Based on the ICMR Guidelines.

1. COVID IN PREGNANCY
Dr Reeta Singh
9 june 2021

2. Antenatal care during COVID pandamic
• Problems

3. SARS COV 2
• CORONA VIRUS STRAIN CAUSE COVID 19
• human to human transmission
• respiratory droplets or secretion,feces and fomite
• close contact with an infected person or surface
• asymptomatic or mildly symptomatic remain infective
for 7- 10 days
• CT value does not corelate with infectivity or disease
severity
• Aerosol generation by cough and sneeze.
• Mask and Hand hygeine mimp intervention to
prevent infection

4. Covid 19 & pregnancy
• pregnant women are not more susceptible for infection.
• same severity as in non pregnant.
• (UK/US /WHO data indicate more ICU admission in
pregnant women)
• 75% asymptomatic or mild symptomatic.

5. Covid 19 & pregnancy
• dysnea,myalgia loss of sense of taste and
diarrhea >10% pt
• fever and myalgia less common in pregnant than
nonpregnant
• mortality less common in reproductive age
women also 60% less likelihood of ICU adm
compared to age matched males( ?estrogen
protects)

6. Covid 19 & pregnancy
• Who have had an organ transplant,on
dialysis,severe asthma,severe COPD,
cystic fibrosis,heart Ds.sickle cell disease.
• Who is having chemotherapy or antibody
treatment ,radiotherapy,target cancer
treatment, on immunosupressants

7. Effect of pregnancy on COVID
• Most ANCs women hospitalised were in
late second or third trimester.
• risk af admission is 5 times more in
second half of pregnancy compared to first
half.

8. Effect of covid on pregnancy
• There is no reports of teratogenacity.
• No evidence to suggest that in early pregnancy it
increases the risk of a miscarriage.
• There is reports of increase preterm births but
were mostly iatrogenic ( for the benefit of the
women’s health and to enable them to recover)
• there is increase in cases of still births but were
due to maternal Ds severity.

9. Effect of covid on pregnancy
• Currently not an indication for Medical
Termination of Pregnancy or change in
antenatal care, mode of delivery or
Postnatal care

10. Verticle Transmission
• Uncommon
• not effected by mode of delivery,feeding
choice or rooming in together.
• At present, there are no recorded cases of
vaginal secretions,amniotic fluid or breast
milk being tested positive for COVI virus.
• Covid positive baby remain well.

11. COVID 2.0 IN INDIA
• more disease in younger pts
• severe ds and mortality on younger pts
• complication occure in first wk of ds
• more pregnant women getting moderate to
severe ds in second and third trimester
• more cluster infection
• more contagious

12. General advice to pregnant women
• They should observe the social distancing
and self isolation regardless the gestation
age, specially after 28 wks (sheilding)
• They should wear mask and practice hand
hygeine.

13. Antenatal care -Key issue
• Reduce /postpone or increase the interval
between ANC visits
• shorten the duration of antenatal visits <
15 mins
• limit visitors in OPD
• indivisualise plan for women requiring
frequent visits
• continue providing AN care to high risk
women

14. Antenatal appointments
• One stop clinic appointments Antenatal
check up,investigation and USG in one
appointments
• WHO 8 VISITS
• RCOG 6 visits
• ICMR minimum 4 visits 12,20,28,and 36
wks of gestation.

15. Antenatal appointments
• Results can be communicated over phone
• any women who has a delay of > 3 wks
should be contacted
• Need of consultation is more than the
risk of getting infection.

