Pregnancy with COVID - 19

 

Pregnancy with COVID - 19

INTRODUCTION:

The COVID - 19 pandemic has caused loss of life and poorer health outcomes , outside and in pregnancy , despite worldwide aggressive public health measures to control the spread .

• 1 : Mass vaccination is a key method by which countries are aiming to control the pandemic .

•2 : Theoretically , COVID - 19 vaccines are safe for use in pregnancy , as they do not contain a live attenuated virus .

•3:A recent report of American health workers who were pregnant or lactating when vaccinated ; found that compared with nonpregnant controls , vaccine - induced humoral immunity was similar , antibody titers were higher following an actual SARS - CoV - 2 infection , and antibodies were present in umbilical cord blood and breast milk , suggesting that vaccination can confer maternal and perinatal immunity .

 • 4 : For COVID - 19 vaccination in pregnancy , there has been no major safety signal from animal reproductive toxicology studies , the very small number of inadvertent pregnancies in vaccine trials .

•5:Based on vast previous experience with other vaccines in pregnancy and no hypothesized mechanism for harm , similar efficacy and side effects are anticipated with COVID - 19 vaccination in pregnancy . However , pregnant women were excluded from the initial randomized controlled trials ( RCTS ) testing the safety and efficacy of COVID - 19 vaccines . Although randomized trials of COVID - 19 vaccination in pregnancy have now begun , the results will not be available until 2022 at the earliest . Some guidelines initially recommended against routine COVID - 19 vaccination in pregnancy but pivoted as safety data accumulated ( eg : the United Kingdom Joint Committeeon Vaccination and Immunisation [ JCVI ] 9 ) , whereas others recommended routine vaccination from the start ( eg : the International Federation of Gynecology and Obstetrics ) .

•6:Therefore , this study aimed to investigate the uptake and safety of COVID - 19 vaccination among pregnant women . We studied the determinants of COVID – 19 vaccine uptake among eligible pregnant women and compared pregnancy outcomes in women who received COVID - 19 vaccination during pregnancy with that of non - vaccinated and contemporaneous pregnant controls of similar risk profiles .

 

 

CLINICAL PRESENTATION OF MILD COVID-19 INFECTION IN PREGNANCY

Asymptomatic

 • Clinical presentation remains same as that of general population . Mean Incubation Period : 5-7 days Typical presentation includes : ( 14 % )

 • Fever 238 ° C ( 100.4 ° F ) ( 40 % )

• Dry cough ( 41 % ) Dyspnoea ( 21 % ) CLINICAL PRESENTATION OF  MILD COVID - 19 INFECTION IN PREGNANCY

• Myalgia ( 19 % )

 • Loss of sense of taste

 • Diarrhoea ( 8 % )

 

MANAGEMENT OF CONFIRM CASES

ASYMPTOMATIC

Home Isolation with self monitoring of temperature , pulse , spo 4 hourly

• Routine appointment delayed until after the recommended period of isolation

• Adequate hydration and rest , healthy diet

• Daily fetal movement count

• Fetal Monitoring after 2 weeks for growt doppler study

• Antenatal care

TREATMENT FOR PATIENT WITH MILD ASYMPTOMATIC DISEASE IN HOME ISOLATION

•In communication with a treating physician 

•Symptomatic management for fever , running nose and cough Warm

•water gargles or take steam inhalation twice a day

•If fever not controlled with a maximum dose of Tab . Paracetamol 650mg four times a day , consider other drugs like NSAIDs ( ex : Tab . Naproxen 250 mg twice a day ) .

 

 

DANGER SIGNS DURING HOME ISOLATION REQUIRING ADMISSION

• Worsening shortness of breath

 • Inability to tolerate oral hydration or needed medications

• Persistent pleuritic chest pain

 • Confusion or lethargy

 • Obstetric complaints such as preterm contractions , vaginal bleeding , or decreased fetal movement

 • Tachypnea

• Unremitting fever ( greater than 39 ° C ) despite antipyretics Oxygen saturation less than 95 % either at rest or on exertion Cyanotic lips , face , or fingertips .

INVESTIGATION

Routinely , no investigation is required for mild covid 19 cases

• In case of persistent or worsening symptoms , following investigations can be done : CBC , absolute lymphocyte count , KFT & LFT every 24-48 hours

• CRP , ESR , Procalcitonin LDH , / Ferritin & D - dimer every 48-72 hours CXR with abdominal shield

 

INTRAPARTUM MANAGEMENT

Maternal and fetal assessment and severity of COVID - 19 symptoms are controlled by :

 • Multi - disciplinary team ( consultant obstetrician , consultant anaesthetist , consultant neonatologist and infectious diseases or medical specialist ) Maternal :

• Temperature

 •PR

•BP

• RR

 •Oxygen saturation

 

FOR SURGICAL PROCEDURE

• Designated COVID OT / suspect OT

• Minimize the number of persons in the OT room

 • Minimize the movement of the team in and out of the OT during the procedure

• Mode of birth should not be influenced by the presence of COVID- 19 , unless the woman's respiratory condition demand urgent delivery .

• COVID 19 is NOT an indication for caesarean section .

 • Decision based on obstetric ( fetal or maternal ) indications and not COVID - 19 status alone.

 

POSTPARTUM MANAGEMENT :

• Maternal Monitoring :

• Asymptomatic - Routine postpartum maternal monitoring

 • Mild symptoms - Monitor vitals every 4 hrs for 24 hrs in Vaginal delivery , 48 hrs in Caesarean section .

• High risk of postpartum depression .