Corona virus infection is a pandemic infection leading to high mortality and it can affect pregnant women also. They need a special attention since we need to treat mother and newborn also. Though definitive guidelines have not been established still we need to follow few fundamental principles in the management.The guidelines are likely to be introduced in due course of time.

1. Dr.Chaduvula Suresh Babu
Professor
Department of OBGYN
GIMSR
Visakhapatnam, AP, India

2.  WHO on Jan 12, 2020 named virus as 2019
New Corona virus [ 2019-n CoV ]
 It is now called COVID – 19
 This was identified following multiple
patients with pneumonia in Wuhan city of
Hubei Province, China.

4.  Coronaviruses are named for the crown-like spikes on
their surface. There are 4 main sub-groupings of
coronavirus, known as alpha, beta, gamma and delta.
 Human coronavirus were first identified in the mid-
1960s. The 7 CoV that can infect people are:
 229E alpha coronavirus
 NL63 alpha coronavirus
 OC43 beta coronavirus
 HKU1 beta coronavirus
 MERS-CoV beta CoV causing Middle East Respiratory
Syndrome (MERS)
 SARS-CoV beta CoV causing Severe Acute Respiratory
Syndrome (SARS)
 2019 Novel CoV (nCoV)

6.  SUSPECT CASE:
A. patients with severe acute respiratory
infection (fever, cough and requiring admission to
hospital) AND with no other etiology AND at least
one of the following:
 A history of travel to or residence in the city of
Wuhan, Hubei Province, China in the 14days
prior to symptom onset OR
 Patient is a health care worker who has been
working in an environment where severe acute
respiratory infections of unknown etiology are
being cared for.

7. B. Patients with any acute respiratory illness AND at
least one of the following:
 Close contact with a confirmed or probable case of
2019-nCoV in the 14days prior to illness onset
OR
 Visiting or working in a live animal market in Wuhan,
Hubei Province, China in the 14days prior to symptom
onset OR
 Worked or attended a health care facility in the 14days
prior to onset of symptoms where patients with
hospital-associated 2019-nCoV infections has been
reported.

8.  PROBABLE CASE:
 A suspect case for whom testing for 2019-
nCoV is inconclusive or for whom testing
was positive on a pan-coronavirus assay.
 CONFIRMED CASE:
 A person with lab confirmation of 2019-
nCoV infection, irrespective of clinical
signs and symptoms.

9.  There are no certain guidelines as far as
optimum time of delivery and also route of
delivery.
 This needs to be decided according to
obstetrical indications only till date.
 There is no clear cut evidence suggesting
that there is vertical transmission from
mother to the foetus

10.  SARS – severe acure respiratory syndrome
CoV
 MERS – middle east respiratory syndrome CoV

11.  Pregnant woman with suspected COVID-19
should be isolated kept in single room for
screening.
 Confirmed cases should be kept in Negative
pressure room preferably or isolation room
 Critically ill patients should be in ICU

12.  Delivery rooms and Operation theatres
should have a dedicated negative pressure
room.
 For newborns also should have negative
pressure isolation rooms
 Visitors should be limited

13.  No definitive treatment
 Differentiate illness from other co infections
and treat accordingly
 Only supportive care
 Adequate sleep and rest
 Adequate caloric intake
 Fluid & Electrolyte balance
 Oxygen and respiratory support in advanced
cases
 ICU stay in serious cases

14.  Initiate broad spectrum antibiotics to cover
community acquired pneumonia
 Empirical Antiretroviral Therapy like not yet
recommended world wide, tried in China
 1. Alpha Interferon Inhalation
 2. Lopinavir or Ritonavir [ 200mg/50 mg
capsules] 2 capsules twice per day

15.  Clinical monitoring - Vitals, oxygen
saturation,
 ABG analysis, review of X-ray chest as and
when needed.
 Monitor CBC, metabolic panel, markers of
end organ function and coagulation profile,
C- reactive protein
 Identify the pathogen
 X-ray chest might be required with
abdominal shield
 CT also may be required after consent
because risk of radiation hazard

16.  Shock mostly due to sepsis is treated with
fluid replacement and nor epinephrine to
maintain mean arterial pressure at 60 mm of
Hg.
 Oxygenation - SaO2 should be at 95 % to
maintain foetal oxygenation also
 Humidified Oxygen, non invasive ventilation
and endotracheal intubation may be required

17.  Extra Corporeal Membrane Oxygen
technology [ ECMO]has limited value in
pregnancy.
 Acute renal failure due to sepsis is difficult
to treat by conservative management and
may require hemodialysis.

18.  EFHR monitoring
 Ultrasound is used as usual
 Doppler
 Amniocentesis is avoided in active infection
 Early delivery only if the mother is critically
ill and that may cause impending death of
foetus
 Vertical transmission is yet to be confirmed
 Antibody production in newborn is doubtful

19.  Negative pressure isolation room or OT is
preferred
 According to obstetrical indications route of
delivery is decided
 Elective LSCS is yet to establish any benefit
 General or Epidural or Regional anaesthesia
can be allowed

20. Treated as Bio-
hazardous
waste

21.  Delayed clamping is not recommended
 Immediate cleaning and drying of neonate
 Newborns of mothers who are suspected or
diagnosed should be isolated for 14 days
 Mother and newborn are isolated separately
 Breast feeding not recommended though it
shows no virus, can be given once the
infection is cleared
 She can express out milk till the disease is
cleared

22.  Pregnant women are at high risk for this viral
infection
 No drugs and Vaccines are available
 Personal Hygiene – wash hands with soap and
water and wear masks
 Isolation, avoid close contact with others
 Get recent updates regarding COVID-19
 Women with suspected symptoms should
contact and follow the guidelines from the
isolation treating doctor

24. 1. EARLY RECOGNITION AND SOURCE CONTROL:
 Encourage HCWs to have a high level of clinical
suspicion
 Institute screening questionnaire
 Awareness in public areas reminding
symptomatic patients to alert HCWs.
 Promotion of respiratory hygiene is an important
preventive measure.
 Suspected cases should be placed in an area
separate from other patients.

25. 2. APPLICATION OF STANDARD PRECAUTIONS FOR ALL
PATIENTS:
 This includes hand and respiratory hygiene measures:
 medical mask to the suspected patients
 cover nose and mouth during coughing with
tissue/flexed elbow
 perform hand hygiene after contact with respiratory
secretions.
 Use of personal protective equipment (PPE)
 Prevention of needle-stick or sharps injury
 Safe waste management
 Environmental cleaning and sterilisation of patient-care
equipment and linen:
 thorough cleaning with water and detergent
 Applying hospital level disinfectants like sodium