Covid infection in pregnancy : All you need to know!!! 

With Coronavirus Pandemic spreading continuously, cases have increased all over. More pregnant women are also getting infected day by day. Most of the pregnant patients have fears and apprehensions about what happens with covid 19 infection in pregnancy. We have tried to explain the same in a simple manner below. According to the present observations, we can say that Pregnant women are at no greater risk of getting infected with covid 19 than the general population. They have to follow the same precautions of staying indoors, social distancing and personal hygiene to be safe. If you have any of these symptoms like fever, cough, sore throat, breathing difficulty or shortness of breath or loss of sense of smell, contact a doctor over telemedicine or phone first and follow advice accordingly. All patients may not require testing or hospital admission. Effects of Covid 19 infection on mother At present very limited data of pregnancy with covid 19 is available, observations are derived from that data. FOGSI GCPR guidelines state that chances of miscarriage or preterm labour don't increase in infected pregnancy. Majority of the pregnant women will be asymptomatic or have mild symptoms that is flu like illness, fever, cough, sore throat or difficulty in breathing. Pregnant women with comorbidities like elderly, obese, hypertension, diabetes, respiratory disease, immunocompromised states may be more affected. In severe cases patient may present with pneumonia or marked hypoxia or rapidly progress to this state from mild or moderate flu like illness or atypical features. Pregnancy is a hypercoaguable state and persons infected with covid 19 also show a hypercoaguable state so chances of venous thromboembolism may increase in pregnancy. Possibility of pulmonary embolism may be there. Mental health issues and domestic violence cases are also increasing in this situation. Effects of Covid 19 on fetus in uterus and newborn baby In preliminary research vertical transmission or mother to fetus transmission of virus in uterus is not identified. But in two cases in newborn babies IgM antibodies were found in blood which suggest fetal infection in uterus. So placental transmission may be probable. No need to do tests like amniocentesis to find fetal infection. No fetal abnormalities or anomalies were seen. RCOG suggests that a sonography after atleast 14 days of patient recovery can be done for fetal wellbeing. No babies born to covid positive mothers have significant clinical infection even if found positive. Babies of a covid positive mothers with active infection or symptomatic babies need to be tested after delivery. Pediatrician will examine newborn guide according to local protocols. Breast feeding in Covid positive mother Breastfeeding is encouraged with good hygienic practices. RCOG states there is no evidence to show that virus can be passed in breastmilk. The well defined benefits of breastfeeding and the protection it offers outweighs any risks of transmission of Coronavirus in breast milk. The main risk of breastfeeding is close contact between you and baby which can lead to infection in baby after birth. It can be given if mother wishes with full precautions like wearing a mask, frequent handwashing etc. Isolation of baby from mother can cause psychological problems. She can still give pumped and expressed breastfeeding through a relative who is well if neonate condition permits. If neonate is isolated from mother she should be offered psychological support. Clinical course and treatment of Coronavirus infection in pregnancy. The data till date shows that pregnant women do not have worse outcomes or consequences with covid 19 infection than the general population. Most pregnant patients can isolate and rest at home if they are asymptomatic or have mild symptoms. Follow your treating doctor advice on this. Inform your treating gynecologist or maternity unit about your test if it was done outside that hospital. Cancel all your routine appointments and sonography for atleast next 14 days. Beware of emergency symptoms in pregnancy. You should isolate yourself from family members for atleast 14 days. The family members who have come in contact with you should also self isolate them from others for 14 days. Request friends or neighbors to run errands and leave things outside your home. Your direct or high risk contacts may need testing according to local protocols if you are found positive. In severe cases ICU admission may be required. You may need oxygen or ventilator support in severe cases. Most of the routine drugs used to treat covid 19 can also be used in pregnancy like hydroxychloroquine and azithromycin. Emergency situations in covid 19 positive pregnancy. In case of emergency symptoms during active covid infection like labor pains, water break, or bleeding or spotting from vagina or decreased baby movements, contact your maternity care provider or emergency contact over phone. Or call an ambulance. If you are suspected or confirmed covid positive you need to go to covid designated hospitals. Wear N 95 mask on your way. Inform hospital beforehand to help them prepare. If you have recovered from infection and tested negative follow your gynecologist advice on place of delivery and emergency or routine appointments. Mode of delivery in positive pregnancy Covid 19 infection has no effect on mode of delivery. Vaginal delivery can be done unless there is any obstetric indication for c section. In severe cases and respiratory compromise in mother, emergency delivery may be required like an emergency section. Epidural analgesia for painless labour can be given in a covid positive pregnant woman. Diet in covid positive pregnant woman Diet should be routine nutritious well balanced diet which helps to increase immunity. No dietary restrictions are required. Knowledge is power!! Don't panic.. Stay home.. Stay safe!! Contact for more queries on yourfamilygynaec@gmail.com Visit our website for articles on women health www.familygynaec.com Disclaimer- These are the views of a qualified doctor and author. These are general suggestions and do not replace actual check up by a doctor. Any resemblance to anybody is coincidental Author information - Dr Harita Kothia, Obstetrician and Gynecologist, Mumbai

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