This document discusses COVID-19 and pregnancy. It outlines that COVID-19 infection does not seem to be worse for pregnant women or affect the fetus. Antenatal care is emphasized through telehealth to reduce risk of exposure. For suspected or confirmed COVID-19 in pregnancy, a multidisciplinary approach is recommended based on symptom severity and obstetric issues. Management includes isolation, testing, monitoring for maternal and fetal well-being, and individualizing care during labor and postpartum based on the mother's condition.

1. COVID 19
&
PREGNANCY
Presented by : Mrs. Mital S.Patel

2. OUTLINE
-The virus and modes of transmission
- Effect of COVID -19 infection on Pregnancy
- Effect of COVID -19 infection on fetus
- Perinatal care for suspected or confirmed
COVID 19 infection

3. NOVEL CORONA VIRUS DISEASE -2019
Severe acute respiratory infection caused by Novel
coronavirus : SARS COV -2
 First identified in Wuhan china.
 Outbreak of pneumonia of unknown cause
 Detected in bronchoalveolar lavage samples

4. EFFECT OF COVID-19 ON MOTHER
• Some viral infections are worse in pregnant women
due to :
 Physiologic changes in pregnancy
 Relative Immunosuppression in pregnancy
• No such evidence for coronavirus infection
• Pregnant women not more susceptible to
consequences of COVID 19 infection vs general
population
• Maternal disease is not aggravated by pregnancy
unless associated co-morbidities

5. • Hypertension
• Diabetes
• Asthama
• HIV
• Heart disease
• Chronic liver , kidney or lung diseases
• Blood dyscrasia
• Patient on immunosuppressive medications
HOW DO WE ASSESSING CO- MORBIDITIES :

6. Effect of COVID- 19 on mother : clinical picture :
M a j o r i t y :
Only mild or moderate
flu :
• Cough
• Sore Throat
• Fever (37.8• C)
A F e w :
Severe :
• Shortness of breath
• SARI
• Pneumonia
• Marked hypoxia
Critically ill :
• Tachypnoea, hypoxia ,
• Imaging:>50% lung
involvemnt

7. No increased risk of :
 Miscarriage
 Early pregnancy loss
 Pre term birth
No evidence of :
 Intrauterine fetal
infection
 Congenital
malformation
 Effect on fetal
growth
 Vertical
transmission
 Transmission
through genital
fluid
Effect of COVID- 19 infection on fetus :

8. ANTENATAL PREPAREDNESS :
maternity health care providers need to prepare :
• Prevent consequences of the infection to
mother
• Prevent consequences of the infection to
newborn
• Prevent consequences of the infection from
infected pregnant woman to other pregnant
woman
• Prevent consequences of the infection from
infected pregnant woman to other health care
workers

9. ANTENATAL CARE FOR NON COVID PREGNANT WOMAN :
IMPORTANT ASPECT :
Antenatal contact :
• Reduce , postpone and increase the interval
between antenatal visits/ routine scan
• Shorten the duration of antenatal visits
• Limit visitors while in hospital
• We Must Continue to provide perinatal care for
high risk people

10. ANTENATAL CARE FOR NON COVID PREGNANT
WOMAN :
• Teleconferencing and video conferencing which could be
- As replacement or
- In addition
- Especially if maternal tests are not required
- what can be done ?
- Virtual prenatal visits
- Online communication with providers
- Consultation with specialist ( maternal medication, genetic
counselling )
- Mental health care

11. ANTENATAL CARE FOR NON COVID PREGNANT
WOMAN :
ADVISE FOR HOME MONITORING
• Blood pressure check
• Maternal weight check
• Daily fetal movement
• Dietary advice : Recommend High protein diet ,
vitamin/ micronutrient supplementation

12. ANTENATAL CARE FOR NON COVID PREGNANT
WOMAN
Advice on hygiene :
Attention to infection prevention
“ Do the five “
 Staying at home
 Hand hygiene
 avoid touching the face- Eye, nose , mouth
 Social distancing
 Respiratory hygiene -use mask

13. ANTENATAL CARE FOR NON COVID PREGNANT WOMAN
ADVICE ON TRAVEL AND QUARANTINE :
 Avoid all non essential travel
 Criteria for Quarantine Same for pregnant woman and general
population
SHIELDING : Measure to protect clinically extremely vulnerable people
• Pregnant women with heart disease HT, DM , Immunocompromised
women
minimise all interaction with extremely vulnerable group and others
• Stay home
• Minimise all non essential contact with other members ( 1 meter
distance )
• Access medical assistance remotely whenever possible

14. ANTENATAL CARE FOR PREGNANT WOMAN
SUSPECTED OR CONFIRMED COVID -19 :
Pregnant woman with suspected , probable or
confirmed COVID-19, Including women who
may need to spend time in isolation , should
have access to woman centred , respectful
skilled care including obstetric , foetal medicine
and neonatal care , as well as mental health and
psychological support with readiness to care for
maternal and neonatal complication.

