofrimento e óbito fetal.

Existem relatos de um baixo risco de transmissão do novo coronavírus da mãe para o feto durante a gestação e, até o momento, não se pode relacionar a infecção a malformações fetais.

A mensagem é sempre a mesma: respire fundo, use máscara, lave as mãos, mantenha o distanciamento social e lembre-se de encontrar recursos internos e externos de apoio, paz e equilíbrio.

Quais são os principais cuidados que a mulher grávida precisa ter?

♡ Uso correto³ de máscaras;

♡ Higienização adequada e frequente das mãos com água e sabão⁴ e/ou álcool a 70%⁵;

♡ Etiqueta respiratória: cubra a boca e o nariz com o cotovelo ao tossir ou espirrar; evite ainda mais sair de casa de estiver com sintomas respiratórios;

♡ Fazer o distanciamento social e evitar aglomerações, especialmente em locais fechados, sem ventilação⁶;

♡ Quando não for possível o distanciamento social, é imprescindível atentar para medidas acima, além de muita atenção para não tocar a face quando em situações de maior exposição;

♡ Procurar manter mente sã num corpo são: alimentação saudável,  atividade física e, com cuidados, até encontros com pessoas queridas ao ar livre⁷.

Este é um momento que nos exige resiliência. Caso note sofrimento mental e emocional não hesite em procurar suporte terapêutico.

Além disso, é importante frisar que devemos ter responsabilidade coletiva, lembrando que, ao nos proteger, protegemos também grupos mais vulneráveis, além de contribuir para aliviar a  sobrecarga dos sistemas de saúde público e privado. Assim reduzimos  a possibilidade de dificuldade de acesso a serviços especializados e cuidados intensivos por causa do número crescente de casos.

Existe alguma evidência de benefício do uso de medicamentos preventivos ou como tratamento precoce para Covid-19?

Infelizmente não⁸. Até o momento, o que realmente se mostra eficaz para proteger as pessoas são todas as medidas de prevenção descritas acima. Para casos leves de Covid-19, a prescrição de sintomáticos, repouso e hidratação costuma ser suficiente. Casos moderados e graves precisam de avaliação complementar e condução individualizada.

E as vacinas?

Nunca se viu na história mundial tanto esforço conjunto para o alcance de um objetivo comum. Isso incluiu a retomada de linhas de pesquisas pausadas, o amplo compartilhamento de dados e resultados científicos, o forte investimento em recursos pessoais e tecnológicos. Daí vem a celeridade do resultado, não da violação de protocolos de ética em pesquisa e desenvolvimento de novas vacinas. As vacinas têm se mostrado seguras e eficazes. É possível que ainda leve um tempo, natural para a ciência executada de forma adequada, até que o seu uso em gestantes esteja liberado⁹.

Em 15/03/21, o Ministério da Saúde soltou uma Nota Técnica importante e animadora a respeito da administração de vacinas contra a Covid-19 para gestantes, puérperas e lactantes.

A nota indica o mesmo posicionamento de outras entidades: muito embora ainda não existam resultados de estudos sobre a vacina nessa população, as tecnologias utilizadas nas vacinas disponíveis no Brasil (vírus inativados e vetores virais que não causam infecção) são reconhecidas por sua segurança de utilização em gestantes, puérperas e lactantes e, por essa razão, cabe avaliar individualmente cada caso e orientar as mulheres após esclarecimentos.

Objetivamente, o Ministério da Saúde recomenda:

♡ Vacinação de gestantes com comorbidades preexistentes: diabetes, hipertensão arterial crônica, obesidade (IMC > 30), doença cardiovascular, asma, imunossuprimidas, transplantadas, doenças renais crônicas e doenças autoimunes;

♡Oferta da vacinação para gestantes sem comorbidades após avaliação de riscos e benefícios, levando em conta as atividades cotidianas da mulher;

♡Inclusão dessas gestantes no grupo prioritário de vacinação (viva!! <3);

♡ Manutenção do aleitamento materno e da doação de leite humano após tomar vacina;

MANTER AS MEDIDAS DE PROTEÇÃO APÓS TOMAR A VACINA! (o efeito de reduzir a circulação do vírus só chega quando a maioria da população está vacinada)

Qual é o risco para a gestante ao frequentar um ambiente hospitalar?

