03rd, Apr 2020
The Belfast Telegrapgh recently spoke to Dr David Glenn FRCOG, Consultant Obstetrician and Gynaecologist at Kingsbridge Private Hospital about Coronavirus and Pregnancy.
Coronavirus (SARS-COV-2) is a new strain of coronavirus causing COVID-19. It was first identified in Wuhan City, China towards the end of 2019. Other coronavirus infections include the common cold and Severe Acute Respiratory Syndrome (SARS-CoV).
Most cases of COVID-19 occur by human to human transmission. There are two routes by which COVID-19 can be spread:
It is likely that there may be many asymptomatic individuals or those with very minor symptoms who are carrying the virus, although the incidence is unknown. The large majority of women will experience only mild or moderate cold/flu like symptoms. Cough, fever, shortness of breath, lack of smell/taste and even gastrointestinal symptoms are other relevant presentations.
Pregnant women do not appear more likely to contract the infection than the general population. Pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19.
Transmission from mother to baby during the pregnancy or delivery is probable, although the proportion of pregnancies affected and the significance to the baby has yet to be determined. Amniotic fluid, cord blood, neonatal throat swabs, placenta swabs, genital fluid and breastmilk samples from COVID-19 infected mothers have so far tested negative for the virus. However, a new report describes a case in which the baby born to a COVID-19 positive mother was found to have antibodies in their blood at birth. This is thought to represent a baby’s response to infection within the womb.
There is currently no evidence of an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. Moreover, there is no evidence that the virus damages the baby. Despite recent evidence that the virus can be passed from mother to baby, the proportion of pregnancies affected and the significance to the baby has yet to be determined.
If you are infected with COVID-19 you are still most likely to have no symptoms or a mild illness from which you will make a full recovery. Most women will experience only mild or moderate cold/flu like symptoms. Cough, fever, shortness of breath, lack of smell/taste and even gastrointestinal symptoms are other relevant presentations.
For women who have had symptoms, antenatal appointments can be deferred until 7 days after the start of symptoms, unless symptoms (aside from persistent cough) persevere.
For women who are self-isolating because someone in their household has possible symptoms of COVID-19, appointments should be deferred for 14 days.
If women develop more severe symptoms or her recovery is delayed, this may be a sign that they are developing a more significant chest infection that requires enhanced care. In this situation you should contact your maternity care team.
If you are well at the moment and have had no complications in your previous pregnancies arrangements for your care may be altered but they are still important to attend.
If you have a routine scan or visit due in the coming days, you will still need to attend but the appointment may change due to staffing requirements. Maternity care is essential to reduce complications in mothers and babies. Even in the context of coronavirus, it is important that pregnant women continue to attend their scheduled routine care when they are well.
Pregnant women will be asked to keep the number of people with you to a minimum. This will include being asked to attend maternity appointments alone.
There may also be a need to reduce the number of routine antenatal visits.
If women have an urgent problem related to the pregnancy but not related to coronavirus, they should get in touch using the same emergency contact details they already have. They should not contact that number unless they have an urgent problem.
If women have symptoms of coronavirus, they should contact their maternity service and they will arrange the right place and time for the visits. They should not attend a routine clinic.
Maternity care is essential and has been developed over many years with improving success to reduce complications in mothers and babies. The risks of not attending care include harm to mother, her baby or both.
Many provisions have been put in place to reduce risk to mothers. These include reducing the number of visits to the hospital to a minimum, advice to mothers on reducing the number of people travelling with mothers to the hospital, attending the appointments alone, keeping numbers reduced in waiting rooms, spacing patients in waiting areas, staff taking additional protective efforts to reduce transmission in clinics with hand washing, cleaning equipment etc.
Very significant changes have been occurring in hospitals over the past weeks to deal with pregnant women with COVID-19. Significant changes have been made in all areas of the hospital, from clinics to wards and including delivery suites. Practice drills are being run frequently to train staff, additional resources have been brought in to help and a huge effort has been made by all levels of non-clinical, clinical, administrative and management staff.
Given the current limited evidence, we advise that women and healthy infants, not otherwise requiring neonatal care, are kept together in the immediate post-partum period.
A risks / benefits discussion with neonatologists and families to individualise care in babies who may be more susceptible is recommended.
The main risk of breastfeeding for infants is the close contact with the mother, who is likely to share infective droplets. In the light of the current evidence, it is advised that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk. Precautions should be taken to reduce spread to the baby such as, hand washing before touching the baby, avoiding coughing or sneezing on the baby while feeding, and considering wearing a face mask, if available, while feeding or caring for the baby.
If you have either a high temperature or a new, continuous cough you should self-isolate with your baby for 7 days. Inform your maternity carers but do not go to a GP surgery, pharmacy or hospital. If you have concerns about the wellbeing of yourself or your baby during your self-isolation period, contact your midwife or, out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.
If you have confirmed or suspected coronavirus when the baby is born, doctors who specialise in the care of new-born babies (neonatal doctors) will examine your baby and advise you about their care, including whether they need testing.
Dr David Glenn FRCOG is a Consultant Obstetrician and Gynaecologist at Kingsbridge Private Hospital and is Clinical Director for Women and Child Health at Ulster Hospital.
Source: The Belfast Telegrapgh