Being pregnant during Covid-19 is no cause for panic, says Dr Roumen Dimitrov, founder and manager of Femina Medical Center
Expecting a child has always been a time of excitement for the future parents, but the Covid-19 pandemic made this precious period in one's life more stressful. What should a pregnant woman do in such a situation? We decided to discuss these issues with one of the best professionals in the field, Associate Professor Roumen Dimitrov. The founder and manager of Femina Medical Center is specialised in surgical gynaecology, endoscopic surgery, urogynaecology and ultrasound diagnosis.
What should pregnant patients know and do during the Covid-19 pandemic?
Pregnant patients should take the same preventive measures during the Covid-19 pandemic as all other citizens. Limiting their social contacts, maintaining strict hygiene and use of PPE remain the main rules. Pregnant women should also not miss the obligatory and recommended prophylactic and screening examinations and tests which are a part of modern pregnancy follow-up. Medical facilities are obliged to provide safe conditions for the visiting pregnant women by implementing appropriate organisational and hygienic measures. There is no data that Covid-19 infection is different or harder in pregnant women, or that it affects the foetus. Pregnant women should be assured that they are not more vulnerable than other people in their age group.
What are the peculiarities in treatment of pregnant patients with oncological diseases?
Oncological diseases have adverse effects mainly on the pregnant women and their life prognosis rather than those of the foetus. The problem is that treatment methods are generally harmful for the foetus, but if treatment is postponed for after birth the disease will progress. When an oncological disease is identified in a pregnancy's early stages, termination can be considered to allow the woman full and timely treatment. In oncogynaecological diseases this is done together with the surgery of the underlying disease. In an advanced pregnancy we wait, then we deliver the baby near term. In gynaecological tumours, surgery can be performed during C-section and treatment continues in accordance with the established protocols. Chemotherapy after the second trimester of pregnancy is feasible if it is of vital importance to save the mother's life. The presence of a preexisting oncological disease in most cases makes conception impossible or contraindicated, but this is not a universal rule. Patients with non-gynaecological oncological diseases in remission can get pregnant and give birth successfully. Treatment of oncological diseases harms the reproductive function, so it is recommended for women who have not given birth and are to undergo such treatment to consider preserving their ova with regard to future pregnancies. Oncologists prefer to start full-range treatment without delay but it is the patient who finally decides about her pregnancy and treatment.
Why is early diagnosis of cervical and ovarian cancer important?
The sooner a malignant tumour is diagnosed, the more successful its treatment and patient's chances for survival are. This is true for all tumours. In cervical cancer the definition "early diagnosis" is not suitable. For this disease there are established reliable methods for prophylaxis via identification and removal of the so-called precancerous conditions. This is done by the Pap-smear test and by the colposcopic examination. If they are performed properly and at regular intervals, cancer would not develop. If cervical cancer has emerged then we do not talk about early diagnosis anymore, but of a case gone rogue.
Ovarian cancer is different. Early diagnosis is crucial, because the disease develops indolently and usually manifests itself and is diagnosed when at an advanced stage. Unfortunately early diagnosis of ovarian cancer is most often accidental. Mass screening with regular ultrasound examinations and tumour markers' evaluation has not shown satisfactory results as it does not improve the early diagnosis and the overall life expectancy. In high-risk groups who are genetically predisposed to ovarian cancer, however, ultrasound screening from an early age is recommended, and prophylactic ovary removal can be discussed.
How can a woman reduce the risks for her and the foetus's health during the pregnancy?
Pregnancy is a normal physiological condition in women and for the great majority of them it goes and ends uneventfully. The pregnant woman should continue with her usual hygienic lifestyle, eating normally and staying active, and should give up bad habits and too intense physical activity. Taking folic acid before pregnancy and in the first trimester has a proven effect for reducing some foetal anomalies and is a routine practice. There are many formulas for pregnant women containing vitamins and microelements designed to satisfy their daily needs. There are several important pregnancy examinations that can identify potential risks for the mother and the foetus. They, together with the history data and some laboratory tests help the physician identify potential problems and implement prophylactic measures and plan the further pregnancy follow-up.
Femina offers a wide range of ultrasound examinations. For diagnosis of what cases are they?
Femina Medical Center is equipped with sophisticated high-class ultrasound scanners. We use them to perform all kinds of examinations in the field of Ob&Gyn and imaging of breasts, thyroid gland, abdominal organs, musculoskeletal system. We perform 3D/4D ultrasound, Doppler studies and elastography. We also offer highly efficient laser procedures for nonsurgical treatment of urinary incontinence, vaginal relaxation and genitourinary menopausal symptoms with erbium laser with equipment by a leading manufacturer.
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