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Pregnant lady with COVID-19 (I.)

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?

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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?

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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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