The Government of São Paulo has published specific clinical protocols for pregnant, postpartum and lactating women in cases of a positive diagnosis for monkeypox. Giving preference to cesarean section depending on the lesions caused by the disease and suspending breastfeeding the baby for at least 14 days are some of these measures.
Pregnant and postpartum women are recognized as a risk group for severe monkeypox. In addition, they can transmit the virus to newborns, who are also at risk for the disease. The scenario causes some guidelines to be aimed at this audience.
“The pregnant mother has a specific protocol”, said David Uip, secretary of Science, Research and Development in Health of the São Paulo government, during a press conference this Thursday (4). In the state of São Paulo, two pregnant women have already been registered with the infection – in total, there are 1,298 cases of the disease.
One of the indications is to give preference to cesarean section in cases of infection by monkeypox – the virus that causes monkeypox. Jean Gorinchteyn, State Secretary of Health, explained that normal delivery can be considered in cases where the pregnant woman does not have the vesicles -bubbles with liquid inside- common to the disease in the vulvovaginal and perianal regions (around the anus).
Another measure involves stopping breastfeeding for at least 14 days. One of the reasons for this recommendation is that breastfeeding increases the baby’s contact with the mother. As the main form of transmission of the virus is by skin-to-skin contact, maintaining breastfeeding can pose a risk to the newborn.
In addition, studies on the transmission of the virus through breast milk are lacking. “We don’t know if, for this disease, there is any transmission through breast milk,” Gorinchteyn said.
The direct contact of the baby with the mother, regardless of breastfeeding, was also an orientation given by the health secretary. “We are discussing other ways of protecting the baby […]but, at this moment, we still don’t have that security and, therefore, the orientation is to keep the baby and the mother away during this scenario.”
According to Gorinchteyn, the state government makes available 56 maternity hospitals in São Paulo that are able to provide care in cases of monkeypox. The secretary also stated that clinical protocols may be changed in the future.
masks and pregnant women
A technical note from the Ministry of Health recommended that pregnant, puerperal and lactating women keep wearing masks due to the monkeypox outbreak. The document also guides them to stay away from people with symptoms of the disease and use condoms in all sexual relations.
“Pregnant women have a clinical picture with similar characteristics to non-pregnant women, but they may have greater severity, being considered a risk group for unfavorable evolution”, says the technical note.
At the press conference, Uip called the guidance “prudent” and “adequate.”
“Mask is something that today is inserted in the hospital context”, said the secretary.
In the case of monkeypox, transmission by respiratory droplets is rarer, as it requires close and prolonged contact. Therefore, the use of masks as a protection against infection is recommended for specific situations.
The CDC (US Centers for Disease Control), for example, indicates the equipment to health professionals, monkeypox patients when in contact with other individuals in a prolonged and close way (on average, less than 2 meters away) .
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