24/03/2020
COVID 19 & PREGNANCY
With the current state of emergency and curfew in our republic I hope the following advice may be of help to my patients as well as to other pregnant ladies. Most of the following notes and advice are mentioned in the Royal College of Obstetricians & Gynecologists’ &Royal College of Midwives. This virus is a new one and policies as well as management of this condition might change with time.
I trust this may be of help to our population in this moment of crisis.
Pregnant women are vulnerable. This means that they should reduce social contact through social distancing measures. Based on the current evidence so far, pregnant women are still no more likely to contract coronavirus than the general population.
It is known that in certain severe viral infections the body of a pregnant woman can alter to handle the infection. What has driven the decisions made by officials to place pregnant women in the vulnerable category is caution. Some viral infections are worse in pregnant women. At the moment, there’s no evidence that this is the case for coronavirus infection and there is no evidence that pregnant women who get this infection are more at risk of serious complications than any other healthy individuals. but the amount of evidence available is still quite limited.
• Does CoVid-19 affect pregnant women?
It does but fortunately it does not appear to be more severe than in other healthy adults. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.
More severe symptoms such as pneumonia appear to be more common in older people, those with weakened immune systems or long-term conditions. As yet, there is no evidence that pregnant women who get this infection are more at risk of serious complications than any other healthy individuals.
• If a pregnant lady is diagnosed being CoVid-19 positive , will her baby be affected?
This is a new virus and there is no evidence to suggest an increased risk of miscarriage.
There is also no evidence that the virus can pass to the baby during pregnancy (vertical transmission). Two cases of possible vertical transmission have been reported. In both cases, it remains unclear whether transmission was prior to or soon after birth.
A recent report from China of four women with coronavirus infection when they gave birth found no evidence of the infection in their newborn babies.
Expert opinion is that the baby is unlikely to be exposed during pregnancy. Some babies born to women with symptoms of coronavirus in China have been born prematurely. It is unclear whether coronavirus caused early labour, or whether it was recommended that the baby was born early in order to preserve the mother’s health.
• What should a pregnant lady do to reduce her risk of catching the virus?
Regular hand washing
Use a tissue when coughing or sneezing and then discard it. Then wash hands. Again.
Avoid contact with someone who is displaying symptoms of coronavirus. (High temperature and/or new and continuous cough)
Avoid non-essential use of public transport when possible
Work from home, where possible.
Avoid large and small gatherings. (Infections spread easily in closed spaces where people gather together).
Avoid gatherings with friends and family.
Keep in touch using remote technology such as phone, internet, and social media.
• Should a pregnant lady continue to work?
Pregnant women who can work from home should do so.
If the lady works in a public-facing role then this can be modified appropriately to minimize her exposure, and this should be considered and discussed with the employer.
If a lady is pregnant less than 28 weeks pregnant with no underlying health conditions, she should practice social distancing but can continue to work in a public-facing role, provided the necessary precautions are taken.
If her pregnancy is more than 28 weeks or have an underlying health condition – such as heart or lung disease, she should then work from home where possible, avoid contact with anyone with symptoms of coronavirus, and significantly reduce unnecessary social contact.
• What advice to pregnant healthcare workers? and pregnant?
If pregnancy is less than 28 weeks pregnant, with no underlying health conditions, she should practice social distancing but can continue to work in a patient-facing role, provided the necessary precautions are taken. She should avoid, where possible, caring for patients with suspected or confirmed coronavirus infection. If this is not possible, you should use personal protective equipment (PPE) and ensure a thorough risk assessment is undertaken.
Some working environments, such as operating theatres, respiratory wards and intensive care/high dependency units, carry a higher risk for all pregnant women of exposure to the virus and all healthcare workers in these settings are recommended to use appropriate PPE.
For pregnant healthcare workers more than 28 weeks gestation, or with an underlying health condition, she should avoid direct patient contact. She should work from home where possible, avoid contact with anyone with symptoms of coronavirus, and significantly reduce unnecessary social contact.
Employers need to be flexible with them and encourage them to work in a no contact zone.
• What about their antenatal appointments?
It is important to attend regular antenatal visits for safety of both mother and baby.
However we are right now in an emergency sanitary state where there is lock down. In these conditions the following should be considered:-
Routine regular appointment or visit might change due to staff inadequacy.
The number of antenatal visits will be reduced.
Some appointments may be conducted on the telephone or using videoconferencing, provided there is a reasonable expectation that maternal observations or tests are not required.
If patient is a high risk case and needs to attend more regularly then she should be in contact with her doctor or hospital where consultations can be arranged
Patient should be in touch with her doctor and inform him / her of any untoward symptoms.
She should continue her regular supplements.
If patient has urgent problems (bleeding, abdominal pain, less fetal movements, fever, etc) she should attend the hospital or her doctor as soon as possible.
Patients are advised to keep the number of people accompanying them to a minimum and not bring children
If she has symptoms of possible coronavirus infection, she should contact the flu clinics or emergencies and seek advice from the heath professional there
• Can a suspected or confirmed Coronavirus lady breastfeed her baby?
Yes. There is no evidence that the virus is carried out in breast milk. The recognized benefits of breast feeding outweighs any potential risks of transmission of the corona virus through breast milk
The following precautions are to be taken while breast feeding:-
Wash the hands before touching baby or breast pumps or bottles.
Avoid coughing or sneezing on baby while breast feeding.
Consider wearing a face mask while breastfeeding.
Do follow strict recommendations for cleaning of breast pump.
Do consider someone who is well to feed the baby with expressed breast milk if patient is COVID-19 Positive.
