COVID 19 and women health including pregnancy

2020 was put on a pedestal with similar respect as the millennial year. There was a ring to it and many believed that it would turn out to be the best year in their lives. Nobody thought that it was going to be an anticlimax. Early this year, the novel virus SARS- Cov2 started raising its ugly hood in various countries of the world and became the talk of the town, or should I say the world by being granted the infamous pandemic status. The disease of COVID- 19 became the reason for the world grinding to a near-halt in many countries. To date, the virus continues to spread as various governments are deliberating on strategies to restart the economic and social wheels.
For us doctors too, these are unprecedented times. We are finding our feet as online consultants, doing teleconsultations, deliberating on various ways to make our patients, hospitals, staff and ourselves safer, developing protocols, training and teaching online as well as wearing the many hats of hands-on parents, housekeepers, maids, cooks and hobbyists.
Women in general also have to contend to changing lifestyles. Homemakers are seeing their frustrated husbands and children at home demanding more than usual. Working women are dealing with the multiplication of chores by the horns. Other than concerns about the COVID-19 infection, health concerns in general have be dealt with as and when they appear. As a gynaecologist, I am seeing a sudden rise in women falling pregnant probably as a side effect of the extra long hours being spent with their partners. Those who are requiring fertility treatment are facing uncertainty due to the general recommendations by various organisations of stalling and deferring assisted reproduction. Elective surgeries are not being done in many hospitals in order to reduce unnecessary risk to women coming to hospitals which could be prime foci of transmitting the infection.
Pregnant women are probably the most affected due to the uncertainties and anxieties associated with the infection on both their and their babies’ wellbeing and health. The following Q&A format aims to address these concerns for the pregnant women in all stages of pregnancy.

Are pregnant women more likely to get infected?

Current evidence and experience is limited and does not suggest so. However, pregnant women are generally more vulnerable to infections and hence precautions are to be taken with discipline and consistency without any complacency.

What precautions should pregnant women take?

Pregnant women should take the same precautions to avoid COVID-19 infection as other people.

  • Washing your hands frequently with an alcohol-based hand rub or soap and water.
  • Keeping space between yourselves and others and avoiding crowded spaces.
  • Avoiding touching your eyes, nose and mouth.
  • Practicing respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

Should pregnant women be tested for COVID 19?

Pregnant women having symptoms will have the priority for testing. However, asymptomatic women are not being tested in many places although the guidelines vary widely. Recently, ICMR and the Indian Government have made testing for COVID at 38 weeks mandatory.

Will the visits to the hospital and other care change?

Certain modifications to avoid frequent visits to the hospital are being done. The pregnant women are being seen at the time of confirmation, at 12, 20 and 28, 32 weeks and then 36 weeks onwards according to the requirement of each patient.

Does the virus affect the unborn baby?

The evidence is still emerging. However, the good news is that so far there has been no evidence to suggest vertical transmission. Samples of the amniotic fluid and breastmilk did not reveal the presence of the virus.

What care is taken for pregnant women in the hospitals?

The first priority is always safety of the patients. Hence, protocols are in place to reduce risk to the patients and the staff in various areas of the hospital. Appropriate personal protection equipment is mandatory for all staff. Also, hospitals have strict protocols of referral to COVID dedicated hospitals if the patient is found positive. Otherwise, the pregnant woman has all the rights for a respectful, safe and effective care. During labour, some precautions are taken in my hospital in terms of reducing the number of personnel in the labour ward.

Are COVID positive women delivered by caesarean section?

No. There is no absolute indication in such situations for a caesarean delivery. However, having a prolonged labour will expose the lady and the personnel to a possibility of the infection and hence certain individualised decisions may be taken in consultation.

Can the lady breastfeed her baby?

Yes, the lady may breastfeed with adequate protection. The antibodies against the virus will be passed on to the baby through the breastmilk and hence will improve immunity of the baby. However, rooming in the baby with at least 6 feet distance, washing hands before and after touching the baby and keeping all surfaces clean are extremely important.

What is the advice for non-pregnant women during these times?

Non-pregnant women may seek care depending on the conditions of the location, hospital and the consulting doctor and the existing government stipulations. If the issue is an emergency, care can certainly be sought immediately. It would be best for the lady to call the hospital or the doctor, seek a tele- or online consultation and then determine whether a physical consultation is mandatory or not. Regarding new fertility treatment, the current recommendations are to defer until COVID situation improves. Although, research suggests that there is lack of increased risk to the mother or baby, it would be prudent to postpone the fertility treatment until it is deemed safe to commence.

Although, these are the guidelines at the time of writing, the recommendations and protocols may evolve and change continuously.
Overall, prevention is better than cure and it is important to take self-care measures with utmost degree and consistency. Stay safe…

Dr. Aruna Muralidhar.