brand logo

Covid-19 and pregnancy: Complication and considerations

2 years ago

Share on

By Dr. Dilshan Anthony Fernando   Sri Lanka is currently facing a raging third wave of Covid-19 infections, and pregnant mothers are being reported as testing positive for the virus. On 5 May, Sri Lanka reported the first death of a pregnant woman from the Covid-19. According to health authorities, this 45-year-old lady, who was three months into her pregnancy, had succumbed to the virus at the Ragama Teaching Hospital. Since then, five more maternal deaths have occurred due to Covid-19. According to the Family Health Bureau (FHB), more than 70 pregnant women with Covid-19 are being treated in hospitals across the country.   Vaccination of pregnant women With the rapid progression of Covid-19, many vaccines were developed the world over. However, in this process, testing was not conducted on pregnant or lactating mothers, and therefore clinical trial data is not available. Given the current circumstances, many countries have approved the vaccination of pregnant women. The Sri Lanka College of Obstetricians and Gynaecologists recommended that all pregnant women be vaccinated, irrespective of the gestation. On 9 June, the administration of the Sinopharm vaccine to pregnant women commenced at the Piliyandala Medical Officer of Health (MOH) office, with it being administered to 35 pregnant women over the age of 35 with various complications. Director General of Health Services Dr. Asela Gunawardena, who was present at the occasion, announced that steps will be taken to implement the vaccination programme for pregnant women islandwide in the future.   Transmission of the virus The virus transmits mainly through respiratory droplets and aerosols from person to person. In the vertical transmission of Covid-19 from mother to baby, reports are unclear about the mechanism. Few cases of neonatal (newborn) infection have been reported, but it may be from horizontal infection, which is when viruses are transmitted among individuals of the same generation as opposed to vertical transmission, which is transmitted from mothers to their offspring. There is no evidence that Covid-19 spreads from breast milk, and thus there’s absolutely no necessity for an infected mother to abstain from breastfeeding or to be separated from the baby.   Progression of disease in the patient The incubation period – or the period from the infection to the appearance of symptoms – can be as varied as two to 14 days, with an average of about six to seven days, even if the pregnancy remains the same. An increased risk of complications is present for mothers with pre-existing comorbidities, which is the simultaneous presence of two or more diseases or medical conditions in a patient, such as diabetes, hypertension, and heart disease. In mothers who are obese, complications are higher in mothers of advanced age, which is above 35 years. The symptoms of Covid-19 are again the same in pregnancy, them being fever, body aches, chest pain, general malaise, loss of sense of taste and smell, difficulty in breathing, sore throat, etc. Pregnancy is a physiological state which has a high requirement from the mother physically and thus they are more susceptible to infection. In pregnancy, there are certain changes in respiration of the mother with the growing fetus, which affects the respiratory mechanisms. Diaphragm is pushed up by the growing fetus in the pelvic cavity and the respiratory capacity is somewhat reduced, therefore making the mothers more susceptible for respiratory compromise in Covid-19. Considering the complications to the fetus, when the mother is infected, there is currently no evidence of teratogenicity, stillbirths, or growth restrictions in Covid-19-infected mothers. However, clinical data is insufficient to come to a conclusion yet. However, in symptomatic Covid-19 cases, there have been complications such as premature delivery of the fetus.   Managing a pregnant mother with Covid-19 A pregnant mother diagnosed with Covid-19, even if asymptomatic, should be treated and observed in a hospital with specialised treatment facilities for pregnant mothers. Under special circumstances, if the patient is to be kept at home, clear instructions should be given for indications to admit to a specialised unit. If the pregnant mother is asymptomatic after 10 days of hospital stay, they may be sent home for another further four days of home isolation. If the pregnant mother is symptomatic at day 10, they may be admitted in hospital for the full 14 days or even longer as required However, hospital admission, duration of stay, and discharge should only be at the discretion of the consultant obstetrician. Moreover, treatment with antibiotics is not required, unless a secondary bacterial infection is suspected in the Covid-19-infected mother.   Managing delivery of the child of a Covid-19-infected mother Even though the mother may have previously discussed the mode of delivery as normal delivery or C-section, it may change purely on the discretion of the clinician after the mother has been tested positive for Covid-19. The same applies to the timing of delivery. Prior to being infected, you may have discussed with your obstetrician a particular timeline for delivering the baby. However, induction of labour or elective cesarean sections are avoided in Covid-19-infected mothers, especially in their isolation period Pregnant women with a known Covid-19 infection in labour will be managed in an isolated labour room with all required equipment by staff donned in full personal protective equipment (PPE). In the case of any complications during labour, the infected mother may be offered emergency C-section as decided by a consultant obstetrician.   Precautions to be taken after delivery Current evidence suggests that breastfeeding a neonate is safe even if the mother has tested positive. However, the mother should wear masks and sanitise herself before handling the baby. The benefits of breastfeeding far outweigh the minimal potential risk of the transmission of the virus to the neonate. Colostrum, which is the first part of breast milk, plays a vital role in development of immunity in the newborn. If the mother is not in a position to feed, expressed breast milk may be given. The newborn should not sleep in the same bed as the mother, but should ideally be in a separate cot. Postpartum women are prone to mental health issues such as postpartum blues, postpartum depression, and postpartum psychosis, and in a case of a Covid-19-infected mother in isolation, without family support, the risk is even higher. Thus, higher attention should be given to maintaining their mental health.   (The writer is a medical officer currently attached to a government hospital. His experience spans across the medical profession as a medical practitioner, and across the pharmaceutical and surgical equipment industry. He also possesses an MBA and a Diploma in Economics. Having represented his university rugby team in international tournaments, he also has a special interest in sports medicine)

You may also like