how to diagnose and manage pregnant women with Covid 19 like symptoms.

1. Management of pregnant women
with COVID-19 like symptoms
By;
Dr Syeda Sumaiya(2019-2022)
Pg scholar Dept of OBG
NIUM, Bengaluru-91
Under the guidance of;
Prof Wajeeha Begum
HoD Dept of OBG
NIUM, Bengaluru-91

3. DIFFERENTIAL DIAGNOSIS OF COVID-19
IN PREGNANT WOMEN

5. COMMON COLD DURING PREGNANCY

6. • It is caused by numerous viruses and is usually a self-limiting illness.
• However, sometimes the infection spreads to other nearby organs, leading
to a serious bacterial infection. Because of immunological changes during
pregnancy, pregnant women are susceptible to many infections.
• Although there are many over-the-counter (OTC) medications that help to
relieve symptoms of the common cold, there are only a few medicinal
ingredients in these products.
1. Heikkinen T, Järvinen A. The common cold. Lancet 2003;361(9351):51-9. 2.
2. Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD. Williams obstetrics.
22nd ed. New York, NY: McGraw Hill; 2005. p. 130-1, 1276.

7. 3. Centers for Disease Control and Prevention. Treating for two: safer medication use in pregnancy.
www.cdc.gov/treatingfortwo. Accessed June 20, 2019.
4. Erebara A, Bozzo P, Einarson A, Koren G. Treating the common cold during pregnancy. Can Fam Physician.
2008;54(5):687-689
Management of common cold in pregnancy

8. INFLUENZA IN PREGNANCY

9. • Pregnant women are at high risk of serious complications of influenza (flu)
infection such as ICU admission, preterm delivery, and maternal death.
• Patients with suspected or confirmed influenza should be treated with antiviral
medications presumptively regardless of vaccination status.
• Do not rely on test results to initiate treatment; treat presumptively based on
clinical evaluation.
5. D. J. Jamieson, R. N. Theiler, and S. A. Rasmussen, “Emerging infections and pregnancy,” Emerging Infectious Diseases, vol. 12,
no. 11, pp. 1638–1643, 2006.
6. G. Gaunt and K. Ramin, “Immunological tolerance of the human fetus,” The American Journal of Perinatology, vol. 18, no. 6, pp.
299–312, 2001.
7. V. R. Laibl and J. S. Sheffield, “Influenza and pneumonia in pregnancy,” Clinics in Perinatology, vol. 32, no. 3, pp. 727–738, 2005.
Assessment and treatment for pregnant women
with suspected or confirmed influenza

11. • The Centers for Disease Control and Prevention (CDC) recommends women in
any trimester of their pregnancy who have a suspected or confirmed influenza
infection receive prompt antiviral therapy with Tamiflu (oseltamavir) or Relenza
(zanamivir).
• Relenza and Tamiflu are both FDA approved for treatment of influenza.
• The CDC has looked at these issues carefully for pregnant women: because the
risks of influenza for pregnant women are serious, CDC believes that the benefits
of antiviral therapy outweigh the potential for risks from the drugs. Both drugs are
designated "Pregnancy Category C," which means that they have not been studied
in pregnant women. However, Pregnancy Category C does NOT mean the drug
cannot be used in pregnant women. Pregnant women can and should receive a
category C drug when the possible benefits of using the drug are more likely than
the possible risk of harm to the woman or her baby.
8. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the
2009-2010 Season (http://www.cdc.gov/H1N1flu/recommendations.htm)
9. CDC H1N1 Flu Page (http://www.cdc.gov/h1n1flu/)

12. • The WHO and the American College of Obstetricians and Gynecologists
(ACOG) recommend the use of inactivated influenza vaccine to all
women who are pregnant during the influenza season. This is
recommended as an essential element of prenatal care. The vaccination of
the mothers has been shown to produce excellent protective antibody
titers in the pregnant woman.
• The WHO classifies pregnant women as the top priority to receive the
influenza vaccination.
Influenza Vaccine

13. • The Injectable (not the nasal) vaccine is completely safe in pregnancy,
can be given in any trimester of pregnancy and has the advantage that
immunity achieved by the antibodies produced is passed on to the
unborn fetus and remains so after birth, hence protecting the newborn as
the vaccine is not recommended for infants below 6 months of age.
10. WHO Position paper Vaccines against influenza. Wkly Epidemiol Rep. 2012;87:461–476. [PubMed] [Google Scholar]
Committee on Obstetric practice and immunization expert work group.
11. Influenza vaccination during pregnancy. Am Coll Obstet Gynecol 2014;608. https://www.acog.org/-/media/Committee-
Opinions/Committee-on-Obstetric-Practice/co608.pdf?dmc=1&ts=20151224T0453487952. Accessed 24 Dec 2015.

