FAQs on COVID-19:
Dr. Aruna Nigam, MS (Obstetrics & Gynaecology).
COVID-19 disease caused by the novel corona virus is a new and emerging pathogen that has caused a global pandemic leading to unprecedented levels of stress and anxiety among the general public. One of the more supposedly vulnerable group at this point is that of pregnant women. We encounter many such pregnant women who are concerned about the well-being of their unborn babies as well as themselves during these tough times. Therefore, knowing the basics about this virus and its effect on pregnancy will definitely reduce anxiety amongst them. Here is a list of some of the most frequently asked questions to doctors: –
1. Is a woman more susceptible to this corona virus because of her pregnancy?
No, as per recent guidelines by WHO, pregnant women are not more susceptible to this virus as compared to general population. The symptoms exhibited by pregnant women are also not more severe as compared to the general population.
2. Will the corona virus have any effect on the foetus/unborn baby?
As of now there is no data indicating the effect of corona virus on the unborn foetus or on pregnancy. There is no evidence to suggest that the virus is teratogenic or there is any increased risk of miscarriage or early pregnancy loss in relation to the corona virus infection. In some cases, an association has been found between preterm labour and corona infection although extensive research still needs to be done in this area.
3. Can the corona virus pass vertically from mothers to foetus during delivery?
With proper management of corona virus positive pregnant patients during labour, the risk of passing the infection to a foetus appears to be very low. Currently there is no evidence suggesting any foetal malformations or side-effects due to maternal corona virus infection.
4. What precautions should pregnant women take to prevent contracting the corona virus?
The most important precaution is to practice excellent hand hygiene. Frequent hand washing with soap and water for a minimum of 20 seconds. One should avoid touching the face, especially the eyes, mouth and nose. stay home as much as possible. Social distancing is important to limit the spread of the virus. Most states now require people to wear face masks in public. Even a cloth mask, when used to cover the mouth and nose completely, helps protect the user and others.
5. How many times should a woman ideally visit her gynaecologist for routine check-ups during pregnancy in times of COVID-19 pandemic?
In order to minimize the risk of exposure, pregnant women can follow a “Rule of four” in an otherwise uncomplicated pregnancy: once in the first trimester, second time during 18-20 weeks for a level 2 scan, third time between 28-30 weeks and the fourth and final time around 36 weeks. Apart from the above 4 times one can visit the doctor any time if one experiences labour pains, bleeding and/or leaking per vagina or decrease in foetal movements.
6. When should a pregnant woman get herself tested for corona virus?
If a pregnant woman believes or suspects that she may have been exposed to the corona virus and has any of the symptoms of the disease like fever, cough or difficulty in breathing or even some of the lesser frequent symptoms like muscle pain, fatigue or a loss of sense of smell, she should immediately call the COVID-19 help line numbers or a health care professional for advice and undergo testing if required. In the meantime, before testing is complete, she should wear a mask and keep herself isolated.
7. How should the disease be managed if a woman tests positive for corona virus during pregnancy?
If a woman tests positive but is asymptomatic, she should be home quarantined for 14 days. But if she is symptomatic, she needs to be quarantined in a specific health care center as designated by the government for COVID-19 management. There is no data suggesting that the course of the disease is any different in pregnant woman as compared to other patients. However, during time of labour and at the time of delivery, health care workers attending to the patient need to take extra precautions which includes PPE (personal protective equipment) to minimize the risk of exposure. It is very clear that being infected with the corona virus does not affect the mode of delivery i.e. normal or caesarean.
8.Can a mother breast feed if she is corona virus positive?
So far, the virus has not been found in breast milk. But there is not enough information yet on whether women who are sick can pass the virus through breast milk.
Breast milk gives babies protection against many illnesses. It also is the best source of nutrition for most babies. A mother should wash her hands and consider wearing a face mask to minimize infant exposure to the virus. The Royal College of Obstetricians & Gynaecologist recommends that mothers infected with corona virus express breast milk and allow someone else to feed the baby.
9. What other measures should be taken so that a baby does not get infected if the mother is corona virus positive?
The mode of transmission of the virus is mainly via droplet infection. Therefore, it is advisable to wear a mask while handling the baby and also maintain perfect hand hygiene while touching the baby. Hands must also be washed before touching any breast pump or bottle parts and clean all pump and bottle parts must be thoroughly cleaned after use. Some recent data recommends isolation of mother from new-born until viral shedding resolves.
10. If a woman is planning to get pregnant, should she wait for the COVID-19 pandemic to be over?
Based on current research, it is unlikely that corona virus can pass from mother to foetus during pregnancy, labour or delivery. However, there needs to be extensive research on this aspect. Therefore, it is entirely a personal choice. One should make the decision to get pregnant or not based on the state of one’s health, the potential risks of corona virus, and other factors.
Authors:
Dr. Aruna Nigam
Professor – Obstetrics & Gynaecology, Hamdard Institute of Medical Sciences & Research (HIMSR), Hamdard Nagar, Delhi.
Dr. Ankita Srivastava
Sr. Resident – Obstetrics & Gynaecology, Hamdard Institute of Medical Sciences & Research (HIMSR), Hamdard Nagar, Delhi.
May 21, 2020.
