The world today is fighting the battle against the novel coronavirus pandemic and there is distress everywhere. At this time of chaos, about two percent of the world female population would be pregnant. For these millions of women, pregnancy has become a period of anxiety. The most anticipated and beautiful time in a woman’s life has now changed into a stressful situation.
Since the first case diagnosed in November 2019, most of us know about the symptoms and ways to prevent transmission of this coronavirus now named COVID 19. Its implication in pregnancy is not much different than the general population but there are few aspects that need to be addressed specifically in relation to the health of a mother and a baby.
Pregnancy is an immuno compromised state in general but pregnant women are not shown to be more susceptible to COVID 19than the general population. Precautions to be taken to prevent acquisition and transmission of the virus are no different during pregnancy. General measures of physical distancing, handwashing, and wearing personal protective equipments like masks are a must. In context of Nepal, where there are people under investigation and only two confirmed cases at present, the need for prevention of transmission is even greater. Pregnant women should be aware that labor wards are emergency facilities and are always open. Most hospitals have obstetric units and doctors will be there to treat emergency pregnancy cases.
The good news is COVID 19 is not transmitted to the baby in the womb. From a few case studies of pregnant women in China, this has been confirmed. If the symptoms of fever, cough or difficulty in breathing arises during pregnancy, visiting a health facility is a must. The tests for COVID 19 are available at only a few hospitals in Nepal so, if possible, it’s recommended to go to these hospitals. If not, other health facilities can send specimen to those hospitals to confirm the diagnosis. If there are symptoms, visiting any health facility is a must. Women should make sure that they reveal any travel history to the treating physician. Any contact with a person with a recent travel history should also be mentioned to the doctor.
If a pregnant woman is tested positive for the virus, she will be managed by the obstetrician according to the guidelines of professional bodies and she will be taken care of. There is a small chance of having preterm delivery but, from whatever little data we have,it is confirmed that the virus will not lead to any birth defects in the baby. Once the baby is born, mother and baby will be separated and the baby will be kept in isolation at least for two weeks. The baby can be given breastmilk by pumping.
For pregnant women who are not affected, they should follow the general measures to prevent transmission. If the pregnancy is healthy and there are no complications, please remember this is not the time to visit the hospital. Routine antenatal checkups can wait for the time being. Hospitals have suspected cases so there is a high chance of acquiring the infection. Most obstetricians are now available on phones and on social media and can be consulted for any problems.
Pregnant women in the first three months of pregnancy who have not visited a doctor yet, can start taking folic acid tablets and can consult a doctor through distance communication. In case of severe vomiting, pain or vaginal bleeding, she should go to the emergency department of the nearby hospital.
Women in between three to eight months of pregnancy should keep calm, have a balanced diet and continue with their prenatal exercises and vitamins. Make sure the prenatal vitamins are enough to last till the due date. The main indicator of a healthy pregnancy is fetal movements. If the baby kicks at least 10 to12 times a day, there is no imminent danger to the baby. Immediate visit to the hospital is necessary if there are decreased fetal movements, headache, dizziness, vaginal bleeding or severe abdominal pain. Women in labor should go to the emergency department and will be taken care of, even amidst patients with suspected COVID 19 infection. After delivery, breastfeeding is not contraindicated. The mother should wear protective mask and can breastfeed.
The situation in Nepal so far is good but we are preparing for the battle. We are self-isolating and doing what we can. We can only hope there will be no further infection in the country and even if there is, it will be contained well. We wish good health to all the pregnant mothers and pray for a safe delivery with both healthy mother and baby. But, at this time, if there are any women planning a baby shower, it would be a good idea to cancel the event and stay at home, for your own safety as well as that of your unborn child.
The writer is an assistant professor, Obstetrics and Gynecology, at Lumbini Medical College Teaching Hospital. She can be reached at firstname.lastname@example.org.