Comprehensive Insights on Covid in Pregnancy

We have often heard pregnancy is an immunocompromised state, and acquiring COVID during such time can be a difficult position for the expecting mother. In this blog, we shall discuss all the aspects of COVID concerning pregnancy. 

COVID-19 is a notorious virus that can mutate and complicate the disease further. Some new variations of zoonotic origin affect humankind. They are:

• SARS-CoV
• Middle East respiratory syndrome (MERS-CoV) 
• Novel coronavirus of 2019 (SARS-CoV-2) : COVID 19, Wuhan Virus

COVID is transmitted through respiratory droplets. These droplets can be from an Asymptomatic or presymptomatic person and can cause up to 40 to 50 % of transmissions. Thus, Social distancing is the most effective way of preventing this infection. Masking, regular hand washing, and sanitization can help avoid this disease. 

If a female gets COVID-19 during pregnancy, the disease has an Incubation period of 5- 14 days. No peculiar symptoms can differentiate the presentation of COVID-19 in the general population and pregnant females. The common symptoms seen are:

• Fever: Ranging from high-grade to low-grade fever.
• Cough: This can easily progress to decreased saturation of oxygen, commonly known as SpO2, and difficulty breathing
• Myalgia- Increased body temperature can cause muscle pains
• Anosmia and Ageusia: Loss of smell and loss of  taste 
• Diarrhea:  Diarrhea can even progress to severe dehydration 
• Nausea and Vomiting
• Signs of worsening disease
  • Dyspnea: Difficulty breathing
  • Tachypnea: Increased respiratory rate 
  • Decreased Oxygen Saturation (SpO2)
  • Acute Respiratory Distress Syndrome

When the affected female’s lungs are imaged using the most basic examination technique, chest X-ray, we can easily see Multiple Peripheral lobular consolidations and Ground glass opacities.

Pregnancy can get complicated and cause severe Illness in pregnant females, which may be associated with abortions and Preterm Labor. In some cases, there could also be a requirement for Intensive care, which develops severe complications. These cases may also require invasive ventilation to help them breathe.

There is no denying that COVID-19 has claimed many lives during the pandemic. Mortality in complicated cases is very common.

While we are talking about COVID in pregnancy, we have to discuss the possible side effects on the fetus as well. The infection can spread to the fetus through the placenta by SARS-CoV-2. Such cases of Transmission to the fetus are rare, but their existence can't be denied. All the other bodily fluids of the expecting mother with COVID-19, such as amniotic fluid, cord blood, neonatal throat swabs, and breast milk samples, have tested negative for coronavirus.

Currently, there is no evidence to prove that COVID-19 can be transmitted through genital fluids. To avoid any complications during labor, electronic fetal monitoring is done. It is done using a handheld device, or it could be done by mounting a device onto the mother’s abdomen. Electronic fetal monitoring helps to know if the baby is undergoing any kind of distress or not.

If vertical transmission does occur, that is, direct transmission from the mother to baby via the placenta, then the baby might exhibit a range of symptoms from mild illness to severe respiratory failure. The baby can also be completely asymptomatic in some cases.

Breastfeeding is a vital part of motherhood. A newborn is completely dependent on their mother for nutrition. No evidence suggests transmission through breast milk, but proximity can transmit infection through a respiratory droplet. However, the lack of breastfeeding is more of a concern than the infection. Newborns with SARS-CoV-2 do not need to be separated from their mothers, although they have to be isolated from other newborns.

The diagnosis of COVID-19 can be made by RT-PCR (reverse transcriptase polymerase chain reaction) and Rapid antigen testing. RT-PCR is a time-consuming method. However, the results are highly sensitive and specific. RAT testing is a quick test that anyone can easily perform at home.

Identifying the disease is the first step toward better patient management. The mainstay of the treatment of SARS-CoV-2 is based on the symptoms(symptomatic treatment).

• Delivery: Vaginal delivery is preferred, and the only indication for cesarean section is Obstetric Indication.
• Mild illness with Pregnancy: Anti-SARS-CoV-2 monoclonal antibodies can be given within 10 days.
• Moderate illness with Pregnancy: Admission and supportive care
• In case of Severe illness
• Support Respiratory Function: a constant oxygen saturation of  SpO2 >95% is targeted. Constant oxygen can also be started to decrease the chances of Tachypnea(inc respiratory rate) & Dyspnea(difficulty breathing)
• Prone ventilation has shown excellent results in COVID-19 patients, and it can also be done here. However, due to the baby bump, this might be a little difficult for an expecting mother.
• Dysregulated Inflammatory Response (Cytokine storm) can harm the fetus and the mother. Thus, giving Dexamethasone 6 mg daily for 10 days reduces mortality.
• Intravenous remdesivir is now FDA-approved and is given especially for low-flow, Ventilated patients. It is known to shorten the time to recovery.

Nowadays, there is a huge debate on COVID-19  vaccines. Therefore, it becomes very important for us to be well-informed about the real news and hoaxes created by people to gain a better following on social platforms. Rest assured, all vaccines have side effects, but these are very rare. In the end, comparing the risks versus benefits of these vaccines, we see that they have more merits than demerits.

All pregnant women and lactating mothers can be vaccinated in all trimesters.

• Low-risk mothers: Covisheild ( Viral Vector Vax) 
• High-risk mothers:   mothers having comorbidities such as PIH, GDM, Anemia, etc - Covaxin (Killed)

The interval between 2 doses: Covisheild: 12-16 weeks, Covaxin: 4-6 weeks 

Some Special situations are worth mentioning before we end this blog. These conditions can cause a dilemma, so it is better to discuss them beforehand and be prepared for whatever situation arises in the exam or the clinic while practicing.

• TD and COVID-19 vaccines can be on the same day without interaction.
• Anti-D and COVID vaccines can be on the same day as well
• COVID-19 vaccine can be combined with Blood transfusion and iron sucrose if needed.
• If a woman is COVID-19 positive, leave 3 month gap before vaccination.

COVID-19 is a scary disease, but as time progresses, new advancements have shown that it can be managed, and patients have shown full recovery. There are videos in the PrepLadder app in the obstetrics and gynecology section by Dr. Prassan Vij, which can give much more detailed knowledge about the topic.

Hope you found this blog helpful for your Recent Advances OBS-GYN preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.