More risks for pregnant women in COVID second wave

The second wave of COVID-19 has been impacting pregnant women in the State quite adversely. A sudden increase in maternal deaths and a handful of near-miss mortality events among pregnant women in Kerala in the past three months following COVID-19 have sent alarm bells ringing, with obstetricians calling for close monitoring of all pregnant women contracting COVID-19.

“In the initial days of COVID-19, we were apprehensive about its impact on pregnant women but it did not pose a serious risk. But in its second wave, COVID-19 has been very aggressive and its presentation so different that we have been losing many mothers unexpectedly. We are extremely worried,” V.P. Paily, a senior obstetrician and the State coordinator of Confidential Review of Maternal Deaths, a maternal death auditing process undertaken by Kerala Federation of Obstetrics and Gynaecology (KFOG), said.

In the last one year from March, seven pregnant women in the State died of COVID-19. While some deaths were largely due to issues in advanced pregnancy, in some, COVID-19 aggravated underlying issues. However, this year, in the past three months alone, 14 pregnant women have lost their lives following COVID-related complications.

Near-miss mortality events

There have also been some 24 near-miss mortality events and many of those women are still in ICUs and ventilators, fighting for their lives. Near-miss events are under-reported and hence the actual number could be much more. (A near-miss event is one wherein a woman nearly dies but survives the complications during pregnancy/child birth/post-natal period). The Health Department is yet to bring the data to the public domain.

Fourteen of all COVID-19 deaths of pregnant women had occurred in the third trimester, while the others had happened in the second trimester and in the post-natal period. COVID pneumonia was the cause of death in 17 cases, while COVID-associated cytokine storm and pulmonary embolism led to the death of others.

Diabetes, most common

Diabetes was the most common co-morbidity, while some others had hypertension, hypothyroidism or asthma. The new onset morbidities following COVID included renal failure, myocarditis, pneumothorax and placental abruption.

“Some of the mothers were only in the second trimester. Their clinical history was not prolonged and their disease seemed to deteriorate rapidly. During H1N1, we had a good antiviral drug, Tamiflu, which worked. In the absence of a sure-shot drug, all pregnant women with COVID-19 need to be monitored closely and those with co-morbidities like gestational diabetes will need special attention. A multidisciplinary team should manage these women, because many of them go on to develop thromboembolic and renal issues,” Dr. Paily said.

Poor glycaemic control has been a primary cause contributing to complications and mortality following COVID-19 . It is thus important that pregnant women are educated on this and are helped to achieve adequate blood sugar control.

The KFOG had written to the Centre earlier that pregnant women should be offered COVID-19 vaccination to protect them from serious complications. Now that the NITI Aayog has left it to the choice of pregnant women, whether they should vaccinate or not, the KFOG will encourage all pregnant women to get vaccinated as the benefits outweighs risks. The KFOG has already asked the State Health authorities to modify its vaccination protocols.

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Printable version | Jul 28, 2021 1:08:57 AM |

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