15. PREGNANCY WITH SUSPECTED COVID 19
INFECTION :
How and where to contact ?
 Must not attend routine clinic
 Attend triage and screening area for suspected
cases
 keep minimum number of people with you
 Use private transport
 If ambulance required, inform to call handler
about the current suspect status

16. ALGORITHM OF SUSPECTED CASES :
First point of contact / initial assessment area for triage and screening
Any patient with symptoms :
• Fever
• Cough
• Breathing difficulty
History of exposure :
• Travel to infected
country within 14 days
• Contact with infected
person
Give medical mask and maintain 1 mt.
distance
O
R

17. ASSESSMENT OF SUSPECTED CASES :
Iinfectious
disease specialist
Assess severity :
 Elevated risk ?
 Moderate risk ?
Obstetrician
Does she have
any obstetric
emergency /
labour / delivery
Isissue ?
No
Isolation for 14 days and
clinical monitoring
Yes
Needs
admission

18. MANAGEMENT OF SUSPECTED CASES NOT IN LABOUR
On admission :
• Institute infection prevention and control meassures :
- Immediately transfer to an identified isolation room
- Donning appropriate PPE by health care provider
• Testing of the pregnant woman with suspected infection ;
- To be done urgently
- Samples to be sent : Nasopharyngeal swab
- Do not delay obstetric care in order to test for COVID 19
- Treat as confirmed cases until test results are available
- Multidisciplinary approach is required : obstetric, neonatal
and intensive care specialist

19. ANTENATAL CARE FOR PREGNANT WOMEN WITH
SUSPECTED OR CONFIRMED COVID -19 :
• Routine appointments delayed untill after the
recommended period of isolation
• No additional tests are required.
• If concerns about well being of self or fetus during
isolation , patient should be advised to contact
maternity team
• Additional care if any complications
• Provide counselling and information about potential
risk of adverse pregnancy outcomes

20. MANAGEMENT OF CONFIRMED CASES:
• Hospitalise the pregnant woman
based on :
- severity of symptoms
- obstetric emergency / labour

21. Admission criteria
• Assess the need for
ICU admission using
maternal early warning criteria
Systolic BP < 90 or > 160 mm of Hg
Diastolic BP> 100 mm of Hg
Heart rate < 50 or >120 /min
Respiratory rate < 10 or >30 /min
Oxygen saturation in room air of <94
Oliguria defined as urine output <35 ml/hr for ≥ 2
hours
Maternal confusion, agitation, unresponsiveness.
Known patient with preeclampsia reporting a non
remitting headache or shortness of breath.
Quick sequential organ failure assessment tool.
Systolic BP < 100mmhg
Respiratory rate > 22
Altered level of consciousness
yes no
Severe failure criteria :
(consider emergency
cesarean delivery)
Septic shock
Acute organ failure Consider ICU admission
Continue
monitoring

22. MANAGEMENT OF CONFIRMED CASES:
Maternal surveillance :
• TPR ,BP ( 3-4 times per day )
• Chest imaging (High resolution CT Scan )
- only if indicated
- with abdominal shield
- after informed consent
• Consider oxygen therapy to keep o 2 saturation > 95%
• Encourage oral hydration
• Limit IV fluid if concern for cardiovascular instability

23. MANAGEMENT OF CONFIRMED CASES:
Maternal surveillance (contd .) :
Antipyretic therapy :
• Maternal comfort
• Limit the fetus to the risk of maternal increased
body temperature
• Screen for viral infections and any bacterial
infection
• Consider empiric IV / oral antibiotics / antimalarial/
antiviral treatment :

24. MANAGEMENT OF CONFIRMED CASES:
FETAL SURVEILLANCE :
• Monitor FHR and daily fetal movement
• Antenatal corticosteroids :
 women at risk of preterm birth where there is
NO clinical evidence of maternal infection

25. RECOVERY :
Recovery from illness :
• Little evidence of natural history of pregnancy after recovery
• Recovery from infection in 1st trimester :
- consider detailed mid trimester anatomy ultrasound
examination
• Recovery from infection in later half of pregnancy :
- consider sonographic assessment of fetal growth 2 weeks after
infection