16. Teleconsultation
• At appointments where tests are not
required
• Adjunct to physical appointmentcan review
• At 16/24/32/38 wks
• results of tests can be discussed and
shedule physical appointments

17. Home monitoring
• BP,
• Blood Sugar
• Maternal Weight
• DFMC
• stay hydrated and mobile at home (risk of
VTE)
• Mental health
• regular exercise and proper diet

18. Indication for obstetric scans-SFM oriented guidelines

19. Indication for obstetric scans-SFM oriented guidelines
• Dating scans between 6 and 10 weeks should be
postponed and dating should be done at the Early
Morphology 11–13 weeks 6 days scan window.
• Second trimester scans should be given priority over first
trimester scans
• “Routine” Growth and Doppler scans should be
postponed to a 36 weeks assessment. If the pandemic
recedes, these can be rescheduled earlier
• “Decision Making” Growth and Doppler scans between
28 and 41 weeks should be considered on priority

20. Indication for obstetric scans-SFM oriented guidelines
• For women who have had symptoms, appointments can
be deferred until 7 days after the start of symptoms,
unless symptoms (aside from persistent cough) become
severe. Foetal Kick count to be maintained.

21. ICMR guidelines for ANC care
• For women who are self-quarantined because
someone in their household has possible
symptoms of COVID-19, appointments should
be deferred for 14 days.
• Even if a woman has previously tested negative
for COVID-19, if she presents with symptoms
again, COVID-19 should be suspected.
• Referral to antenatal ultrasound services for
foetal growth surveillance is recommended after
14 days following the resolution of acute illness.

22. • With symptoms like fever,cough,sore
throat
• history of close contact with confirmed
case of COVID
• Before admission

23. Do’s & DonT’s for Obstetricians
• A woman meeting criteria for testing should
be tested. Until test results are available,
she should be treated as confirmed COVID-
19.
• Do not delay obstetric management in
order to test for COVID-19.

24. Do’s & DonT’s for Obstetricians
• If a woman tests positive, she should be
advised to deliver at least at an FRU

26. intrapartum care
• Assessment of the severity of COVID-19 symptoms,
which should follow a multidisciplinary team approach
including medical specialist.
• Maternal observations including temperature, respiratory
rate & oxygen saturations.
• Confirmation of the onset of labour, as per standard
care.
• Hourly oxygen saturation during labour.

27. Care in Labour
• Aim to keep oxygen saturation >94%, titrating oxygen
therapy accordingly
• Continuous electronic foetal monitoring in labour is
recommended.
• no evidence to favour one mode of birth over another
• LSCS only for obstetrical indication unless the woman’s
respiratory condition demands urgent delivery.
• Epidural analgesia should recommended in labour to
women with suspected/confirmed COVID19 to minimise
the need for general anaesthesia if urgent delivery is
needed

28. Care in Labour
• An individualised 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 in Labour
• Manage labour as do in covid negative ANC.
• 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 birth if this
is likely to assist efforts to resuscitate the mother
• Emergency LSCS for benefit of maternal
condition is allowed after 32 wks of gestation
age.

30. Postnatal care
• Facilities should consider temporarily
separating (e.g. separate rooms) the mother
who has confirmed COVID-19 till mother is
COVID positive.
• The decision to discontinue temporary
separation of the mother from her baby should
be made on a case-by-case

31. Postnatal care
• If colocation or rooming is unavoidable
implement measures to reduce exposure of the
new-born to the virus.
• Consider using physical barriers (e.g., a curtain
between the mother and new-born) and keeping
the new-born ≥6 feet away from the ill mother.
• facemask and practice hand hygiene before
each feeding or other close contact with her
new-born.

32. Breastfeeding
• Expressed milk during room separation
after appropiate hand hygeine.
• If rooming in then can breastfeed if she
wishes after face mask and appropiate
hand hygeine.

33. Vaccination in pregnancy
• GOI has not recommonded covid vaccine
during pregnancy.
• UPT is not recommonded prior to
vaccination.
• If after vaccination one confirms
pregnancy MTP is not advised.
• Pt shold be assured that no adverse effect
on pregnacy or fetus is reported.

34. Vaccination during lactation
• Reccommonded during lactation.
• All 3 tepes of vaccine available in india are
safe and effective during lactation.