Novel coronavirus (SARS-COV-2) is a new strain of coronavirus causing COVID-19, first identified in Wuhan City, China. Other coronavirus infections include the common cold (HCoV 229E, NL63, OC43 and HKU1), Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).
Cases of COVID-19 globally have evidence of human to human transmission. Recently cases have appeared where there is no evidence of contact with infected people.This virus appears to spread readily, through respiratory, fomite or feco-oral methods. People are recommended to employ strict infection prevention and control (IPC) measures; guidance is available as per local Health advisories.
Two cases of possible vertical transmission (transmission from mother to baby antenatally- before delivery or intrapartum- during delivery) have been reported. In both cases, it remains unclear whether the transmission was prior to or soon after birth. Expert opinion is that the fetus is unlikely to be exposed during pregnancy. A case series published by Chen et al tested amniotic fluid, cord blood, the newborn’s throat swabs and breast milk samples from COVID-19 infected mothers and all samples tested negative for the virus. Furthermore, in a different paper by Chen et al, three placentas of infected mothers were swabbed and tested negative for the virus; and in another case series by the same team, of three infants born to symptomatic mothers tested for the coronavirus, none had positive tests.
Transmission is, therefore, most likely to be as a newborn and in another case series by the same team, of three infants born to symptomatic mothers tested for the coronavirus, none had positive tests. There is currently no evidence concerning transmission through genital fluids.
The large majority of women will experience only mild or moderate cold/flu-like symptoms. Cough, fever and shortness of breath are other relevant symptoms. More severe symptoms such as pneumonia and marked hypoxia are widely described with COVID-19 in older people, the immunosuppressed and those with long- term conditions such as diabetes, cancer and chronic lung disease. These symptoms could occur in pregnant women so should be identified and treated promptly. At present there is one reported case of a woman with COVID-19 who was admitted to hospital at 34 weeks of pregnancy, had an emergency Caesarean section for a stillborn baby and was admitted to the intensive care unit with multiple organ dysfunction and acute respiratory distress syndrome, requiring extracorporeal membrane oxygenation. Within the general population, there is evolving evidence that there could be a set of asymptomatic individuals or those with very minor symptoms that are carrying the virus, although the incidence is unknown.
There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. Case reports from early pregnancy studies with SARS and MERS do not demonstrate a convincing relationship between infection and increased risk of miscarriage or second-trimester loss.
As there is no evidence of intrauterine fetal infection with COVID-19 it is therefore currently considered unlikely that there will be congenital effects of the virus on fetal development.
There are case reports of preterm birth in women with COVID-19, but it is unclear whether the preterm birth was always iatrogenic (brought about by a medical professional or by treatment or by treatment environment), or whether some were spontaneous. Iatrogenic delivery was predominantly for maternal indications related to the viral infection, although there was evidence of fetal compromise and pre-labour premature rupture of membrane, in at least one report.
As a pregnant woman, the news of the coronavirus pandemic may have caused you concern.
We would like to reiterate that the evidence we have so far is that pregnant women are still no more likely to contract the infection than the general population. And it's high in the general populace right now. What we do know is that pregnancy, in a small proportion of women, can alter how your body handles severe viral infections. This is something that midwives and obstetricians have known for many years and are used to dealing with.
What is there is the need to restrict the spread of illness because if the number of infections was to rise sharply the number of severely infected women could rise and this could put the lives of some pregnant women in danger.*
My friendly gynaec’s take on Pregnancy and SAR CoV 2 pandemic is:
Pregnant women are a special category in terms of healthcare and are possibly more susceptible. They should therefore, follow these guidelines fastidiously. They can protect themselves by the motto “Do the Five”. The principle elements of this are:
|Home||Stay at home as much as possible unless there is a medical need related to development of symptoms of infection or related to pregnancy. |
Routine antenatal visits are to be deferred. If there is a minor query, it can be sorted out telephonically. At present, telephonic consultations are permitted by the Medical Council of India till the situation comes under control (9).
Keep the traffic of home visitors including homecare personnel, maids, and staff members to a minimum or avoid completely if possible.
|Hands||Washing their hands frequently and properly with a soap and water or an alcohol-based hand rub for minimum 20 seconds|
|Elbow||Covering their mouth and nose with their bent elbow, handkerchief or tissue while coughing or sneezing. Then the used tissue should be disposed off immediately. This is an important component of respiratory hygiene.|
|Face||Avoid touching your face, eyes, nose and mouth with hands.|
|Space||Keep a distance of at least 1 meter from the next person outside and in the house.|
Instructions for contacts, When a pregnant woman is home quarantined
The home quarantined pregnant lady should:
· Stay in a well-ventilated single-room preferably with an attached/separate toilet.
· If another family member needs to stay in the same room, it's advisable to maintain a distance of at least 1 meter between the two.
· Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household.
· Restrict his/her movement within the house.
· Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc.
General health measures to be followed in quarantine include hand washing, avoiding sharing fomites, wearing a surgical mask and changing it every 6 to 8 hours with correct disposal in 1% hypochlorite solution. If symptoms appear during quarantine, the pregnant woman should contact a health facility by telephone and follow the given advice.
Family members of the pregnant woman quarantined at home should keep a distance from her at all times and avoid direct contact with her and her fomites. Disposable gloves should be used in case soiled linen has to be handled. Visitors should not be allowed. Clothes should be washed separately.
The duration of home quarantine is 14 days from the time of exposure to a confirmed case or earlier if a test is performed on a suspect case and it is negative.
*SOURCE- ROYAL COLLEGE OF OBSTETRICS AND GYNAECOLOGY ,UK ,UPDATED MARCH 18 2020
FOGSI 28/3/2020 (FEDERATION OF OBSTETRICS AND GYNAECOLOGICAL SOCIETY OF INDIA)
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