Step-by-step guide to dealing with Covid-19 during pregnancy

GN Focus talks to Dr Nashwa Magdy Abulhassan, Head of Obstetrics & Gynaecology and Consultant Obstetrics and Gynaecology at Dr Sulaiman Al Habib Hospital, Dubai to find out how pregnant women should deal with the coronavirus infection.

What is your advice for pregnant women who have tested positive for Covid-19?

Most pregnant women who test positive for Covid 19 will have no symptoms. If symptoms occur, they are usually in the form of mild to moderate flu-like symptoms, mainly fever, sore throat 
and cough. The less common symptoms of Covid 19 infection in pregnancy are difficulty in breathing, muscle aches, and loss of sense of smell or taste.

I would like to reassure pregnant women with Covid 19 that the available current evidence suggests that the virus is unlikely to cause problems to the development of the baby. Moreover, there is no evidence to suggest that infection in early pregnancy increases the chance of a miscarriage.

A small percentage of pregnant women can become unwell with Covid-19. They are at increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester. The sequelae of this is having their babies delivered prematurely. In most cases, this would be recommended in order to enable them to recover.

Therefore, it is essential for pregnant women to adopt social distancing and ensure good hand hygiene particularly from 28 weeks of pregnancy onwards. Recent evidence shows that transmission of the virus from the mother to the baby during childbirth seems to be uncommon regardless of the mode of delivery, whether natural birth or caesarean section.

What should pregnant women do if they develop severe Covid symptoms such as high fever, cough and fatigue?

Mild to moderate Covid 19 symptoms can be managed at home by drinking plenty of fluids and rest, as well as using medication to reduce fever, alleviate pain or mitigate coughing.

However, if symptoms become severe, then it would be important that pregnant women contact their healthcare professional within 24 hours for further advice. Admission to the hospital within designated wards is usually arranged. The care within the hospital would be based on a multidisciplinary team-based approach involving the obstetrics, infectious disease, pulmonary, critical care, and paediatric specialists.

Are there any specific symptoms that pose extra danger to a pregnant woman?

It is important to seek medical attention if they show severe symptoms such as trouble breathing, persistent pain or pressure in the chest, confusion, and inability to stay awake.

Pregnant women are equally advised to consult their healthcare provider if they develop symptoms specific to the pregnancy such as reduced foetal movements from 20 weeks onwards, bleeding or excessive vaginal discharge.

Pregnant patients with underlying health conditions, for example diabetes, high body mass index and cardiovascular disease, are at a higher risk of developing complications from Covid-19.

What should pregnant women do if they still feel fatigue even after turning negative for Covid-19?

A proportion of women will experience prolonged Covid symptoms. It is unclear if pregnancy has an impact on these symptoms. It is recommended that pregnant women contact their healthcare provider for further assessment if Covid symptoms continue despite a negative test result.

For asymptomatic Covid-19 pregnant women, what are the health guidelines?

Asymptomatic Covid positive pregnant women can shed and transmit the virus to others. It is essential that they self-isolate for two weeks until their test becomes negative. Informing recent contacts is recommended as an infected person can spread Covid-19 virus around 48 hours before developing any symptoms or testing positive.

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