Covid 19 pregnancy RCOG guideline Flashcards
Mode of transmission of SARS-Cov-2
From respiratory droplets or secretions, faeces and fomites (objects)
Vertical transmission: if vertical transmission does occur, it is uncommon.
If it does occur, it appears to not be affected by mode of birth, method of feeding or whether
the woman and baby stay together (rooming in)
Effect of covid-19 on pregnant women
Pregnant women do not appear more likely to contract the infection than the general population
Symptoms of covid-19 in pregnant women
Mostly symptoms of a mild respiratory illness
Systematic review “PregCOV-19” :
Most common symptoms of COVID-19 in pregnant women were fever (40%) and cough (39%).
Less frequent symptoms were dyspnoea, myalgia, loss of sense of taste and diarrhoea, each present
in more than 10% of women.
Pregnant women with COVID-19 were less likely to have fever or myalgia than non-pregnant women of the same age.
An estimated 74% (95% CI 51–93) are asymptomatic based on studies that reported universal
screening for a total of 162 pregnant women
Relationship between gestation and covid-19
Severe illness appears to be more common in later pregnancy.
In the UKOSS study, most women were hospitalised in their third trimester or peripartum. The median gestational age at hospital admission was 34+0 weeks of gestation.
An analysis of women in French hospitals showed that
those in the second half of pregnancy, from 20 weeks of gestation, were five times more likely
to be admitted to ICU than those in the first half of pregnancy
Intensive care admission may be more common in pregnant women with COVID-19
than in non-pregnant women of the same age.
Effect of Covid-19 on pregnancy
- 3x higher risk of preterm birth (mostly iatrogenic)
- Increased risk of CS due to maternal/fetal concerns and increase risk of requiring GA
Risk factors for hospital admission with COVID-19 infection in pregnancy
- Black, Asian and minority ethnic (BAME) background - possibly due to socioeconomic factors, response to disease, vitamin D deficiency
- Being overweight (BMI 25–29 kg/m2) or obese (BMI 30 kg/m2 or more)
- Pre-pregnancy co-morbidity, such as pre-existing diabetes and chronic hypertension
- Maternal age 35 years or older
- Living in areas or households of increased socioeconomic deprivation
The risk of becoming infected is higher in those with increased exposure risk e.g. healthcare workers or other public-facing occupations
Specific advice for women of BAME background in UK
Vitamin D supplementation in pregnancy
Effect of COVID-19 on the fetus
Currently no evidence to suggest increase in congenital abnormality, neonatal death, still birth
Insufficient evidence to suggest impact on miscarriage
No evidence to suggest risk of FGR but 2/3 of pregnancies with SARS had FGR
Overall data for neonatal outcomes appears to be positive. Small rate of transmission to baby and in general they did well. Rate of admission of term babies to NICU was 10% but 95% of babies born in good condition.
Service related impact of covid-19
In the UK antenatal and postnatal visits were reduced.
Study n London found an increase in stillbirth rate but no evidence of covid-19 infection therefore this may be due to other factors eg reduced antenatal care
two women committed suicide and were unable to access help due to covid-19 restrictions
Advice regarding provision of ANC during pandemic
- Where possible try to provide same ANC and routine screening
- Recognise that some women may be disadvantaged due to
