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FAQs COVID -19 in PREGNANCY

FAQs COVID -19 in PREGNANCY

FAQs COVID -19 in PREGNANCY

DR.VIMALA KUMARI GEDDA,
MBBS,MD, DRME,

CONSULTANT GYNECOLOGIST,

ANKURA HOSPITAL , MEHDIPATNAM

  • Pregnant women are as prone as general population in getting infected, hence routine covid precautions  have to be observed .
  • However, serious Covid illness in pregnant women is rare as compared to general population as is evident in studies across the globe since Covid outbreak in 2019.
  • Fever, bodyaches, running nose, headache,generalised weakness

loss of taste , smell sensation. Fatigue, breathlessness , palpitations are  sometimes seen in pregnant women. Sudden onset and rapid progress of these symptoms have to be evaluated

High grade fevers in pregnancy  are known to cause preterm labours if  not treated appropriately. Early visit to the doctor is advised to differentiate from other causes of fever like urinary infections, , appendicitis, other viral fevers  and to prevent complications to both mother and fetus.

A pregnant women should be tested if  symptomatic OR

if a close contact has been tested positive   AND

ideally around 1 week prior to expected delivery to facilitate delivery to optimise care ,limit the spread  and minimise risk to hospital personnel.

Apart from the routine measures , using mask, sanitising hands , distancing,   avoiding  gatherings , contact with sick family members , using a protective mask if  attending a sick child or family member ,avoiding elevators ,public transport,  healthy diet, iron&calcium supplements,  limiting visits to hospitals.

  1. Visiting the hospital when absolutely necessary like scan and vaccination.
  2. Limiting the number of scans to NT scan at 11-13 weeks6days, TIFFA at  19-22 weeks, and  Growth scan between 28 -30weeks
  3. Using the virtual consultation platform as far as possible

After 26 -28weeks of gestation, fetal kicks are well perceived by the mother. Feeling a fetal movement at least once per hour is assuring. When in doubt, reach the emergency room.

So far ,there has been no adverse outcome on the fetus, be it anamolies, growth restriction, preterm deliveries or reduced or excess amniotic fluid that have been attributed to Covid infection per se.

  • No, MTP is not indicated for Covid in pregnancy.
  • If a woman requests MTP, medical method is preferable.
So far, Covid infection has a mild to moderate course in pregnant women and serious disease or deaths are rarely seen. Women with other associated risk factors are prone for severe covid illness.
Isolation for 14 days, being watchful for symptoms , monitoring pulse rate, spO2, temperature is required. Medical opinion sought if symptoms develop.
Confirmed patients if asymptomatic are treated like suspected women Ie isolation, watching for symptoms and monitoring. If symptomatic , watch for signs of deterioration like severe fever spikes with falling oxygen saturation and medical care has to be sought without delay.
It would be ideal to avoid elective caesarean or labour induction while in the isolation period if no immediate maternal or fetal risk.

If asymptomatic and stable, women can choose to deliver naturally.

Fetal distress and non-obstetric indications for c section remain same.

In order to reduce exposure and spread, shorter trial labours or  c section is preferred.

In severe illness, priority is given to stabilise the mother and delivery by C-section is done.

Transmission to the newborn has been rare and severe illness or death of neonate due to COVID is not reported

  • In asymptomatic or mild illness, breastfeeding, skin to skincare, rooming-in is encouraged to promote bonding between mother and child.

The virus has not been detected in breastmilk of infected mothers.

Breast feeding is encouraged in asymptomatic and mild COVID infection. The mother has to wear mask and maintain hand hygiene.

  • Exclusive breastfeeding,
  • Hygiene, virtual celebrations
  • Routine vaccination
  • Limiting visitors
  • Isolating from sick family members
  • Having a non infected nurse or attendant
  • Most babies have no symptoms. Vaccination to prevent other serious infections is essential and should be given on a priority basis.
  • If the baby is symptomatic or needs NICU care, Hep B is given and BCG may be postponed for 14days.
  • In COVID positive mothers, all elective procedures including tubectomy are best avoided. Temporary methods should be adopted for contraception.

COVID vaccines being crash-launched in a crisis, hence data regarding safety and efficacy is limited. However, FOGSI has recommended for approval of vaccination in pregnant and breastfeeding mothers on 30th April 2021, due to the rampant spread and serious morbidity of COVID
It would be ideal for women to take the vaccination prior to planning pregnancy.

References

  • GOI, Ministry of Health and Family Welfare Guidelines
  • COVID -19 in Pregnancy, RCOG 24July 2020
  • FOGSI guidelines April 2021
  • ICMR guidelines July 2020
  • Corona in Pregnancy WHO April 2021
Ankura
Author: Ankura

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