14. Ingredient
Quantity
(per dose)
Fluzone High-Dose 0.5 mL
Dose (IM)
Active Substance: Split influenza virus , inactivated strains* : 180 mcg HA total
A (H1N1) 60 mcg HA
A (H3N2) 60 mcg HA
B 60 mcg HA
Other:
Sodium phosphate-buffered isotonic sodium chloride solution QS† to appropriate volume
Formaldehyde ≤100 mcg
Octylphenol ethoxylate ≤250 mcg
Gelatin None
Preservative None
*per United States Public Health Service (USPHS) requirement
†Quantity Sufficient
Fluzone High-Dose Ingredients

16. MANAGEMENT OF OTHER URI'S
DURING PREGNANCY
Sinusitis Bronchitis Pneumonia

17. SINUSITIS
• Acute bacterial sinusitis is an infection of the mucosa of the paranasal sinuses
and nasal cavity, and it develops most commonly as a complication of a viral
upper respiratory infection.
• Acute viral and bacterial sinusitis often present with nasal congestion,
purulent nasal or postnasal discharge, sinus pain or pressure over the affected
sinus, cough, sinus headache, fever, and malaise.
• Although uncommon, complications of acute bacterial sinusitis can be severe
ie, meningitis, brain abscess, and cavernous sinus infection.
12. Kaliner MA, Osguthorpe JD, Fireman P, et al. Sinusitis: bench to bedside. Current findings, future directions. Otolaryngol Head
Neck Surg 1997;116:S1 – 20.
13. Sande MA, Gwaltney JM. Acute community-acquired bacterial sinusitis: continuing challenges and current management. Clin
Infect Dis 2004;39(Suppl 3):S151 – 8.

18. .
• After a diagnosis of acute bacterial sinusitis is made, antimicrobial
therapy and systemic relief should be initiated.
• Analgesics and antipyretics; decongestants; including nasal
irrigation, steam inhalation, and warm packs are useful in providing
relief.
• The American Academy of Otolaryngology-Head and Neck
Surgery’s Guidelines first line of treatment regimens include
Amoxicillin, Amoxicillin– clavulanic acid, or a second-/third-
generation cephalosporin. These are acceptable regimens in
pregnancy and should be given for 10 to 14 days. In penicillin
allergic patients, a course of one of the Macrolides, particularly
Azithromycin, is warranted.
• Acetaminophen (Tylenol) can help with pain relief and/or headaches
& fever

19. BRONCHITIS
• Bronchitis is inflammation of the bronchial mucous membranes.
• Acute bronchitis is associated with cough that develops during an
upper respiratory tract infection that usually is viral in origin
• During an acute upper respiratory infection, a cough with occasional
sputum production and low-grade fever may be present. Dyspnea is
an uncommon symptom of acute bronchitis.
• Antibiotic use should be reserved for suspected bacterial etiology or
for women who do not respond to symptomatic relief. Symptoms
should resolve within a few days, managing respiratory infections
during pregnancy though the cough may persist for months.

20. • Many studies have evaluated the use of antibiotics in the treatment of
acute bronchitis and found no significant benefit from their use.
Guidelines from the National Institute for Health and Clinical
Excellence and the Centers for Disease Control and Prevention do not
recommend antibiotics for the treatment of adults with acute bronchitis.
14. Kochanek KD, Murphy SL, Anderson RN, et al. Deaths: final data for 2002. Natl Vital Stat Rep 2004;53:1.

21. PNEUMONIA
• Pneumonia is an ongoing and prevalent problem among elderly and
immunosuppressed people; what is surprising is that pneumonia is
the third-leading cause of death in pregnant women and the most
common nonobstetric infectious cause of death in women
(Goodrum, 1997).
• There is also a correlation between pregnant women with
pneumonia and preterm labor, in which preterm labor is caused by
hypoxia and acidosis, which are poorly tolerated by the fetus
(Cunningham et al., 2001).

22. • McColgin, Glee, and Brian (1992) reported that the
complication of pneumonia in pregnancy has a preterm
labor rate of 44 percent and a 36 percent preterm delivery
rate.
• Pneumonias are classified as community-acquired or
nosocomial. Causes of pneumonia include infectious
agents, such as bacterias and viruses, as well as
noninfectious agents, such as aspirated food or fluids
(Ignatavicius et al., 1999).

24. Bacterial Pneumonia;
• Antibiotic therapy is a necessary treatment, and studies have shown a
significant decrease in maternal mortality.
• Erythromycin is often given initially. If there is no significant
improvement, cefotaxime or cefuroxime may also be added to the
treatment regime.
• Additional interventions for all pneumonias include hydration and
control of fever, pain, fatigue and anxiety. Respiratory therapy may
be provided through supplemental oxygen, beta-antagonist inhalers,
elevating the head of the bed, and in severe cases chest physiotherapy
(Goodrum, 1997). Cunningham et al. (2001) recommend if pleural
effusion is present, a Thoracentesis may be necessary.

25. Viral Pneumonia;
• Clinically viral pneumonia is difficult to distinguish from bacterial
pneumonia because symptoms are similar.
• The antiviral drugs amantadine or rimantadine, which are given within
48 hours of onset, are effective in reducing symptoms.
• Both are Category C drugs, which are teratogenic or embryocidal
especially during the first trimester of pregnancy (Cunningham et al.,
2001).

26. Fungal Pneumonia;
• Fungal infections are rare in healthy individuals but occur in patients who are
severely immunocompromised, especially in those with AIDS.
• The drugs of choice include Trimethoprim-sulfamethoxazole, Pentamidine or
Diaminodiphenylsulfone.
• A pregnant woman must be treated for three weeks for any hope of survival, but
all of these drugs are Category C and there is concern for the fetus (Cunningham
et al., 2001; McColgin et al., 1992; Saade, 1997).