Pregnant lady with COVID-19 (I.)
Pregnant lady with COVID-19 (I.)
PRE-NATAL CARE: Is pregnant lady
more susceptible to COVID-19 infection or at augmented risk for its complications?
Data are sparse and may
suggest that pregnant lady is NOT at augmented risk for COVID-19 with or without Sms, but she may hv more intense clinical course as compared with non-pregnant
women of same age. However, most infected pregnant ptns usually recover with no
commencing delivery, and the MR is NOT increased.
Does COVID-19 infection increase
the risk for pregnancy complications?
The answer is Yes, infected women, particularly those developing
pneumonia, may have more frequency of
pre-term birth (birth before 37 wks of pregnancy) and cesarean delivery (CD)
that’s probably linked to severe maternal
illness. Pre-term births are mostly iatrogenic (i.e., induced or scheduled cesarean labor).
Does SARS-CoV-2 cross your placenta?
There’s No clear
evidence that severe acute
respiratory syndrome coronavirus
2 (SARS-CoV-2) can cross the placenta
to infect the fetus; however, a few reported cases of placental tissue or
membranes +ve for SARS-CoV-2 and a few observed cases of possible in utero infection
hv bn reported. Some neonates may hv bn false-+ve tests or acquainted the infection immediately after
birth. The given reports about neonatal COVID-19 have generally shown a mild course of the
disease.
How can pre-natal care be
modified to ameliorate the risk of COVID-19 infection?
The American College of Obstetricians & Gynecologists
and Society for Maternal-Fetal Medicine advice the modification the
current protocol for pre-natal visits to decline person-to-person
disease transmission and to help abort
the acquisition of COVID-19 infection.
This modification should be designed for low- vs high-risk
pregnancies (eg, multipara, HT, DM)
and may include telehealth, declining
No. of in-person visits, visit timing,
group testing (eg, aneuploidy, DM,
infection survey) to limit maternal contact,
visitor restriction during OPD visits & lab testing, timing for obstetric USS
testing, and timing & frequency of use of non-stress testing & bio-physical
profile.
Should Steroids be avoided in pregnant lady with COVID-19?
No, pregnant lady meeting
the criteria for steroid therapy for maternal ttt of COVID-19 the standard dose of dexamethasone
can be currently provided. For those who also meet criteria for use of
antenatal steroids for fetal lung maturity,
administration of the current doses of dexamethasone (4 doses of 6 mg given i.v. 12 hs apart) to induce fetal pulmonary maturation & continuing
dexamethasone to complete the current course of
ttt for maternal COVID-19 (6 mg orally or i.v. /d/10 d. or till hospital discharge).
Is maternal COVID-19 infection an
indication for the CD?
No, COVID-19 is
NOT an indication to change the route of
delivery. Even if vertical
transmission is documented, this should
NOT be an indication for CD since it
would aggravate the maternal risk and would be unlikely to improve newly born
survival.
Should the planned induction of labor/cesarean delivery of asymptomatic lady be postponed within the pandemic?
No, for asymptomatic lady,
induction of labor/ CD with the
proper medical indication should NOT be cancelled or re-scheduled. This recommendation
may include 39-wk induction or CD after ptn counseling.
How should labor pain be managed
in a lady with COVID-19?
The neuraxial anesthetic
is currently preferred to other options to manage labor pain as it can provide good analgesia, so,
reducing pain & anxiety-induced cardiopulmonary
stress. Furthermore, it’s widely available in emergency CD, so, obviates the requirement of general anesthesia. The Society
of Obstetric Anesthesia and Perinatology (SOAP)
provided the suggestion: consider suspending use of nitrous oxide for labor
analgesia in patients with confirmed or suspected COVID-19 due to data paucity about cleaning, filtering,
& the potential aerosolization of NO
systems. Moreover, they urge the consideration to limit the use of I.V. ptn controlled analgesia
considering the increased risk of respiratory
depression.
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