26. INTRAPARTUM CARE IN COVID - 19
• A full maternal and foetal assessment should be conducted
• Assessment of the severity of COVID-19 symptoms, which should follow
a multi-disciplinary team approach including an infectious diseases or
medical specialist.
• Maternal observations including temperature, respiratory rate & oxygen
saturations.
• Confirmation of the onset of labour, as per standard care.
• Electronic foetal monitoring using cardiotocograph (CTG).
• Hourly oxygen saturation during labour.
• Positive ANC should be advised preferably to deliver at a tertiary facility
anticipating the complications during delivery if not then at least at an
FRU

27. CARE DURING LABOR IN COVID - 19
• If the woman has signs of sepsis, investigate and treat as per
guidance on sepsis in pregnancy, but also consider active COVID-19
as a cause of sepsis and investigate.
• Continuous electronic foetal monitoring in labour is recommended
• currently no evidence to favour one mode of birth over another.
Mode of birth should not be influenced by the presence of COVID-
19, unless the woman’s respiratory condition demands urgent
delivery.

28. CONT… CARE DURING LABOUR
• No evidence that epidural or spinal analgesia or anaesthesia is
contraindicated in the presence of coronaviruses.
• Epidural analgesia should be recommended in labour to women with
suspected/confirmed COVID-19 to minimise the need for general
anaesthesia
• In case of deterioration in the woman’s symptoms, make an individual
assessment regarding the risks and benefits of continuing the labour, versus
emergency caesarean
• When caesarean birth or other operative procedure is advised, it should be
done after wearing PPE.
• An individualized decision should be made regarding shortening the length
of the second stage of labour with elective instrumental birth in a
symptomatic woman who is becoming exhausted or hypoxic.

29. CARE AROUND BIRTH
Delayed cord clamping : Still
recommended if no contraindication.
Skin to skin contact :
Individual choice : risks Vs benefits
Can do if baby and mother is well.

30. POSTNATAL MANAGEMENT
• It is unknown whether new-borns with COVID-
19 are at increased risk for severe
complications.
• Transmission after birth via contact with
infectious respiratory secretions is a concern.
• Facilities should consider temporarily
separating (e.g. separate rooms) the mother
who has confirmed COVID-19, from her baby
until the mother’s transmission-based
precautions are discontinued.

31. CONSIDERATIONS FOR TEMPORARY SEPARATION OF
BABY
• The risks and benefits of temporary separation of the mother from
her baby should be discussed with the mother by the healthcare
team.
• A separate isolation room should be available for the infant
• The decision to discontinue temporary separation should be made
on a case-by-case basis in consultation with clinicians, infection
prevention and control specialists, and public health officials.
• Taking into account disease severity, illness signs and symptoms,
and results of laboratory testing for virus that causes COVID-19, of
mother and neonate.

32. CONT…
• If “rooming in” in the same hospital room occurs in
accordance with the mother’s wishes or is unavoidable
due to facility limitations- consider implementing
measures to reduce exposure of the new-born to the
virus.
• Consider using physical barriers e.g., a curtain and
keeping the new-born ≥6 feet away from the ill mother.
• If no other healthy adult is present to care for the new-
born, mother put on a facemask and practice hand
hygiene

33. BREASTFEEDING
• Close contact and early, exclusive breast feeding helps a baby to
thrive.
• During temporary separation, mothers should be encouraged to
express their breast milk.
• A dedicated breast pump should be provided.
• Prior to expressing breast milk, mothers should practice hand
hygiene.
• Expressed breast milk should be fed to the newborn by a healthy
caregiver.
• If rooming in – mother should put on a facemask and practice hand
hygiene before each feeding.

34. HOSPITAL DISCHARGE
• follow recommendations described in the guidelines
for discharge of Hospitalized Patients with COVID-
19.
• Two consecutive test should be negative 24 hours
apart.
• Maternal and fetal / neonatal condition should be
stable.

35. KEY MASSAGES :
• All pregnant women should follow the same
recommendations as other persons for avoiding exposure
COVID 19 infection
• Antenatal care through teleconferencing and
videoconferencing key to providing quality care during
pandemic.
• All women despite the pandemic have a right to have safe
and positive childbirth experience.
• Principles of labour management remain same except that
a facility for isolation should be there for safety of woman
and fetus/ Newborn.

36. KEY MESSAGES :
 Pregnant women should follow the same recommendation as
nonpregnant persons for avoiding exposure COVID 19 infection
 Antenatal care through teleconferincing and video conferencing key to
providig quality care during pandemic
 Triage based on symptoms severity and obstetric emergencies
 Multidisciplinary approach to management of suspected or confirmed
cases

37. THANK YOU