COVID 19

PREGNANCY
Presented By
Dr. Gajendra Singh Tomar
MD, MRCOG
Infertility & IVF Specialist @ Indore Infertility Clinic, CHL Hospitals, AB Road, Indore
For Appointment Call or WhatsApp: 9644444066
 Causative organism : SARS-CoV-2
 First identified in Wuhan City, China, towards the end of 2019
Transmission

 Human-to-human transmission
 Readily isolated from respiratory droplets or secretions, faeces
and fomites (objects).
 Close contact with an infected person or from contaminated
surfaces.
 Vertical transmission does occur is uncommon
 Not be affected by mode of birth, delayed cord clamping,
skin-to-skin contact, method of feeding or whether the woman
and baby stay together
Vaccination

 The first vaccine against COVID-19 was approved for use in the
UK on the 2 December 2020
 None of the vaccines have undergone specific clinical trials in
pregnant women
 Vaccination should be considered where the woman has an
underlying condition that puts her at very high risk of serious
complications of COVID-19.
 Similar advice was issued for breastfeeding women.
Effect of COVID 19 on Pregnant
Women

 Majority are asymptomatic

 86% of women who were admitted in labour and who tested
positive for SARS-CoV-2 were asymptomatic
 The PRIORITY (Pregnancy CoRonavirus Outcomes RegIsTry)
study, an ongoing prospective cohort study of pregnant
women from the United States, found the most prevalent first
symptoms in infected women were cough (20%), sore throat
(16%), myalgia (12%) and fever (12%).
Spectrum of Symptoms

 Mild disease (no evidence of pneumonia or hypoxia),

 Moderate disease (viral pneumonia),
 Severe disease (severe pneumonia, e.g. with SpO2 below 90%
on room air) and
 Critical disease (Acute Respiratory Distress Syndrome [ARDS],
sepsis, septic shock, or complications such pulmonary
embolism or acute coronary syndrome).
Severe illness with COVID-19 in
pregnant women

 Compared to non-pregnant women with COVID-19, pregnant

women with COVID-19 are not at increased risk of death
 MMR from COVID-19 is 2.2 per 100 000 maternities
Frequency of severe illness in
pregnant women

 increased ICU admission rates for pregnant

 may in part be explained by a lower threshold for ICU
admission in pregnancy in general.
Effect on pregnancy

 Symptomatic patients : greater risk of preterm birth

 Pregnant women with asymptomatic COVID-19 were not,
however, at increased risk of preterm birth
 49% caesarean birth rate for women with symptomatic COVID-
19 versus 29% for a historical control group from 2018
Effect of COVID-19 on the fetus

• Symptomatic maternal COVID-19 is associated with an increased

likelihood of iatrogenic preterm birth.
• Aside from preterm birth, there is no evidence that COVID-19
infection has an adverse effect on the fetus or on neonatal
outcomes.
 No reported increase in the incidence of congenital anomalies
 no evidence of an increase in stillbirth or neonatal death
 no evidence to date that fetal growth restriction (FGR) is a
consequence of COVID-19
 growth restriction is considered a theoretical possibility in
pregnancies complicated by COVID-19 as two-thirds of
pregnancies with SARS were affected by FGR
Advice

 Women presenting with a fever : testing for SARS-CoV-2 should

be
 offered in addition to blood cultures.
 Radiographic investigations should be performed as for the non-
pregnant adult; this includes chest X-ray and computerised
tomography (CT) of the chest.
 A diagnosis of pulmonary embolism or heart failure should be
considered for women presenting with chest pain, worsening
hypoxia or a respiratory rate above 20 breaths/minute
(particularly if there is a sudden increase in oxygen
requirements), or in women whose breathlessness persists or
worsens after expected recovery from COVID-19.
Advice

 All pregnant women should be assessed for risk of VTE and

prescribed hromboprophylaxis with LMWH
 Corticosteroid therapy should be considered for 10 days or up
to discharge, whichever is sooner, for women who are unwell
with COVID-19 and requiring oxygen supplementation or
ventilatory support
Final words

 Remdesivir should be avoided in pregnant women with

COVID-19 unless clinicians believe the benefits of treatment
outweigh the risks to the individual
 The interleukin-6 receptor antagonist (anti-IL6) tocilizumab has
been shown to improve outcomes, including survival, in
hospitalised patients with hypoxia (oxygen saturation below
92% on air or requiring oxygen therapy) and evidence of
systemic inflammation (C-reactive protein at or abo ve 75
mg/l).
 THANK YOU

Dr. Gajendra Singh Tomar

MD, MRCOG
IVF & Infertility Specialist