Coronavirus in pregnancy

Novel coronavirus (SARS-COV-2) is a new strain of coronavirus causing COVID-19, first identified in Wuhan City, China. Pregnant women and immune compromised people appear to be more susceptible to the consequences of infection with COVID-19than the general population. There are no reported deaths in pregnant women at the moment.

Avoid your routine ante natal checkups if you are not a High risk pregnant woman or in last trimester of pregnancy.

Transmission:

Most cases of COVID-19 globally have evidence of human to human transmission, contact with infected people readily, through respiratory, fomite or faecal methods.

How can pregnant women protect themselves from getting COVID-19?

Pregnant women should do the same things as the general public to avoid infection by taking these actions:

  • Cover your cough (using your elbow is a good technique)
  • Avoid people who are sick
  • Clean your hands often using soap and water or alcohol-based hand sanitizer

Effect on the mother/ symptoms :

The large majority of women will experience only mild or moderate cold/flu like symptoms. Cough, fever and shortness of breath. More severe symptoms such as pneumonia and marked hypoxia are widely described with COVID-19 in older people, the immunosuppressed and those with long-term conditions such as diabetes, cancer and chronic lung disease. These symptoms could occur in pregnant women so should be identified and treated promptly.

Effect on the fetus

There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss, intrauterine fetal infection with COVID so, unlikely that there will be congenital effects of the virus on fetal development.

It may manifest as preterm birth by prelabour or premature rupture of membrane.

General advice for pregnant women who may have been exposed to COVID-19 or are experiencing symptoms suggestive of COVID-19

Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for 14 days.

  • People who are advised to self-isolate
  • Not go to school, work, NHS settings or public areas
  • Not use public transport
  • Stay at home and not allow visitors
  • Ventilate the rooms where they are by opening a window
  • Separate themselves from other members of their household as far as possible, using their own towels, crockery and utensils and eating at different times
  • Use friends, family or delivery services to run errands, but advise them to leave items outside7

Routine appointments for women with suspected or confirmed COVID-19 (growth scans, OGTT, antenatal cares) should be delayed until after the recommended period of isolation. Unless in need of urgent obstetric or medical care.,

  • Care at home
  • Drink plenty of oral fluids
  • High protein diet.
  • Fresh fruits and vegetables
  • Fetal cick count
  • Continuing the prescribed medication
  • Breathing exercises and other relaxation methods.

There is currently no evidence to favour one mode of birth over another Mode of birth should not be influenced by the presence of COVID-19, unless the woman’s respiratory condition demands urgent delivery.

There is no evidence that epidural or spinal analgesia or anaesthesia is contraindicated in the presence of coronaviruses

Neonatal care

Reassuringly, there is no evidence at present of (antenatal) vertical transmission.

All babies of women with suspected or confirmed COVID-19 need to also be tested for COVID-19. It is advisable to have separate isolation of the infected mother and her baby for 14 days.

Infant feeding

In the light of the current evidence, we advise that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk

For women wishing to breastfeed, precautions should be taken to limit viral spread to the baby:

  • Hand washing before touching the baby, breast pump or bottles;
  • Wearing a face-mask for feeding at the breast;
  • Follow recommendations for pump cleaning after each use;
  • Consider asking someone who is well to feed expressed milk to the baby.

Dr. Vasundara Cheepurupalli
Consultant Obstetrics & Gynaecology, Laparoscopic Surgeon, KIMS Hospitals, Secunderabad.

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