Does COVID-19 increase the risk for pregnancy
complications?
Yes,
infected women, especially those who develop pneumonia, appear to have an
increased frequency of preterm birth (birth before 37 weeks of gestation) and
cesarean delivery, which is likely related to severe maternal illness. Most
preterm births are iatrogenic (ie, induced labor or scheduled cesarean
delivery).
Can pregnant women receive vaccines for
prevention of SARS-CoV-2 infection?
Yes,
the first vaccines likely to become clinically available are based on mRNA and
do not contain infectious virus (either SARS-CoV-2 or a vector virus). Although
pregnant women have been excluded from vaccine trials, we recommend not withholding
these vaccines on the basis of pregnancy alone for those who are eligible for
and desire it. Counselling should balance available data on vaccine safety, risks
to pregnant patients from SARS-CoV-2 infection, and the patient's individual risk
for infection and severe disease.
Does SARS-CoV-2 cross the placenta?
There
is no definite evidence that SARS-CoV-2 crosses the placenta and infects the
fetus; however, a few cases of placental tissue or membranes positive for
SARS-CoV-2 and a few cases of possible in utero infection have been reported.
Some of the neonatal cases may have been false-positive test results or due to
acquisition of infection soon after birth. Reports of COVID-19 infection in the
neonate have generally described mild disease.
How can prenatal care be modified to decrease
risk of contracting COVID-19?
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) support modifying traditional protocols for prenatal visits to limit person-to-person contact and thus help prevent spread of COVID-19. Modifications should be tailored for low- versus high-risk pregnancies (eg, multiple gestation, hypertension, diabetes) and may include telehealth in areas of active infection transmission, reducing the number of in-person visits, timing of visits, grouping tests (eg, aneuploidy, diabetes, infection screening) to minimize maternal contact with others, restricting visitors during visits and tests, timing of indicated obstetric ultrasound examinations, and timing and frequency of use of nonstress tests and biophysical profiles.
Should glucocorticoids be avoided in pregnant
women with COVID-19?
No, pregnant
women who meet criteria for use of glucocorticoids for maternal treatment of
COVID-19 can receive standard doses of dexamethasone. For those who also meet
criteria for use of antenatal corticosteroids for fetal lung maturity, we suggest
administering the usual doses of dexamethasone (four doses of 6 mg given
intravenously 12 hours apart) to induce fetal pulmonary maturation and
continuing dexamethasone to complete the usual course of treatment for maternal
COVID-19 (6 mg orally or intravenously daily for 10 days or until discharge,
whichever is shorter).
Are SARS-CoV-2 vaccines safe for pregnant
women and women planning pregnancy?
Probably. Pregnant women have been excluded from trials evaluating COVID-19 vaccines, thus there are no safety and efficacy data in this population. We suggest COVID-19 vaccination for pregnant women rather than deferring vaccination until after delivery, particularly for those at higher risk of exposure or severe disease if infected. Although pregnancy itself is associated with an increased risk of severe infection, some patients may reasonably elect to defer vaccination after weighing their personal risk of COVID-19 exposure and disease severity against the very limited data regarding the safety and efficacy of COVID-19 vaccines during pregnancy.
Vaccination
should be timed so that patients do not receive COVID-19 vaccines within 14
days of receipt of a routinely administered vaccine, such as the Tdap and influenza.
However, a shorter interval between mRNA COVID-19 vaccines and other vaccines
is reasonable when timely administration of another vaccine is important (eg,
tetanus vaccination during wound management) or if it would avoid unnecessary
delays in COVID-19 vaccination. Vaccination is not thought to affect fertility,
and it is not necessary to delay pregnancy after vaccination.
LABOR AND DELIVERY
Is maternal COVID-19 an indication for
cesarean delivery?
No, COVID-19 is not an indication to alter the route of delivery. Even if vertical transmission is confirmed as additional data are reported, this would not be an indication for cesarean delivery since it would increase maternal risk and would be unlikely to improve newborn outcome.
Should planned induction of labor or cesarean
delivery of asymptomatic women be postponed during the pandemic?
No, in
asymptomatic women, inductions of labor and cesarean deliveries with
appropriate medical indications should not be postponed or rescheduled. This
includes 39-week inductions or cesarean deliveries after patient counselling
How should labor pain be managed in women
with COVID-19?
A neuraxial anesthetic is generally preferred to other options for management of labor pain because it provides good analgesia and thus reduces cardiopulmonary stress from pain and anxiety. In addition, it is available in case an emergency cesarean is required, thus obviating the need for general anesthesia. The Society of Obstetric Anesthesia and Perinatology (SOAP) suggests considering suspending use of nitrous oxide for labor analgesia in patients with confirmed or suspected COVID-19 because of insufficient data about cleaning, filtering, and potential aerosolization of nitrous oxide systems, but it remains an option for patients with a negative SARS-CoV-2 test.
Can an asymptomatic partner/support person
attend labor and delivery?
Practices vary by institution. At a minimum, the support person should be screened in accordance with hospital policies, and those with any symptoms consistent with COVID-19, exposure to a confirmed case within 14 days, or a positive test for COVID-19 within 14 days should not be allowed to attend the labor and birth. Most facilities recognize that a support person is important to many laboring women and permit one support person who must remain with the laboring woman (may not leave the room and then return). Additional support persons may be allowed or can be a part of the patient's labor and delivery via video.
POSTPARTUM
How should the baby be evaluated?
If the
mother has known COVID-19, the infant is a COVID-19 suspect and should be
tested, isolated from other healthy infants, and cared for according to
infection control precautions for patients with confirmed or suspected
COVID-19.
Should mothers with COVID-19 be separated from
their baby?
