Covid-19 in pregnancy
Dr Vidhi Chaudhary
Associate Professor .DNB.,MRCOG(UK). DIP.
LAPROSCOPY(KIEL,GERMANY)
Obstetrics and gynaecology
Lady Hardinge Medical College, Delhi
COVID -19 virus
• SARS-CoV-2 is a new coronavirus, and therefore the evidence currently available to guide clinical
management in this specific situation is of low quality
• Human to human transmission.
• Two routes by which COVID-19 can be spread.
• Close contact with an infected person (within 2 metres) where respiratory secretions can enter the
eyes, mouth, nose or airways.
• The second route is indirectly via the touching of a surface, object or the hand of an infected person
contaminated with respiratory secretions and subsequently touching one’s own mouth,nose or eyes
Basic preventive measures
• i. Physical distancing of at least one meter to be followed at all times.
• ii. Use of face covers/masks to be mandatory.
• iii. Practice frequent hand washing (for at least 40-60 seconds) even when
hands are not visibly dirty and use of alcohol based hand sanitizers (for at least
20 seconds).
• iv. Respiratory etiquettes to be strictly followed.
• v. Self-monitoring of health by all and reporting any illness at the earliest
Guidelines on preventive measures to contain spread of COVID-
19 in workplace settings :GOI:18th May 2020
COVID-19 VIRUS IN PREGNANCY
• Pregnant women do not appear more likely to contract the infection than
the general population. Some may have severe symptoms.
• vertical transmission is probable
• Altered immune responses- few may have severe symptoms such as
pneumonia and marked hypoxia( usually in older people, the
immunosuppressed and those with long-term conditions such as diabetes,
cancer and chronic lung disease).
Risks in pregnancy
• Majority asymptomatic
• Risk more towards late trimester
• Preterm birth
• Thromboembolism
Effect on the fetus
• no data suggesting an increased risk of miscarriage or early pregnancy loss .
• no evidence currently that the virus is teratogenic
• case reports of preterm birth in women with COVID-19
SCHEME OF CARE: ZONES .
• The Red zone (COVID +ve) :
• COVID Block
• COVID Emergency ( complete erstwhile emergency area) + Mat IV area
• YMCA - is Red zone for Asymptomatic COVID +ve cases.
Orange zone (suspect) includes:
Mat I ,Mat II ,SARI, KSCH,
TEST
• Full blood count,
• Testing for COVID-19
• transfer the woman to an isolation room and donn appropriate PPE.
Strategy for COVID19 testing in India (Version 5, dated 18/05/2020)
• 1. All symptomatic (ILI symptoms) individuals with history of international
travel in the last 14 days.
• 2. All symptomatic (ILI symptoms) contacts of laboratory confirmed cases.
• 3. All symptomatic (ILI symptoms) health care workers / frontline workers
involved in containment and mitigation of COVID19
Strategy for COVID19 testing in India (Version
5, dated 18/05/2020)
• 4. All patients of Severe Acute Respiratory Infection (SARI).
• 5. Asymptomatic direct and high-risk contacts of a confirmed case to be tested once between
day 5 and day 10 of coming into contact.
• 6. All symptomatic ILI within hotspots/containment zones.
• 7. All hospitalised patients who develop ILI symptoms.
• 8. All symptomatic ILI among returnees and migrants within 7 days of illness.
• 9. No emergency procedure (including deliveries) should be delayed for lack of test.
• However, sample can be sent for testing if indicated as above (1-8), simultaneously.
Glossary: Testing strategies.
• ILI case is defined as one with acute respiratory infection with fever ≥ 38 ◦C AND
cough.
•
• ● SARI case is defined as one with acute respiratory infection with fever ≥ 38◦C AND
cough AND requiring hospitalization.
•
• ● All testing in the above categories is recommended by real time RT-PCR test only.
Guidelines on preventive measures to
contain spread of COVID-19 in
workplace settings :GOI:18th May 2020
PREGNANT :Clinically assigned as a very mild
case/ pre-symptomatic case
• Eligibile for home isolation
• Requisite facility at their residence for self-isolation and also for
quarantining the family contacts.
