COVID-19 positive/suspected pregnancies
Management in pregnancy & labour

Prof L Ranjit *

The 40 day nationwide lockdown led to anxiety and boredom among people and some believe the lockdown may see a spurt in the birth of children nine months later. But becoming pregnant in this period is not advisable.

In the case of current lockdown, there is fear of the unknown and people would face economic crunch that can lead to depression subsequently. It is important to analyze the impact of COVID-19 in pregnancy even though the subject matter is still evolving and only scant literature is available till date.

Effect of COVID- 19 infection on mother:

Even though some viral infections are worse in pregnancy due to physiologic changes of pregnancy and relative immune-suppression, there is no such evidence for corona virus infection. Maternal disease is also not aggravated by pregnancy unless associated with co-morbidities e.g. hypertension, diabetes, asthma, immune-suppression, kidney, liver, lung diseases etc.

Effect of COVID- 19 infection on foetus:

There is no documented increased risk of miscarriage, early pregnancy loss or preterm birth. Till date, there is no evidence of intrauterine infection and transmission of the virus from mother to the unborn child as IgM does not cross placenta. It is said that COVID- 19 infection during pregnancy does not cause congenital malformations in the newborn.

Antenatal care for non-COVID pregnant women:

Immunization during antenatal care can go on as before. We must reduce, postpone and/or increase the interval between antenatal visit/routine scan. It is highly important to shorten the duration of antenatal visit. Sometimes women requiring frequent visits may need to have individualized planning.

In today’s world, tele-conferencing and video-conferencing may be an option especially if maternal observation or tests are not required in some parts of the globe. Online communication with service providers is coming in a big way and may be a boon for patients during the pandemic. Home monitoring has also a role to play and that will essentially include BP record, measuring weight and daily foetal movement count.

Pregnant women need to consume high protein diet, vitamins and micronutrient supplementation. Personal hygiene is ever important that will include: staying at home, social distancing, and hygiene, avoid touching face, respiratory hygiene etc.

Pregnant women should avoid all non-essential travels to hotspot areas and overseas. For quarantine, it is same for pregnant women and general population.

Pregnant women with significant heart disease and immune-compromised ones should avoid interaction with others. They have to stay at home at all times for at least 12 weeks. Family members should also stay at home not to bring infections.

Antenatal care for pregnant women with suspected or confirmed COVID- 19:

This group of women may need to spend time in isolation, should have access to woman-centred, respectful skilled care including obstetric, foetal medicine and neo-natal care as well as mental health and psychosocial support. They can have isolation at home for 14 days with self monitoring as mentioned earlier.

Pregnant women with mild symptoms should not be panic but contact their maternity team. For women with severe symptoms it should be done immediately. It is better not attend routine antenatal clinic. Rather a designated initial assessment area (triage) and screening area is ideal. Private transport is preferred with minimum number of people and face mask is compulsory.

If the patient recovered from COVID- 19 infection in first trimester, detailed mid-trimester anatomy ultrasound examination is advised. In case of infection in latter half of pregnancy, ultrasound examination for foetal growth may be considered after two weeks.

There is no specific treatment for COVID-19 infection. However, patients with COVID-19 may require supportive and symptomatic treatment and therefore treatment is based on patient’s clinical condition. Various drugs used in treatment of COVID-19 patients are Antiviral/Steroid/Hydroxychloroquin and Azithromycin.

COVID- 19 infection in pregnancy is not an indication for Medical Termination of Pregnancy. Moreover, MTP medications can’t be prescribed on the phone.

COVID- 19 infected women can continue breastfeeding as any other non-infected women.

It is not established whether corona virus spreads through semen, genital fluids or sexual contact.

It is better to postpone treatment for infertility during COVID-19 pandemic as you may have to visit physicians frequently and you have to undergo procedures which are non-emergency. Moreover, extensive research has not been done in this regard.

We all are aware that there is no remedy for the virus except prevention. In fact, prevention is the key to successful containment of the COVID19- pandemic. A vaccine is not in our armamentarium right now and we all need to hide ourselves from this deadly virus till a vaccine is available.

Therein lay the importance of following social distancing norms and frequent hand washing. We, as citizens of the country have huge responsibility as individuals and role models in observing various norms of lockdown. It is worthwhile to remember that lockdown is practised to minimize community transmission of an infection at times of pandemic. Well, you may go out for medical needs anytime anywhere.

Pregnant women should follow the same recommendations as non-pregnant persons for avoiding exposure to COVID- 19 infection.

Antenatal care through tele-conferencing and video-conferencing are keys to providing quality care during pandemic in developed countries.

Triage based on symptom severity and obstetric emergencies.

Multidisciplinary approach is required for optimum management.