Covid-19 and Pregnancy Care



20 April 2020: It has been a busy time for all of us with the current situation of COVID-19 and all the questions surrounding it. As a private obstetrician, I get asked lots of questions by both patients and the general public, so I have done a short Q&A on pregnancy and COVID-19 , which hopefully would address some of your worries.

Is it safe to fall pregnant now?


As the virus is still very new to us, we are yet to have much data on its effects in the first and second trimester of pregnancy. From previous experience with the other coronaviruses (SARS and MERS) there may be an association with growth restriction, therefore I would offer a growth scan in the pregnancy. There is also a general increase incidence of pre-eclampsia and miscarriage as well (although this is across all coronaviruses).


Is there evidence of vertical transmission?


Currently, there is no evidence of the virus in tested amniotic fluid, cord blood and neonatal throat swabs although there has been one case report that may have suggested this. But the link is still uncertain.


What is the commonest adverse outcome?


So far to date, preterm birth is commonest with a rate of up to 41%. The cause for it is unclear, although it is thought to be done for maternal benefit (i.e pregnant women was too unwell to continue on with pregnancy)


Is it still safe to have a baby at the hospital?


Please rest assured that the hospitals are all doing their best to provide the best and safest care for all women and their babies in current times. Sometimes, events of labour can be unpredictable and this can increase the risk of having the baby at home.


What can women expect when they come in labour?


Women who are suspected/confirmed to have COVID 19 would be asked to wear a mask. Don’t be alarmed as well when staff looking after you are dressed in protective gear. It may seem very scary, but please remember this is done for everyone’s safety. In current time, most places are allowing ONE support person (no swapping/changing) and I would recommend that they bring some food/disposable utensils/phone charger/other essentials with them. The above may change with time, so please check with the hospital you are booked at. We also recommend that the baby is being monitored throughout labour as there is an association with babies getting distressed in confirmed cases.


What about staying in hospital after the baby is born?


This is something that we would need to weigh out. Initially we had thought that it would be best to let new moms go home early with their baby/ babies. But literature has shown that there is an increased rate of readmissions for newborns, so we would need to ensure a couple of things before discharging women home. We should ensure that a good breastfeeding/infant feeding routine is established, jaundice checked, weight checks and newborn tests attended (when needed) before going home. This would minimise the chance of having to return to the hospital for a review. Please check this with your healthcare provider.


Pain relief in labour?


At the moment, pain relief such as TENS, mobilisation, injections are epidurals are still available. The only pain relief availability that differs in different hospitals are the use of gas and waterbirth. Some places do not have the right equipment so these options might be limited. Again, please check with the hospital you are booked at.

You might have heard that epidural are being recommended – this may have a role in some patients as it might reduce the risks associated with an emergency C/S. Please check with your obstetrician regarding this as this would depend on your individual circumstances.


Does COVID-19 change the preferred mode of delivery (MOD)?


No, the MOD should still be based on obstetric indications as we do not have enough data to support a vaginal birth over CS or vice versa.


What about breastfeeding?


Evidence shows that the benefits of breastfeeding outweighs the risk and therefore, WHO and RANZCOG still encourages breastfeeding. So far, tested breast milk has been negative for the infection (but bearing in mind, the sample size is only 10). Good hand hygiene and mask are recommended while breastfeeding/expressing.


Once again, I hope this has helped you in some way in alleviating some concerns for our mothers-to-be and please feel free to contact the practice at 02 9629 3559 or e-mail at info@aretehealth.com.au.

Our practice, Arete Health, is also set up for virtual appointments/ telehealth to ensure we can keep everyone as safe as possible throughout this period.


This article is accurate as of 20 April 2020.


Updated advice on COVID-19 can be found:

https://ranzcog.edu.au and https://www.health.nsw.gov.au/Infectious/diseases/Pages/coronavirus.aspx

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