Covid19 / Coronavirus Disease: Information to Pregnant and breastfeeding women
The purpose of this video is to clear doubts among pregnant women amidst the coronavirus crisis. I know a lot of you have any questions while the COVID-19 is rampant. I will do my best to address your concerns and will keep you updated with the latest recommendations as and when they become available. For now, we only a limited knowledge base as to what can happen to the course of pregnancy during the COVID-19 pandemic.
In a small study in pregnant women with COVID-19 pneumonia, intrauterine transmission which in literal terms is the transmission of the virus to the baby while in the mother’s womb has not been found and no maternal deaths were documented.
There appears to be an increased frequency of preterm labor which is the possibility of delivering the baby before the completion of 9 months and cesarean delivery because of abnormal fetal heart rate tracings which can happen during any fever producing illness. This occurs in cases where the mothers are severely ill.
Pregnancy and childbirth did not worsen the course of pregnancy. Some mothers have recovered without undergoing delivery also.
The approach to prevention, evaluation, diagnosis, and treatment of pregnant women with suspected COVID-19 should be similar to that in nonpregnant individuals.
The United States Centers for Disease Control and Prevention (CDC) has advised hospitals to consider temporarily separating the mother and the baby in separate rooms in mothers with confirmed or suspected COVID-19 until the mother’s transmission-based precautions are discontinued.
This is a shared decision between parents and health care providers. Additionally, infants born to mothers with confirmed COVID-19 should be considered a patient under investigation and appropriately isolated and evaluated.
For women with suspected or confirmed COVID-19 in the third trimester who recover and have no medical/obstetric indications for the prompt delivery, it is reasonable to postpone planned cesarean delivery or induction of labor until a negative testing result is obtained or isolation status is lifted to minimize postnatal transmission to the neonate.
It is unknown whether the virus can be transmitted through breast milk. The only report of testing we have at hand found no virus in the maternal milk of six patients. However, droplet transmission could occur through close contact during breastfeeding.
So mothers with confirmed COVID-19 or symptomatic mothers with suspected COVID-19 should take precautions to prevent transmission to the infant during breastfeeding (including hand hygiene and use of a facemask).
Alternatively, to minimize direct contact, the infant can be fed expressed breastmilk by another caregiver until the mother has recovered, provided that the other caregiver is healthy and follows hygiene precautions.
In such cases, the mother should use strict hand washing before pumping and wear a mask during pumping. If possible, the pumping equipment should be thoroughly cleaned by a healthy person.
Women who choose not to breastfeed must take similar precautions to prevent transmission through close contact when the formula is used.
In summary, based on the available clinical and research data, the clinical characteristics of patients with COVID-19 infection presenting from mid-trimester onwards are similar to those of non-pregnant adults. Currently, there is no evidence that pregnant women are more susceptible to COVID-19 infection and that those with COVID-19 infection are more prone to developing severe pneumonia. There is also no evidence of vertical mother-to-baby transmission of COVID-19 infection when the maternal infection manifests in the third trimester. Our opinions are in line with the recommendations of the Centers for Disease Control and Prevention. COVID-19 infection should not be the sole indication for delivery; rather, the patient should be duly assessed, and management, timing, and mode of delivery should be individualized, dependent mainly on the clinical status of the patient, gestational age and fetal condition. Ongoing collection of clinical data and
research is underway with the aim of answering questions in relation to the risk of congenital infection and the
optimal intrapartum management, and timing and mode of delivery. Lastly, we would like to pay tribute to all frontline medical professionals who are working tirelessly to bring the COVID-19 epidemic under control.
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