By. Dr Sunil Kumar Kota
The pandemic of COVID-19 poses grave challenge to some risk categories of people including the elderly and the very young ones, those with Diabetes, Hypertension, Chronic lung, heart, kidney and liver problems and those with infections like HIV and tuberculosis. Pregnant women themselves do not appear to be more susceptible to the consequences of infection with COVID-19 than the general population. Data is limited but special consideration should be given to pregnant women with concomitant medical illnesses who could be infected with COVID-19 until the evidence base provides clearer information. There are no reported deaths in pregnant women at the moment.
Most cases of COVID-19 globally have evidence of human to human transmission. However, recent cases have appeared where there is no evidence of contact with infected people. This virus appears to spread readily, through respiratory, fomite or faecal methods. Few cases of possible vertical transmission (transmission from mother to baby during pregnancy or during childbirth) have been reported. However it remains unclear whether transmission was prior to or soon after birth. Expert opinion is that the fetus is unlikely to be exposed during pregnancy. Transmission is therefore most likely to be as a neonate There is currently no evidence concerning transmission through genital fluid.
1. Vulnerability of Pregnant women-
A pregnant woman is placed in a vulnerable group -so social distancing is mandatory. As yet, there is no evidence that pregnant women who get this infection are more at risk to develop severe infection or serious complications than any other healthy individuals.
2. Social Isolation for pregnant women
– 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 outside.
3. Effect on Mother
The large majority of women will experience only mild or moderate cold/flu like symptoms. Cough, fever and shortness of breath are other relevant symptoms. More severe symptoms such as pneumonia and marked hypoxia are widely described with COVID-19 in older people, the immune-suppressed 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.
4. Effect on Fetus
There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. As there is no evidence of intrauterine fetal infection with COVID-19 it is therefore currently considered unlikely that there will be congenital effects of the virus on fetal development. There are case reports of preterm birth in women with COVID-19, but it is unclear whether the preterm birth was always iatrogenic (induced by doctor), or whether some were spontaneous. Iatrogenic delivery was predominantly for maternal indications related to the viral infection, although there was evidence of fetal compromise and prelabour premature rupture of membrane, in at least one report.
5. Advice for Pregnant Women
Pregnant women should do the same things as the general public to avoid infection. You can help stop the spread of COVID-19 by taking these actions:
• Cover your cough (using your elbow is a good technique or your hand kerchief, tissue)
• Avoid people who are sick.
• Maintain social distancing.
• Clean your hands often using soap and water or alcohol-based hand sanitizer.
• Use mask, whenever need to visit outside. Now days Govt of India recommends usage of handmade reusable masks.
If you are well at the moment and have no complications in any past pregnancies then follow a few steps during this crisis period. If you have a routine scan or visit due in the coming days please contact your doctor for advice and to fix a date. You will have to visit the hospital but the date and time may vary according to patient load and availability of the doctor. Your doctor may ask you to delay the visit or reschedule. So its always better to contact your doctor and take a re-appointment before visiting the hospital. If you have an urgent problem related to your pregnancy but not related to Coronavirus, get in touch with your doctor immediately. If you have symptoms of Coronavirus, contact your doctor and they will arrange the right place and time to come for your visits. You should not attend a routine clinic. You should keep minimum number of people with you and avoid bringing children with you to the hospital. There may be a need to reduce the number of antenatal visits you have which will be communicated with you. Do not reduce your number of visits without asking first with your doctor.
6. Advice for Covid-19 positive Pregnant Women
Women should be advised to attend via private transport where possible or call an ambulance but you should inform both the ambulance service and your hospital beforehand about your positive status, even prior to entering the hospital. And there are Govt designated specific hospitals, where you need to be treated by specialists. If you have suspected or confirmed coronavirus at the time your baby is born, your baby will be tested for coronavirus. It is purely the prerogative of the pregnant women to decide if she wants stay with the baby or give skin to skin contact. Provided your baby is well and doesn’t require care in the neonatal unit, you will be kept together after you have given birth.
7. Breastfeeding And Post Partum Care In The Time Of Covid-19
Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (flu) and other respiratory pathogens spread. Transmission through breastfeeding has still not been confirmed. The centre of disease control (CDC) has given an interim guidelines regarding breastfeeding for those mothers who are COVID-19 positive or PUI (person under investigations). The brief is as follows
To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued. The newborn should be at least 6 feet away from the ill mother and whenever possible use physical barrier like curtains between the mother and newborn. If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed COVID-19 or is a PUI should put on a facemask and practice hand hygiene before each feeding before touching your baby, breast pump or bottles or other close contact with her newborn. She is asked to avoid touching eyes, nose and mouth. She should also try to avoid coughing or sneezing on the baby while feeding at the breast. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on transmission-based precautions in a healthcare facility. During temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be used. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver. Again if no healthy adult available and mother have to breastfeed her child then she should put on a facemask and practice hand hygiene before each feeding.
8. If you are planning for Pregnancy
Ans- If you don’t have COVID-19, there is no medical reason to change your plans about trying to conceive but access to medical care over the next few months may be harder to come by (and pregnant women need medical care!), so if you’re flexible on conception timing, you may want to consider waiting. If you have been advised for assisted reproductive technology (ART) like intrauterine insemination (IUI) or in-vitro fertilization (IVF) it’s better to delay after speaking to your fertility specialist. If you meet the diagnostic criteria for COVID-19, it’s recommended that you avoid getting pregnant and wait until the illness subsides before pursuing ART.
Dr Sunil Kumar Kota, MD (Med), DNB (Endo), Consultant Endocrinologist, DIABETES & ENDOCARE Clinic, Berhampur, Email: diab.endocare@gmail.com, Ph: +917749804401
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