Management of Pregnant Women in Times of Covid-19: A Review of Current Literature

Abstract

Its impact on pregnant women is not yet clear owing to limited data and the knowledge is evolving in several aspects. Based on the available evidences, various clinical guidelines for management of COVID-19 have been formulated. This article intends to compile and summarise guidelines from esteemed organisations, along with their implication in the Indian scenario, and offers an easy tool for clinicians managing pregnant women in times of COVID-19.

Recommendations for prenatal, intrapartum, and postpartum care during COVID‐19 pandemic in India

“…For suspected COVID pneumonia, computerized tomography (CT scan) is investigation of choice even in pregnancy with minimal risk of radiation exposure to fetus. 23,24 Specific tests include reverse transcriptase-PCR (RT-PCR) on respiratory samples with high sensitivity (95% detection probability). 8,25,26 The US FDA has recently approved rapid molecular PCR-based assay Cepheid's COVID-19 test whose results are available within 45 minutes.…”

“…There is no scientific evidence that COVID-19 increases the risk of fetal congenital malformations or causes miscarriage in early pregnancy and it is definitely not an indication of medical termination of pregnancy. 24,36,37 Some case reports and small studies observed increased complications and adverse maternal and fetal outcome with COVID-19 severe disease. [46][47][48] Royal College of Obstetricians and Gynecologists Guideline has reported some adverse outcome with COVID-19 in pregnancy in the form of slight increased risk of preterm delivery, premature rupture of membranes, maternal sepsis, preeclampsia, and postpartum hemorrhage.…”

“…Breslin et al 62 and to avoid failure of the healthcare system due to overburdening. 24,36,37,53 It has been recommended by RCOG, ACOG, SOGC, FOGSI, FIGO and WHO in their guidelines and by various authors in their studies or reviews. [9][10][11][12][13][14][15][16][17][35][36][37]53 Even the COVID-positive patients can be further triaged depending upon their severity of symptoms.…”

“…[9][10][11][12][13][14][15][16][17][35][36][37]53 Even the COVID-positive patients can be further triaged depending upon their severity of symptoms. 11,12,24 14,16,17,24 Various drugs to be given to COVID-positive patients in pregnancy as recommended by FOGSI or other societies are shown in Table 2. FOGSI recommends the use of hydroxychloroquine 200 mg thrice daily orally with meals and azithromycin 500 mg once daily orally for 10 days for all pregnant women with COVID-19 in pregnancy.…”

“…8,9,24 The pregnant woman should be kept in left lateral position with judicious intravenous fluid, oxygen therapy when needed, appropriate antibiotic and antiviral therapy, and mechanical ventilation as per patient's requirement as recommended by FIGO, ICMR, and FOGSI guidelines. 9,16,17,24 Low molecular weight heparin should be given in selected patients. 12…”