In times like this, we are all scared but many times we don’t really know why and what to do. When a virus is around, we try not to get it and protect ourselves as much as possible. But there are always more vulnerable people that need more protection than the others. And almost always is about the old people, people that already suffer from chronic diseases and, last but not least, pregnant women. Therefore, in this post, we will talk about the novel Coronavirus (COVID-19) and its impact on pregnancy, adding, of course, advice and recommendations.
This post comes from Dr. Shiva Harikrishnan, Consultant Obstetrician & Gynaecologist / Laparoscopic Surgeon at Medcare Hospitals & Medical Centres.

What is COVID-19

Currently, coronavirus infection has made a significant impact on the human race worldwide. COVID-19 is a new strain of coronavirus which is a type of RNA virus that specifically affects the respiratory tract. It can cause an array of symptoms ranging from mild to severe and can cause acute respiratory distress syndrome (ARDS) and even death. This virus belongs to the same family of the virus which causes the common cold, but it has the potential to cause severe disease. It also has the ability to spread exponentially.
COVID-19 primarily spreads through droplets generated when an infected person coughs or sneezes or through saliva or discharge from the nose. It can spread through direct contact and fomites too. Many international bodies like World Health Organisation have suggested the strong possibility that it may be airborne spread, too.

COVID-19 and pregnancy. How does it affect pregnancy?

In Pregnancy, the immune system is altered, and new research suggests that immunity is in-flux during this time. As with any other virus, pregnant women are at risk of acquiring this infection also. But the good news is that until now there have been no maternal deaths reported due to corona infection. Most of the corona infection has led to a mild variety and it has not been noted that coronavirus infection increases the risk of miscarriage rate or that it is teratogenic (can cause congenital abnormalities in the fetus).
There is also no risk of vertical transmission i.e. spread of infection from mother to unborn baby in the womb. If a pregnant woman contracts coronavirus infection in advanced pregnancy, there is a high probability that she may experience difficulty in breathing. The reason behind this is that in advanced pregnancy already the respiratory capacity is reduced due to the gravid uterus pressing the diaphragm. In this situation, the attending obstetrician may have to take a decision to deliver the baby earlier than the expected due date after a thorough discussion with the couple. There is no contraindication for vaginal delivery in COVID-19 positive pregnant women as there is no risk of acquiring infection for the baby while coming through the birth canal.
It is also safe to breastfeed even if a mother is COVID positive, but she will need to take extra precautions such as washing hands directly before and wearing a mask while breastfeeding.

Precautions and treatment for pregnant women:

• Pregnant women should avoid going out of their homes as much as possible.
• Working women should opt for working from home (worldwide guidelines are in favour of this).
• Saline gargling twice a day would be a good suggestion to prevent infection.
• Wash hands as many times as possible with soap and water or sanitizer for a minimum of 20 seconds.
• Staying at home does not mean that you can stay awake late at night and get up very late. Try to maintain a healthy routine. It is also important to drink plenty of warm water, fruits and vegetables.
• Engage in positive activities – Try to do Yoga, meditation, reading and listening to music that lifts your mood.
• Try to avoid watching negative television and unfollow any negative social media like but stay informed for the latest updates.
• Avoid unnecessary visits to hospitals and try to have contact with your obstetrician and team through Whatsapp or telephone. Number of antenatal visits should be minimized through tele-consultation. In case of emergencies like bleeding, reduced baby movements and pain in the abdomen or high blood pressure or labour pain, you must visit the emergency department (which should be separate from the general emergency department).

There is no vaccination for COVID- 19 until now, but it is underway. Medicine like Hydroxychloroquine which is used in several parts of the world for the prevention and treatment of this infection cannot be used in pregnant women.
Please remember there is no need to panic about the infection, but at the same time, you need to be careful and cautious to protect yourself. Approximately 90% of corona infection in pregnant women will be of a milder variety and COVID positive pregnant women can deliver normally and cesarean section is reserved only for obstetric indications.

About Dr. Shiva Harikrishnan, Consultant Obstetrician & Gynaecologist / Laparoscopic Surgeon

Highly qualified and experienced obstetrics and gynecology specialist, Dr. Shiva Harikrishnan completed her MBBS, DGO and MD degrees from India. She is a fellow of the Royal College of Obstetricians & Gynaecologists (FRCOG) UK, and has also been awarded a Fellowship in Cosmetic Gynaecology by the International Association of Aesthetic Gynaecology, UK. She has completed a Diploma in IVF & Reproductive Medicine from Germany, a Diploma in Endoscopy from Germany and a Diploma in Advanced Laparoscopy from IRCAD in France.
Dr. Harikrishnan has further built on her knowledge by her vast work experience at hospitals in India and the UAE. She has been associated with Medeor 24×7 Hospital, International Modern Hospital, Welcare Hospital, and Dr.Abdul Lateef Clinic in the UAE. She has also worked at the A.J.Hospital in Trivandrum, India. Dr. Harikrishnan is a member of the International Society for Ultrasound in Obstetrics and Gynaecology (ISUOG), UK.