Looking at our population and birth rate, this is a discussion that would be happening every minute across the nation and no Obstetrician is really in a position to give a clear cut reply. Primarily owing to very little data available from across the globe, leave alone India. Despite the numbers involved.
Fortunately, current evidence, though grossly insufficient, points to the below-mentioned facts that bring some relief for pregnant ladies and their family members. These are from recommendations made by the Federation of Obstetric & Gynecological Societies of India (Version 1, 28-03-2020), related to Pregnancy With Covid-19 Infection.
- Pregnant ladies infected with COVID-19 do not appear to be more likely to be severely sick than other healthy adults.
- only slight to moderate cold or Flu-like signs and symptoms will be experienced
- If the pregnant woman has co-morbid conditions which includes diabetes, hypertension, obesity, respiratory ailment or is elderly, she is more likely to have a severe form of respiratory sickness
- Preliminary studies show that the contagion is neither likely to be transmitted from the mother to foetus nor secreted thru the breast milk
- According to two documented reports in 18 pregnant girls with suspected or conrmed COVID-19 pneumonia, not even one of the neonates, born thru C- section, tested positive for the corona virus, at birth
- The reports further said that there have been no strains of the virus in either the mom’s amniotic fluid, cord blood or breast milk
The general Coronavirus Infection in Pregnancy guidance published (30-03-2020) by the Royal College Of Gynecologists (RCOG) has data of a single case where vertical transmission has been proved to have occurred. Either this could be a one off case due to some existing conditions or there could be probability of transmission from mother to foetus. Due to insufficient data we are none the wiser about the reasons why this might have occurred in this particular case. Nevertheless, the RCOG has labelled the occurrence of Vertical Transmission as ‘probable’. Incidentally, the baby recovered and was discharged.
Coming back therefore, to the moot question whether the couple should proceed with the pregnancy or not – this would be a highly personalised decision taken in consultation with the Obstetrician. If termination is not an option, the couple needs to register at a nursing home where due precautions will be taken to ensure a safe and infection-free pregnancy. At a cost that is within the means of the couple. They should select a provider carefully, without simply banking on the tertiary capability. A provider dedicated to Obstetric and Gynec care may be a better option than a multi-speciality where all types of patients are admitted and may compete for resources in short supply.
The current international advisory to limit pregnancies as far as possible and avoid fertility treatment makes sense for 2 reasons-
- Lack of sufficient data about Pregnancy and Novel Corona Virus
- Helps reduce the load on the medical infrastructure and professionals who are already coping well beyond their means in trying to overcome the Corona Virus
Undoubtedly though some couples will prefer to terminate, there will be lakhs who may not have the option. Termination is a time sensitive procedure. Those who are beyond 20 weeks of gestation would not have the choice of termination. They have to proceed with the pregnancy and take all possible steps as recommended by their Obstetrician, in line with the recommendations issued by the national society of Gynecologists (FOGSI) and state specific additions / modifications made by the state level societies (AMOGS in Maharashtra).
To generalise the recommendations-
- If you are planning a pregnancy- put it off till things stabilise, if possible
- If you are already pregnant, you need to consult your Obstetrician and decide thereafter
Do bear in mind that medical capabilities will probably ensure a good result. However, depending upon your location in India, the situation at the time of delivery may be such that medical help may either not be accessible or too expensive.
And finally we come to the question of immunity. Covid-19 positive Women who may decide to abort would like to have some guarantee that they will be safe when they conceive again! Unfortunately, this can’t be guaranteed yet, because we just don’t have any data on this. The Novel Corona Virus is a slippery virus and capable of mutating. Which means immunity developed after the first infection may be transient.
Secondly, it’s going to take time for herd immunity to develop in India, according to Dr Jayaprakash Muliyil, one of India’s foremost epidemiologist & former principal CMC Vellore. According to him, as on Mid April 2020, barely 1% of our population has been exposed to the virus. For herd immunity to develop we require 50% of India’s population to be exposed. This will take time and will have its consequences.
Management of Labour and Delivery in women with COVID-19 infection
Should labour be induced or the woman delivered early because of COVID-19 infection? There is no rationale to support this unless the individual has a specific set of circumstances that warrants one of these options. The route of delivery should be determined by the standard universally recommended obstetric practice norms in most situations.
Newborn care: should be practised as per routine, at the present. Testing is suggested if the mother has COVID-19 infection or if the baby is symptomatic. Breastfeeding is recommended but good hygiene practices must be strictly observed.
Isolation of the mother from the neonate may be required, depending upon her or the baby’s condition and degree of illness. In such a situation, psychological assessment and support is recommended.