Generally
no because the newborn's risk for acquiring SARS-CoV-2 from the mother is low,
and data suggest no difference in risk of neonatal SARS-CoV-2 infection whether
the neonate is cared for in a separate room or remains in the mother's room.
However, mothers should wear a mask and practice hand hygiene during contact
with their infants. At other times, physical distancing >6 feet between the
mother and neonate or placing the neonate in an incubator is desirable when feasible.
How long should mother-baby precautions at
home continue after recent infection?
Previously
symptomatic mothers with suspected or confirmed COVID-19 are not considered a
potential risk of virus transmission to their neonates if they have met the
criteria for discontinuing isolation and precautions:
- At least 10 days have passed since their symptoms first appeared (up to 20 days if they have more severe to critical illness or are severely immunocompromised).
- At least 24 hours have passed since their last fever without the use of antipyretics.
- Their other symptoms have improved.
For
asymptomatic mothers identified only by obstetric screening tests, at least 10
days should have passed since the positive test.
Can breast milk transmit SARS-CoV-2?
There is general consensus that breastfeeding should be encouraged because of its many maternal and infant benefits. It is unknown whether SARS-CoV-2 can be transmitted through breast milk because very few breast milk samples have been tested. In a World Health Organization (WHO) study, breast milk samples from 43 mothers were negative for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and samples from three mothers tested positive, but specific testing for viable and infective virus was not performed.
What precautions should mothers with confirmed
or suspected COVID-19 take when breastfeeding?
Droplet transmission from infected mothers to their baby could occur through close contact during breastfeeding. Mothers can take precautions to prevent this by performing hand and breast hygiene and using a face mask. In a study from New York City that tested and followed 82 infants of 116 mothers who tested positive for SARS-CoV-2, no infant was positive for SARS-CoV-2 postnatally, although most roomed-in with their mothers and were breastfed. The infants were kept in a closed isolate while rooming-in, and the mothers wore surgical masks while handling their infants and followed frequent hand and breast washing protocols.
Alternatively,
the infant can be fed expressed breast milk by a healthy caregiver following
hygiene precautions until the mother has recovered or is proven uninfected. In
such cases, the mother should use strict hand washing before pumping and wear a
face mask during pumping.)
Can pregnant and postpartum women with
COVID-19 take NSAIDs and acetaminophen?
Yes,
nonsteroidal anti-inammatory drugs (NSAIDs) and acetaminophen can be
used for treatment of fever and pain during pregnancy and postpartum.
Antepartum, the lowest effective NSAID dose is used, ideally for less than 48
hours and guided by gestational age-related potential fetal toxicity (eg,
oligohydramnios, premature closure of the ductus arteriosus). Lowdose aspirin
for prevention of preeclampsia is safe throughout pregnancy. In patients with
abnormal liver chemistries secondary to COVID-19, a potential concern of
acetaminophen use is hepatic toxicity; however, doses less than 2 grams per day
are likely safe in the absence of severe or decompensated hepatic disease.
Are SARS-CoV-2 vaccines safe for
breastfeeding women?
Probably. Breastfeeding women have been excluded from trials evaluating COVID-19 vaccines, thus there are no safety and efficacy data in this population. We suggest COVID-19 vaccination for breastfeeding women rather than deferring vaccination until after breastfeeding, particularly for those at higher risk of exposure or severe disease if infected. Some women may reasonably elect to defer vaccination after weighing their personal risk of COVID-19 exposure and disease severity against the very limited data regarding the safety and ecacy of COVID-19 vaccines during breastfeeding.
Vaidehi Women's & Children Hospital in Ahmedabad is fully equipped with modern medical machines and exclusive services for Gynecology-Maternity, Fertility & IVF, Vaccination Clinic, NICU, Pathology, Sonography, 24 Hours Pharmacy, Exclusive Health Checkup, Round The Clock Emergency Service. Our doctors and staff are always committed to listen to your complaints and answering your each and every question to your utmost satisfaction. We give all kind of preventive as well as curative treatment. Our services for women and children are set in with trained and seasoned nurse who ensure that you and your baby are well taken care of. Vaidehi Women's & Children Hospital is staffed with experienced consultants to offer professional care in Obstetrics, Gynaecology, Neonatology, Pediatrics and other specialities and subspecialties for you and your baby.
- 24-hr consultant-led emergency and specialty services including perinatal services
- All pediatric and allied services for children
- Sophisticated maternal care
- State-of-the-art labour rooms
- Committed team of professionals 24x7
Dr. Nirav Patel (M.S. Gynec)
Dr. Manisha Patel (M.B.B.S., D.C.H.)
Dr. Chintan Patel (M.D., DNB Medicine)
105 to 112, 1st Floor, Shashwat Mahadev-1 Complex, RTO Road,
Opp. Suryam Greens, Vastral, Ahmedabad - 382418.
Call for Appointment: +91 76230 40999
Source : by VAIDEHI WOMEN'S & CHILDREN HOSPITAL, Vastral, Ahmedabad.
Disclaimer : This tool does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. The content of these article if for information only, Information is gathered and shared from reputable sources; however, Ahmedabad Medical Guide is not responsible for errors or omissions in reporting or explanation. No individuals, including those under our active care, should use the information, resource or tools contained within to self-diagnosis or self-treat any health-related condition. Ahmedabad Medical Guide gives no assurance or warranty regarding the accuracy, timeliness or applicability or the content.
Publisher : Ahmedabad Medical Guide (P. R. Communication) (www.ahmedabadbiz.blogspot.com, www.ahmedabadmedicalguide.blogspot.com)
DR. NIRAV PATEL
DR. MANISHA PATEL
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