Por causa do Coronavírus, as pessoas passaram a ver o hospital como um local de risco para contrair doenças. Mas, na verdade, do ponto de vista bacteriológico e viral, ele sempre foi um local de risco, tendo em vista que é o local que pessoas doentes buscam  para se curar.  

Para evitar o risco de contaminação em ambiente hospitalar, no pré-natal, no parto, no nascimento e no pós-parto, as mulheres e suas parcerias podem e devem tomar todos os cuidados citados acima ou procurar assistência fora do hospital. Considerar viver essa experiência fora do ambiente hospitalar é uma possibilidade para mulheres e bebês saudáveis.

 Em Brasília, a Luz de Candeeiro é a casa de parto privada que presta esta assistência sempre com segurança, cuidado, gentileza e amorosidade.

Qual é o local mais seguro para o parto e o nascimento em tempos de Covid?

Isso vai depender de cada gestação e do risco gestacional. Esse contexto tem levado muitas pessoas a enxergarem que parto e nascimento não devem ser tratados como um eventos que tem que acontecer em um ambiente hospitalar obrigatoriamente.

Assim, tem crescido a procura por assistência ao parto e ao nascimento fora do hospital, uma vez que está mais clara a relação entre riscos e benefícios do ambiente hospitalar. Parto em centro de parto normal (fora do hospital) e também parto domiciliar são opções possíveis. 

A Covid-19 mudou a atenção da Luz no recebimento de novos atendimentos em relação ao tempo gestacional?

Mantemos o mesmo padrão de cuidado associado a todas as medidas necessárias de proteção das pessoas. A equipe de enfermeiras e obstetras da Luz de Candeeiro está pronta para  receber as mulheres e suas parcerias  e prestar todo cuidado físico e emocional que esse momento exige. 

Acreditamos que ainda levaremos algum tempo processando e assimilando todos os aprendizados que essa pandemia nos trouxe, não só do ponto de vista científico, mas também enquanto comunidade e humanidade.

Seguimos fortalecendo nosso compromisso com um cuidado ético, cientificamente embasado, que fomenta e fortalece a autonomia e o protagonismo das mulheres no gestar e parir, e que é preenchido sempre de amor. Mudando o mundo, uma família de cada vez.

Aqui  deixamos nosso abraço. Virtual, mas não menos amigo e caloroso.

  • ¹Grávidas tem mais risco de desenvolver complicaçõespor causa de Covid-19, mostra estudo https://brasil.elpais.com/sociedade/2020-11-05/gravidas-tem-mais-risco-de-desenvolver-complicacoes-por-causa-da-covid-19-mostra-estudo.html#:~:text=Segundo%20o%20estudo%20do%20CDC,intensiva%20(10%2C5%20casos%20por
  • ² Brasil é o país com mais mortes de gestantes por Covid-19 https://radis.ensp.fiocruz.br/index.php/home/noticias/brasil-e-o-pais-com-mais-mortes-de-gestantes-por-covid-19
  • ³ Como usar máscara de maneira correta https://saude.estadao.com.br/noticias/geral,veja-como-usar-uma-mascara-da-maneira-correta,70003296152
  • ⁴ Como lavar as mãos corretamente https://drauziovarella.uol.com.br/coronavirus/como-lavar-as-maos-corretamente
  • ⁵ Covid-19: como usar o álcool a 70% e quais os riscos existentes? https://pebmed.com.br/covid-19-como-usar-o-alcool-a-70-e-quais-os-riscos-existentes/
  • ⁶Como as pessoas estão contraindo a Covid19? https://www.leticiakawano.com/post/como-as-pessoas-est%C3%A3o-contraindo-a-covid19
  • ⁷Encontros seguros em tempos de covid-19 https://www.leticiakawano.com/post/encontros-seguros-em-tempos-de-covid19
  • ⁸ Mitos e verdades na Covid-19: vamos lá? https://www.leticiakawano.com/post/mitos-e-verdades-na-covid-19-vamos-l%C3%A1⁹
  • ⁹ O que sabemos sobre vacinas para Covid-19 no Brasil até agora http://revistaquestaodeciencia.com.br/artigo/2021/01/07/o-que-sabemos-sobre-vacinas-para-covid-19-no-brasil-ate-agora
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