Covid 19 in Pregnancy | Jindal IVF Chandigarh

1
Covid 19 in pregnancy

• 
  Dr Anupam Gupta
• 
  Senior Consultant
• 
  Jindal IVF Sant Nursing
  Home,
• 
  Chandigarh

2


Case 1

• A 32 years old booked primigravida at 28 weeks
  gestation with no co- morbidity reports to ANC
  clinic on 1st May 2021 with c/o mild cough
  fever for 3 days
• No difficulty in breathingSARS CoV2 RTPCR
  positive
• On pulse oximeter her RR 22/ min
• SpO2
  96
• Temp 99.4F

3
Q 1

• How will you categorize this patient? Dr
  Rimpy Tandon

4
(No Transcript)
5
Q2

• How will you proceed to manage this case?
  Dr Umesh Jindal

6
(No Transcript)
7
Q 3

• What tips would you like to give on home
  isolation? Dr Amandeep
• 
  Dr
  U.N Jindal
• - Place and diet
• - Self monitoring
• - Rx of mild cases
• - Practical instructions to
  the family

8
Tips on home isolation

• Place of stay

• Respiratory hand hygiene

• Use triple layer medical mask
• Discard mask after 8 hours of use or earlier if
  becomes wet
• Respiratory etiquettes at all times
• Frequent hand washing with soap water for at
  least 40 sec or clean with alcohol based sanitizer

• Isolate
• Well ventilated room with cross ventilation
• Do not share personal items with others
• Ensure cleaning of surfaces that are touched with
  1 hypochlorite solution

Take rest drink lot of fluids to maintain
adequate hydration
9
Self monitoring chart
Day of symptoms time( every 4 hourly) Temperature Heart rate(from pulse oximeter) SpO2(from pulse oximeter) Feeling( better /same/worse) Breathing( better/ same/ worse)


10
Rx for mild disease

• In communication with treating physician
• Symptomatic management for running nose, cough,
  fever
• Warm water gargles or steam inhalation twice a
  day
• If fever not controlled with max dose of
  paracetamol 650 mg 4 times a day, consider other
  drugs like NSAIDS ( e.g tab naproxen 250 mg twice
  a day)

11
Instructions for care givers

• Wear a triple layer medical mask
• N95 may be considered when in same room
• Front portion of mask should not be touched
• Discard the mask after use and perform hand
  hygiene after disposal of the mask
• Use disposable gloves while handling the patient
• Perform hand hygiene before and after removing
  gloves

• Food must be provided to the pt in her room
• Utensils and dishes used by the pt should be
  cleaned with soap and water wearing gloves
• The utensils and dishes may be reused

12
Q 4

• Danger signs during home isolation? Dr Vikas
  Suri

13
Danger signs during home isolation
14
Q 5

• Would you like to get any investigations done? (
  Dr Rashmi Bagga)

15
Investigations

• In mild disease, no investigations are required
• Only investigations related to obstetrical
  indication are required

16
Further..

• However, the pt reported in 2 days with pain
  abdomen which was suggestive of threatened
  preterm labor pains
• She was admitted , tocolysis with tab nifedipine
  was given, antibiotics given to cover any
  potential source of infection and steroids for
  lung maturity and discharged in satisfactory
  condition

17
Q 6

• What impact can Covid 19 infection have on
  pregnancy at this stage?
• 
  Dr Rashmi Bagga
• SARS CoV2 infection was associated with increased
  risk of pre eclampsia, preterm birth, still birth
  and NICU admissions , more so in severe cases
  (CMAJ April 2021)
• Limitation of these studies is that they do not
  distinguish between spontaneous and iatrogenic
  preterm birth

18
Q 7

• When should she come for ante natal follow up?
• Do women with Covid19 infection need additional
  antenatal surveillance after recovery from
  illness?
• 
  Dr Rimpy Tandon

19
(No Transcript)
20
Antenatal surveillance

• In mild infection, though routine follow up is
  required but pt can decompensate after several
  days of apparently mild illness and so should
  report immediately if symptoms particularly
  shortness of breath worsen
• Interval growth assessments by USG should be
  considered, the timing and frequency dictated by
  other maternal risk factors

21
Further..

• She is worried and wants to know the timing
• and mode of delivery?
  Dr Rashmi Bagga
  
• Breast feeding?
  Dr U.N Jindal
• Can she take the Covid vaccine?
  Dr Amandeep

22
Delivery

• Timing and mode of delivery is not influenced by
  Covid infection
• For women with Covid infection in 3rd trimester
  who recover, it is reasonable to postpone
  delivery ( if no other medical indications
  arise), until a neg test result is obtained or
  quarantine status is lifted in an attempt to
  avoid transmission to the neonate
• Caesarean delivery should be based on obstetrical
  indication not Covid status alone

23
Breast feeding

• Women with Covid 19 infection can breast feed
  their babies
• However infected mothers can transmit the virus
  through respiratory droplets while breast
  feeding. So they should be counselled on how to
  minimize the risk while breast feeding
• Mother should take all possible precautions like
  hand hygiene , wearing a mask while breast
  feeding
• Milk can be expressed from the breast with a
  manual /electric pump using all precautions and
  then fed to the baby

24
Vaccination

• According to GOI, individuals having lab test
  proven SARS-2 CoV-19 illness, Covid vaccine to be
  deferred by 3 months after recovery
• FOGSI has recommended Covid 19 vaccine for
  pregnant and lactating women. However, it has
  acknowledged that there is limited data on the
  use of Covid 19 vaccines in pregnancy, esp those
  vaccines available in India.
• GOI recommends Covid 19 vaccination for all
  lactating women

25
Conclusion (mild disease)

• 1st and 2nd trimester
• Home isolation
• Symptomatic management( Antipyretics, hydration)
• Sonographic assessment of fetal anatomy/ growth
  as appropriate
• 3rd trimester
• Home isolation in majority
• Decision for delivery to be individualized based
  on obstetric indication and need

26

• THANK YOU