• A care giver should be available to provide care on 24 x7 basis.
• A communication link between the caregiver and hospital is a prerequisite
for the entire duration of home isolation.
PREGNANT :clinically assigned as a very mild
case/ pre-symptomatic case
• The care giver and all close contacts of such cases should take Hydroxychloroquine
prophylaxis as per protocol and as prescribed by the treating medical officer.
• Download Arogya Setu App on mobile
• The patient shall agree to monitor his health and regularly inform his health status
to the District Surveillance Officer
• The patient will fill in an undertaking on self-isolation (Annexure I) and shall follow
home quarantine guidelines.
https://www.mohfw.gov.in/pdf/
RevisedguidelinesforHomeIsolationofverymild
presymptomaticCOVID19cases10May2020.pdf)
When to discontinue home isolation
• Patient under home isolation will end home isolation after 17 days of onset
of symptoms (or date of sampling, for pre-symptomatic cases) and no fever
for 10 days.
• There is no need for testing after the home isolation period is over.
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When to seek medical attention
• Patient / Care giver will keep monitoring their health.
• Immediate medical attention must be sought if serious signs or symptoms develop.
i. Difficulty in breathing,
ii. Persistent pain/pressure in the chest,
iii. Mental confusion or inability to arouse,
iv. Developing bluish discolorations of lips/face
v. As advised by treating medical officer
Management
• Antenatal
Mild cases- isolation (self or facility)
Severe symptoms- admit in covid hospital
• Labor
Efforts should be made to minimise the number of staff members
Inform consultant obstetrician, consultant anaesthetist, and consultant neonatologist.
Hourly observations should include respiratory rate and oxygen saturations
Spontaneous labor may be allowed with caesarean for obstetric indications.
Caesarean
section
• Donn full surgical PPE.
• Usual aseptic precautions.
LABOR AND DELIVERY
• MONITORING BY CTG
• USUAL OBSTETRIC GUIDELINES TO FOLLOW FOR ALL STAGES OF
LABOR.
• RARE VERTICAL TRANSMISSION
POSTPARTUM
• ALL SUSPECTS AND POSITIVE - BABIES ARE ISOLATED FROM MOTHERS
• EXPRESSED BREAST MILK
• TILL REPORT NEGATIVE
Risk profiling of contacts
• Contacts are persons who have been exposed to a confirmed case anytime between 2
days prior to onset of symptoms (in the positive case) and the date of isolation (or
maximum 14 days after the symptom onset in the case).
• High risk contact- quarantined for 14 days. Test as per ICMR guidelines
• Low risk contact- continue to work and closely monitor their health for next 14 days.
Guidelines on preventive measures to contain spread of COVID-19 in workplace
settings :GOI:18th May 2020
High-risk contact
• Touched body fluids of the patient (respiratory tract secretions, blood,
vomit, saliva, urine, faeces; e.g. being coughed on, touching used paper
tissues with a bare hand)
• Had direct physical contact with the body of the patient including physical
examination without PPE
High-risk contact
• Touched or cleaned the linens, clothes, or dishes of the patient. • Lives in
the same household as the patient.
• Anyone in close proximity (within 1 meter) of the confirmed case without
precautions.
• Passengers in close proximity (within 1 meter) in a conveyance with a
symptomatic person who later tested positive for COVID-19 for more than 6
hours.
Low-risk contact
• Shared the same space (worked in same room/similar) but not having a
high-risk exposure to confirmed case of COVID-19.
• Travelled in same environment (bus/train/flight/any mode of transit) but not
having a high-risk exposure.
When one or few person(s) who share a room/close office space is/are
found to be suffering from symptoms suggestive of COVID-19:
Place the ill person in a room or area where they are isolated from others
Report to concerned central/state health authorities. Helpline 1075
Undertake risk assessment(district RRT/treating physician).
