‘Courage is contagious, ignorance is pandemic’ is the logo of the association of Maharashtra Obstetrics & Gynecologists. Therefore first and foremost is dispensing with ignorance and embracing knowledge about the current scenario for pregnant women, during the Coronavirus pandemic, a global catastrophe on an unprecedented scale.
“COVID-19” is the illness caused by the novel coronavirus, technically known as “SARS-CoV-2”. The brief issued by AMOGS outlines the possible specific impact of this infection on pregnant women given their unique requirements as well as the needs of their unborn or new-born babies. In many cases, we are dealing with twins due to assisted fertility programs (IVF, etc)
Owing to the evolving nature of data and the lack of sufficient information, these recommendations and guidelines will also evolve and subsequent updates will be issued by AMOGS based on updated info. This particular epidemic is of special concern in pregnant women because it severely affects the respiratory system and we know that even under normal circumstances, pneumonia is an important cause of maternal morbidity and mortality because physiologic changes that occur in pregnancy lead to natural suppression of the body’s immunity. Which means that a simple cold or Flu infection can lead to lung infection manifesting into pneumonia.
Based on an understanding of the current situation, which is dependent on current knowledge and experience of the medical fraternity from across the world, specific recommendations for antepartum (pre-childbirth), intrapartum (during delivery) and postpartum (post-childbirth) care have been issued by Amogs, with the rider that they are likely to be updated as our understanding and experience deepens. Patients must understand this and while following these guidelines, must temper them with the latest regulations and updates available.
The first question that is likely to be asked is – Do I need to be tested for COVID-19 if I exhibit some of
Should you be experiencing or have experienced fever > 100 deg F (38 deg C ) and/or difficulty in breathing and/or Cough – you should immediately consult your Obstetrician. This can be done online now. Based on your symptoms and travel/contact history you may be advised to get tested for COVID-19 or other tests may be prescribed.
What if I Test Positive for the Coronavirus infection?
If the test for COVID-19 is recommended and turns out to be positive, you will have to get admitted for treatment and isolation at a suitable facility that is authorized by the local health authorities for admitting & treating Covid-19 patients.
Antepartum fetal monitoring of confirmed COVID-19 cases ought to happen month to month and incorporate fetal ultrasound appraisal for development and anatomy. However, risk of travelling and exposure at the USG clinic needs to be taken into account by your health provider and based on this scans may be restricted to 12, 20 and 32 weeks, as currently recommended by the health authorities.
What if I Test Negative for the Coronavirus infection ?
If the test for Coronavirus is negative you will be required to home quarantine and resume ante- natal after 14 days symptom-free status or negative test result.
If self quarantined and if ante-natal care cannot be delayed, alternate arrangements should be organized in discussion with the medical team. Fortunately, with available communication technology and consent of the Medical Council, avenues like telemedicine, online consultation, video calling, etc are ways to keep in touch with the treatment providers.
IF Positive, How Is The Baby Safeguarded in the Womb and after Birth?
So far, as on mid-April 2020, apart from a single documented case by the RCOG, there is no robust evidence of vertical transmission of the Coronavirus. That is maternal-to-fetal transmission of SARS-CoV2 is probable but not evidenced. However, data is still coming in and the situation is evolving as the disease onset and pattern are new. This situation may change subsequently. Nevertheless, it may be noted that in the evidenced case the outcome was a baby that survived & recovered well.
After birth comes the big question of breastfeeding. This is recommended, even in positive mothers, because there is no evidence of secretion of the virus through the mothers milk. Breastfeeding is to be done with strict protocols for hygiene. So handwashing, mask, screen, etc become a must.
The baby will be tested for the virus after birth if the mother is positive. Based on the test reports, further action will be taken. As on date, the earliest that a COVID-19 infection has been observed in a baby was 30 hours post-delivery, as per the guidelines issued by the Royal College of Gynaecologists (UK), 30-04-2020.