The nodal body for testing and treatment of Covid-19 in India is The Department Of Health Research, at the Indian Council Of Medical Research (ICMR), which has updated the ‘Strategy for COVID19 testing for pregnant women in India (Version 1) on 20th April 2020.
All clinicians and institutes dealing with pregnant ladies are required to carry out Testing as per the ICMR testing strategy (https://icmr.nic.in/content/covid-19).
Pregnant women who are residents of containment zones or clusters, who present in labour or are likely to deliver within subsequent 5 days, need to be tested even if they do not show any symptoms of Covid-19 (asymptomatic). This applies equally to those pregnant ladies evacuated from from hotspot districts or members of large migration gatherings.
Testing of asymptomatic pregnant women should be performed at the health facilities where they were scheduled to deliver.
The facility is required to make all arrangements to collect and transfer samples to authorised testing facilities.
Lack of testing facilities can not be a justification for referring the Women to higher facility, please note.
The testing is done according to the same criteria as employed for evaluating all normal adults. Testing for Covid-19 in pregnant women is to be performed only on those who
- have acute respiratory illness
- history of exposure, travel, contact,
- are themselves Health Care Workers or
- those requiring hospitalisation
Another category is pregnant women who do not fall in any of the above categories but present with Severe Acute Respiratory disease (SARI) .
Recommended Test Techniques and Facilities– All institutes must observe the Government of India Guidelines on testing.
Other investigations – supportive investigations include blood research for contamination and systemic assessment and imaging by way of CT scan with the precaution of abdominal shielding.
Test methods and facilities
Sampling strategy:
The Center for Disease Control & Prevention (CDC) recommends a nasopharyngeal swab specimen to be collected for COVID-19 test.
An oropharyngeal swab may additionally be recommended but is not essential. However, if it is collected, the oropharyngeal swab should be placed in the same container as the nasopharyngeal specimen.
Sputum is to be collected only if the patient has a productive cough.
Testing methodology:
As of now, detection of COVID-19 is done by a technique known as ‘Reverse-transcription polymerase chain reaction’ (RT-PCR). The test can only be performed from a center which is authorized by the Central or State government.
Currently there are 114 ICMR approved public laboratories where the test can be done.
As far as private laboratories are concerned, the government has authorised some private labs to conducted Covid-19 tests from 22 March 2020.
The cost of the tests
This has been capped in private labs at Rs 4500/-.
Lead Time For Results to be available
Reports generally take at least 24 hour to become available.
Test is to be repeated only if clinically warranted.
Rapid Testing Facilities
Molecular diagnostic tests that can give results in 2-3 hours may be available soon across the country. Currently the supply is limited to few areas and centers only.
Points To Be Noted
False negative tests (Patient is infected with Covid-19 but the test is negative) are known to occur. The occurrence rate is between 10-30% even if two serial swabs are evaluated by the RT-PCR technique.
More Reliable Testing Method
Serological testing for the presence of antibodies to the Covid-19 infection and Nucleic Acid Amplication Test (NAAT) are more advanced tests that may be available in the near future. NAAT is a gold standard test but it is more expensive and in this method there is an inherent risk of multiplication of viral particles.
Serological testing, on the other hand, is faster and cheaper. On a large scale, as at a population level, serological testing to evaluate the prevalence of Covid-19 infection in that population is a more feasible method.
Also, after 3 weeks of infection, the serology would give the correct diagnosis as compared to the RT-PCR, which would be negative.
Other investigations
X-rays and CT scans are the other investigations likely to be asked for in patients suspected of and also those with confirmed Covid-19 infections. For pregnant women undergoing these radiological investigations an abdominal shield must be provided to protect the foetus from exposure to harmful radiation.
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