Coronavirus | Managing pregnancy and childbirth

Updated - April 02, 2020 02:02 am IST

Published - April 01, 2020 11:32 pm IST

Dr. A. Jaishree Gajaraj, 
Senior obstetrician and gynaecologist.

Dr. A. Jaishree Gajaraj, Senior obstetrician and gynaecologist.

“Doctor, I am in my 31st week of pregnancy; neighbours and friends tell me that I am more prone to get the infection. I am afraid. What should I do?”

As obstetricians taking care of mums-to-be, we have received many a phone call seeking help and reassurance. The fear and anxiety is understandable. Thorough knowledge of the infection and its consequences will certainly help allay this fear and anxiety.

Does pregnancy make a woman more susceptible to coronavirus infection? Although pregnancy is an immuno-compromised state, we know from years of experience that most pregnant women go through pregnancy without any major compromise. Compared to the general population they are more likely to contract the infection and hence categorised as a high-risk group. There is, therefore, a need for more strict measures to be followed by both the pregnant women and their caregivers.

Sneezing, running nose, sore throat, fever and sometimes cough – extremely common symptoms. Then, how does one differentiate the common cold from a possible corona infection? Common treatment for such symptoms would be steam inhalation, paracetamol and antihistaminics (for cold).

In the absence of exposure to or contact with a known COVID suspect or history of travel within close contacts (family and friends), the initial treatment should contain the infection. If however your symptoms persist, become more severe or recovery is delayed – it may be an indication of a more severe respiratory infection and you should contact your doctor. Please do not panic as this may still not be indicative of a COVID infection. Kindly ascertain from your doctor regarding the place of consultation. It may not be the clinic where you regularly visit.

The need for social distancing and self isolation cannot be overemphasized. Pregnant women should stay indoors, not participate in social gatherings and postpone “baby showers”. If a family member develops a cough or cold you should isolate yourself for a minimum of two weeks in a separate room or till he/she recovers.

Our knowledge of the infection itself and its spread is limited. Given the limited information currently available, it would be prudent to strictly adhere to social distancing, especially beyond 28 weeks of pregnancy.

COVID infection and pregnancy There is insufficient evidence at present to support vertical transmission from mother to baby in utero, during delivery or breast feeding. Reports of miscarriage, growth restriction in the baby, especially when the infection occurs in the last trimester and induced preterm labour, though occasional, should be kept in mind.

Routine Antenatal (pregnancy) Care

You may be at various stages in your pregnancy. Trimester I or upto 12 weeks, after pregnancy confirmed on ultrasound scan, there is no need for an urgent AN visit.

Certain scans i.e., the first trimester scan, anomaly scan and growth scan are time-bound and you should contact your doctor. If you do not have any significant risk factors i.e., age, multiple pregnancy (twins), raised blood pressure, diabetes or other medical or pregnancy related disorders, you can at your doctor’s discretion reschedule your monthly visits. The aim would be to minimise exposure to the women and their caregivers. Routine clarification of doubts can be over telephone or video calls.

Delivery and immediate post partum

Your obstetrician and maternity unit may not be able to comply with all aspects of care you may have agreed to in your birth plan. Safety is of utmost importance and this will be definitely ensured. Risks of airborne transmission is high during normal delivery and precautions will be taken even if you are not a COVID suspect. If an emergency caesarean section is required, your doctor will advise you accordingly.

You can breastfeed your baby. Isolation may be advised only if there is suspicion or history of exposure.

Home Delivery

We have had requests for “home delivery” as it is presumed to be a “safer” place than a maternity unit in a hospital. Delivery at home certainly has many attendant risks and should be strongly discouraged in the current scenario. Monitoring of the mother and foetus may be sub-optimal. Access to emergency care, if it becomes necessary, i.e., transport, availability of blood and maternity units and personnel may be very difficult to organise.

Working women

Working women without any co-morbid factors can continue to work but must follow social distancing. If you are more than 28 weeks pregnant or have any risk factors it is best to coordinate with your workplace and your doctor and make a decision.

There could be a number of asymptomatic individuals among us who are carrying the virus.

The care of pregnant women affected by the coronavirus will be protocol driven and is not discussed here.

Remember, my dear parents to be. Our priority should be reduction of transmission and safety first. My wishes to all of you for a smooth, safe pregnancy and delivery.

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